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Using Doll Therapy to Reduce Falls in Patients with Neurodegenerative Diseases in an Acute Care Setting
No full textBackground
Hospital admissions for neurodegenerative diseases like dementia and Alzheimer\u27s, along with neuropsychiatric symptoms (NSS), are increasing. Patients with NSS are 4-5 times more likely to fall and sustain serious injuries, impacting patient experience and causing financial strain on the organization. Current interventions to reduce the challenging NSS include psychotropic medications, which can cause further adverse effects. Therefore, non-pharmacological interventions are considered an important 1st line treatment to lessen challenging behaviors.
Local problem
At this facility, over 50% of elderly patients who fall out of bed have confusion, accounting for 20% of our 500 falls per year. The purpose of this quality improvement was to reduce falls in patients with NSS such as agitation, wandering, and confusion.
Method
The PDSA cycle a problem-solving methodology for testing and implementing changes, guided this project. An interdisciplinary team that included clinical nurses with neurodegenerative disease experience recommended Doll Therapy (DT). Literature supports DT as a nurse-driven, patient-centered method to reduce challenging behaviors by promoting attachment and companionship. The team collaborated with an external consultant for baby dolls and educated staff. A DT manual was available on the units for procedural information.
Results/Conclusions
Data was collected via paper forms and EPIC. Forty patients received dolls during the pilot, with completed data for 29 patients. Average age was 75 years, 68% female and 32% male. Restraints, safety sitters, and psychotropic medication were discontinued. Seven patients fell before DT, with no falls after DT. There was a 77% reduction in NSS. DT improved quality of life for patients and their families. Family members felt less distressed as their loved ones were calmer and had better social interactions.
Implications for Practice
Doll Therapy is a non-pharmacological method to reducing NSS and falls. This pilot project showed DT\u27s effectiveness in acute care settings and is being expanded to seven more units
Advocate Nurses Collaborate for Stronger Legal Shields Against Workplace Violence
No full textBackground/Introduction
Healthcare workers (HCW) face disproportionately high rates of workplace violence (WPV) and are five times more likely to be injured than other types of workers (Lim et al., 2022). HCWs account for 73% of all nonfatal workplace injuries in 2018 (OSHA, 2020). National studies show that 12% of nurses planning to leave the profession in the next 5 years cite WPV as the reason (Smiley et al., 2025). Despite implementation of security measures, WPV continues to escalate, contributing to burnout and workforce attrition (The Joint Commission, 2018).
Purpose or Objective
This initiative aimed to expand legal protections for all healthcare workers in Illinois by advocating for legislation that classifies assault against any healthcare worker—not only nurses—as a felony.
Method or Evaluation
A collaborative effort was led by the Chief Nursing Officer at Advocate Sherman and the Director of Teammate Health for the IL & WI Division. The team partnered with the Kane County State’s Attorney to draft bipartisan legislation. Activities included a review of laws from other states, a literature review on WPV, and coalition building with other hospital CNOs and the Illinois Hospital Association.
Results or Findings
The proposed bill introduces a new criminal offense for knowingly assaulting or intimidating hospital personnel while performing their duties. This initiative marks a significant step toward equitable legal protections for healthcare workers and reflects a proactive, nurse-led approach to workforce safety (Algunmeeyn et al., 2022).
Conclusions/Implications for Practice
This project highlights the vital role of nursing leadership in policy advocacy and demonstrates how nurses can drive legislative change. Legal protection is a crucial strategy to support workforce safety, reduce burnout, and retain staff. This initiative is sustainable and scalable, with potential to serve as a model for other states seeking to safeguard healthcare workers through law
Taking a Pulse: Nursing Student Rounding as Best Practice to Support, Stand Out, and Recruit
No full textBackground
Organizations attracting new nursing talent must provide welcoming and meaningful experiences for students onsite for clinical rotations (Anyango, Ngune, et al, 2024). Tailored support and in-person resolution of questions and concerns demonstrate the organization\u27s commitment to hosting students and building connections between students and healthcare organizations (Lundell Rudberg et al., 2022).
Aim
The aim was to provide face-to-face contact with students, instructors, and/or units as a welcome, proactive visit, or reactive/service recovery follow-up. While the intent was to maintain an organic experience focusing on what mattered now, the team wanted to capture data on student experience, satisfaction with the organization, and potential for recruitment (Anyango, Adama et al., 2024). This sought to identify student priorities and concerns while generating strategies to support the organization’s strategic hiring goals.
Implementation Plan
A sub-team of nursing professional development specialists who support nursing students created a Microsoft Forms survey. This included rounding reason, demographics, wins and challenges, and future employment opportunities (Jaastad et al., 2025). This was piloted during the Spring 2025 semester before becoming a widespread initiative across all 29 hospital locations in Illinois and Wisconsin.
Outcomes
The team completed 55 rounding surveys during the pilot with 88% of the rounds as welcome or proactive visits. As a result of rounding, 37% of the visits included follow-up interventions based on the discussion. Teammate status or interest was addressed in 31% of the rounds. Students identified that setting/population and orientation would influence their first nursing job selection.
