A standardized process to improve compliance with venous thromboembolism prophylaxis and hospital-based inpatient psychiatric services Core Measures was developed, implemented, and evaluated by a clinical nurse specialist team. The use of a 1-page tool with the requirements and supporting evidence, combined with concurrent data and feedback, ensured success of improving compliance. The initial robust process of education and concurrent and retrospective review follow-up allowed for this process to be successful.

Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California. Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nursespecific interventions is not clear. Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip or knee arthroplasty from one of four community hospitals between March 1, 2016 and April 30, 2017. Data extracted included patients' sociodemographic characteristics, daily morphine equivalent, average time between nursing pain assessments, actual and acceptable levels of pain, and use of adjunct therapy. Descriptive and inferential statistics were used to describe the sample and examine relationships between variables. Binomial logistic regression was utilized to identify factors that increased the likelihood of controlled pain during hospitalization for the study sample. Results: Approximately two-thirds (65.3%) of patients had their pain controlled during hospitalization; the average daily morphine equivalent day 2 post op was 1.25 mg (SD = 1.03) for the overall sample, and 1.28 mg (SD = 1.08) for those with controlled pain; slightly over one-fourth (26.8%) used aromatherapy during hospitalization. Significant group differences between patients reporting controlled vs. uncontrolled pain during hospitalization were found in patients' age, BMI, surgeon, time between nurse pain assessments, sedation status, nerve block, aromatherapy and comfort massage use. Logistic regression indicated patients with lower BMI, longer time between nurse pain assessments on day 2 post op, received aromatherapy during hospitalization, and a nerve block were more likely to have controlled pain during hospitalization, χ 2 (14) = 122.47, p < .001. Patients whose surgeons conducted less than 60 or more than 89 surgeries during the study and patients who were not lightly drowsy or easy to arouse were more likely to experience uncontrolled pain during hospitalization. Conclusions: The daily morphine equivalent administered to patients on day two post op and during hospitalization was not significantly different for patients with controlled vs. uncontrolled pain. The results of this study show patients with controlled pain are using adjunct therapies more than those with uncontrolled pain during hospitalization; more information is needed regarding the reasons patients with uncontrolled pain are not using adjunct therapy. Pain level and lack of readily available adjunct therapies may present overwhelming barriers to patients with uncontrolled pain. Implications: Nurse-controlled variables empower nurses to improve patient care while decreasing pati...

Individuals with primary brain tumors experience a range of physical, cognitive and psychosocial sequelae which impact their independence, safety and quality of life. These impairments may be addressed through rehabilitation intervention. Despite acknowledgement that timely rehabilitation services over the course of the disease process is of benefit, few outpatient neuro-oncology treatment teams include a rehabilitation professional. Purpose: The aims are: (1) to describe a rehabilitation consultation model of care integrated into outpatient neuro-oncology treatment for individuals with primary brain tumors; and (2) to describe the characteristics of individuals referred for rehabilitation services. Methods: This retrospective descriptive study examined data from 200 individuals that received rehabilitation consultation from January 2015 to March 2016 at Princess Margaret Hospital, Pencer Brain Tumor Centre. Information on patient demographics, referral characteristics, and number of patient care visits was collected. Descriptive statistics were calculated. Preliminary Results: Of all patients, (n=195), the most common diagnosis is glioblastoma, 39% (n=76), and 50% are 50-69 years of age (M=55, SD=15.0). The most common reason for initial referral was decline in physical functioning, strength and balance (41%). In 77% of cases, patients were seen immediately at the time of referral. In total, 540 consultations were completed (face-to-face=230, telephone=310) with 2.78 on average (SD=4.0) per patient. Conclusion: Given the range of symptoms that individuals with primary brain tumors experience coupled with changes in functional status as the disease progresses, integrated and timely rehabilitation consultation is feasible.