Implications for Practice
Electronic documentation of student touchpoints yields a wealth of previously uncaptured data while maintaining a serendipitous interaction. By making rounding a focused priority, the team hopes to demonstrate appreciation of what nursing students bring to the workforce. Next steps include comparing student satisfaction surveys in rounding versus non-rounding units. Use of the survey will also expand across all sites
Comparable disease-specific survival between Mohs surgery and wide local excision for acral lentiginous melanoma: A National Cohort Study
No full textThe role of patient, clinician, and neighborhood characteristics in predicting telemedicine engagement and modality in primary care: A cross-sectional analysis
No full textCritical care management of right ventricular failure in pediatric left ventricular assist devices: An advanced cardiac therapies improving outcomes network (ACTION) endorsed statement
No full textThe care of the right ventricle (RV) following left ventricular assist device (LVAD) implantation remains a major clinical challenge, with right ventricular failure (RVF) contributing significantly to morbidity and mortality. While much of the literature focuses on preoperative risk stratification and long-term management, there is limited guidance on the immediate postoperative period from a critical care perspective, particularly in pediatric patients. This review aims to provide practical guidance on the bedside management of the RV in the perioperative period following LVAD implantation in children with biventricular circulation, offering a framework for optimizing RV function and preventing failure. We discuss the pathophysiology of RVF in this setting, highlight key hemodynamic principles, and explore targeted interventions including volume management, inotropic and pulmonary vasodilator support, ventilatory strategies, mechanical circulatory support options, and strategies to mitigate secondary organ dysfunction. By addressing these pediatric-specific critical care considerations, we aim to assist bedside providers in optimizing outcomes for children undergoing LVAD implantation
Anesthesia management of a patient with chronic pain, susceptibility to malignant hyperthermia, difficult airway, undergoing temporomandibular joint surgery
No full textProceeding with coronary artery bypass graft following cardiac arrest during anesthesia induction
No full textIntroduction: Cardiac arrest following induction of anesthesia is a rare but serious event that significantly increases morbidity and mortality in patients undergoing cardiac surgery. Data from the American College of Surgeons National Surgical Quality Improvement Program indicates that approximately 3% of cardiac surgery patients undergo cardiopulmonary resuscitation (CPR) following cardiac arrest [1]. However, the exact incidence of arrests occurring specifically after the induction of general anesthesia remains unknown. This presents a challenging decision: whether to proceed with coronary artery bypass grafting (CABG) following a peri-induction arrest or to cancel the procedure. Case Presentation: An 80-year-old male with hypertension, hyperlipidemia, and a family history of coronary artery disease presented with exertional dyspnea for one year. A cardiac workup showed normal sinus rhythm on ECG, mild valvular disease on TTE, and a severe perfusion defect on Lexiscan stress test. Coronary angiography revealed severe coronary artery disease, including 99% stenosis of the right coronary artery (RCA) and 80% stenosis of the left anterior descending (LAD) artery, making him a candidate for coronary artery bypass grafting (CABG). On the day of surgery, after induction, the patient developed severe bradycardia with a heart rate of 20–30 bpm, profound hypotension (BP 36/27 mmHg), and ST elevations in leads II, III, and aVF. He required four rounds of CPR, 4 mg of epinephrine, and glycopyrrolate to stabilize. TEE revealed severe right ventricular hypokinesia and dilation. Given the critical situation, the surgical team was immediately advised to proceed with coronary artery bypass grafting (CABG). A four-vessel CABG was performed with 157 minutes on cardiopulmonary bypass (CPB). Due to persistent hemodynamic instability, an intra-aortic balloon pump (IABP) was inserted. During the procedure, the patient developed ventricular fibrillation, requiring amiodarone, escalating doses of vasopressors, and blood product transfusions. Given his critical condition, sternal closure was delayed, and he was transferred to the Surgical Intensive Care Unit (SICU) on IABP and milrinone. By postoperative day (POD) 2, he underwent delayed sternal closure. By POD 3, he demonstrated hemodynamic stability, allowing for IABP removal. By POD 4, he was extubated and weaned off vasoactive support. With continued improvement, he was transferred to telemetry and later discharged to a cardiac rehabilitation program. Conclusion: This case highlights the challenges of peri-induction cardiac arrest in CABG patients, exacerbated by the lack of standardized protocols and limited outcome data. Rapid resuscitation and TEE-guided diagnosis facilitated timely revascularization, leading to a full recovery. It underscores the importance of early recognition, advanced hemodynamic monitoring, and prompt intervention in optimizing outcomes. Additionally, it raises the critical dilemma of whether to proceed with CABG after cardiac arrest, emphasizing the need for future research to establish standardized management strategies. 1. Newland MC, et al. (2002) Anesthesiology. 97(1):108-115. 2. Sprung J, et al. (2003) Anesthesiology. 99(2):259-269
Overcoming perioperative challenges: Aspirated blood clots during internal jugular line placement in a factor v leiden patient
No full textIntroduction: Hypercoagulable coagulopathy is a serious condition associated with increased morbidity and higher complication rates. In this case, we highlight the devastating consequences of a hypercoagulable state in a young female patient and emphasize the critical role of the anesthesia team in perioperative management. Case Presentation: A 33-year-old female with a history of diabetes mellitus, hypertension, and heterozygous Factor V Leiden mutation presented with extensive right lower extremity deep vein thrombosis (DVT) and an acute non-occlusive pulmonary embolism (PE) in the right lower lobe, along with a stable chronic PE. Her medical history was significant for multiple thrombotic events, including a left femoral vein DVT requiring inferior vena cava (IVC) filter placement in 2016 and a pulmonary embolism in 2023. Given the severity of her condition, the vascular surgery team performed suction thrombectomy for extensive right iliac vein thrombosis. Venography revealed IVC filter erosion into the vein wall, necessitating an open IVC filter explantation with iliac vein reconstruction and partial explantation of the left common iliac vein stent on January 13, 2025. Despite these interventions, she developed recurrent thrombosis due to her hypercoagulable state, requiring mechanical thrombectomy of the IVC and iliac veins on January 21, 2025. During preoperative evaluation, Doppler ultrasound revealed left upper extremity arterial occlusion with no detectable flow. A right radial artery catheter was successfully placed. Given the critical nature of the surgery, ultrasound assessment of bilateral upper extremity veins showed thrombosed, non-compressible veins, necessitating left internal jugular (IJ) vein catheter placement. Under ultrasound guidance, the needle was correctly positioned in the left IJ vein, but blood return was scant. Despite this, guidewire insertion was attempted but met resistance at 5 cm. Ultrasound confirmed longitudinal guidewire passage, so the angiocatheter was advanced, revealing four medium-sized blood clots on aspiration. A second guidewire attempt at 10 cm also met resistance, but a triple-lumen catheter was successfully threaded, yielding additional blood clots upon aspiration. To maintain patency, heparinized saline flushes were performed until fresh blood aspiration was achieved. The vascular surgery team utilized the catheter due to extensive right IJ vein thrombosis, using it for heparin administration and venography. This facilitated successful mechanical thrombectomy, improving venous patency and perfusion. Conclusion: Factor V Leiden is a genetic mutation that increases the risk of thrombosis by making factor V resistant to inactivation by activated protein C, with varying prevalence across populations[1,2]. This case highlights the challenges of managing hypercoagulable patients, particularly when thrombosis complicates central venous access, necessitating innovative anesthesia approaches. Despite significant clot burden, successful ultrasound-guided cannulation provided critical vascular access, functioning as a mini suction thrombectomy and facilitating the vascular surgery team’s intervention. 1. Thorelli E, et al. (1999) V. Blood. 93(8):2552-8. 2. National Library of Medicine. Factor V Leiden thrombophilia. MedlinePlus Genetics. Available at: https://medlineplus.gov/genetics/condition/factor-v-leiden-thrombophilia. Accessed February 10, 2025
Symptomatic hemi-diaphragmatic palsy following rescue interscalene brachial plexus nerve block
No full textIntroduction: Proximal humerus/shoulder surgeries usually cause a significant amount of pain in post-operative period and Interscalene brachial plexus (ISB) nerve block promises good pain relief for the same. However, one of the major complications of the interscalene brachial plexus block is hemi -diaphragmatic palsy [1], which can pose a genuine concern for ambulatory surgeries. We hereby present a case of an elderly female who developed symptomatic right hemi diaphragmatic palsy after interscalene brachial plexus block. Case Presentation: This is a 73-year-old female with a past medical history of obesity (BMI 37), HTN, DM type II not on insulin, dyslipidemia, and traumatic right proximal humerus fracture, who got operated for open reduction internal fixation of proximal humerus fracture with repair of right rotator cuff tear under general anesthesia. Intraoperatively she received 200 mcg of Fentanyl for analgesia. The patient complained of severe pain (10/10) after surgery, so she received right sided interscalene block with 20 ml of bupivacaine-Epinephrine (PF ,0.5 % -1:200000) as rescue analgesia in the post operative period. Two hours following the block the patient complained of dyspnea with intermittent desaturations to SpO2 of 60% on room air. X ray chest showed new elevation of right hemidiaphragm with right lower lobe atelectasis, consistent with right hemi diaphragmatic palsy. Patient was admitted overnight on telemetry ward, where she received incentive spirometry and chest physiotherapy, following which she was able to wean off the supplemental oxygen requirement. Conclusion: Transient diaphragmatic palsy is common after interscalene (ISB) nerve block but symptomatic hypoxemia is a rare occurrence. Underlying pulmonary disorders, including obesity can further deplete pulmonary functional reserve following interscalene brachial plexus block. Proper patient selection, timing of block, use of ultrasound or alternative technique of nerve block [2] can plummet the incidence of symptomatic hemi -diaphragmatic palsy. 1. Kang, R. et al. (2023) Anesth Pain Med 18(1):5-10 2. Kim, DH. et al. (2019) Anesthesiology 131(3):521-53