1734 research outputs found
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Safe Intra-Hospital Transport of Adult Patients on Non-Critical care Units
Get PDFPlan:
Between 2021 and 2022, two non-critical adult patients returning from the imaging department after an invasive procedure developed increased oxygen needs, which ended in death for on patient and a transfer to critical care for the other.
No formal guidelines exist for the intra-hospital transport by unlicensed personnel may be absent. An intra-hospital transport checklist was developed for non-critical care patients leaving the unit for procedures in the imaging department.
Do: A RN Pre-Invasive Procedure Transport Safety Checklist was created by a telemetry RN (MSN student, Greta Titus) and CNS, Teresa Jahn The checklist was designed to answer questions to determine a patient\u27s hemodynamic and respiratory stability prior to transport by an unlicensed person The checklist is to be completed prior to transport on all patients leaving the unit for a procedure in the imaging department (i.e. paracentesis, thoracentesis, biopsy, etc.) If one of the questions answered is yes , the next step is to prompt a huddle with Resource RN or Charge RN to identify f a patient is safe for transport without a RN. The why for the change was presented by Greta Titus during the November 2022 CentraCare Heart and Vascular Center Clinical (CCHVC) Practice meeting Staff were also notified of this change during Telemetry daily huddles and weekly updates The trial started on Telemetry beginning 11/1/2022 Follow up on the progress of the practice change was presented by CCHVC CNS during Telemetry Education Days in January-February 2023https://digitalcommons.centracare.com/nursing_posters/1161/thumbnail.jp
Dynamic Bronchoscopy for Excessive Dynamic Airway Collapse
Get PDFDefinition:
Excessive Dynamic Airway Collapse (EDAC) is a respiratory condition characterized by \u3e50%luminal narrowing on expiration.https://digitalcommons.centracare.com/nursing_posters/1153/thumbnail.jp
Promotion of National Certification in Telemetry
Get PDFSituation:
Goal to bring awareness to telemetry nurses, the specialty certifications they are eligible for, and criteria for eligibility. Currently, six telemetry nurses hold a nationally recognized certification.
Action Plan: March 19, 2023 was Certified Nurses Day and was the kickoff for the start of encouragement for telemetry nurses to be certified. Each telemetry nurse was delivered a card and lifesaver candy inviting them to consider a nationally recognized certification. A certification informational packet promoting CV-BC and PCCN certification was placed at each desk and referenced during huddle for one week. Certification preparation books are available upon request.https://digitalcommons.centracare.com/nursing_posters/1157/thumbnail.jp
From Silos to Collaborative Working Relationships with EMS and ED
Get PDFOpportunity:
To establish a strong, collaborative relationship between St. Cloud Hospital Stroke Center, St. Cloud Hospital Emergency Department and Emergency Medical Services.
Background:
Two separate health care systems with one goal in mind: best stroke care for a community member experiencing stroke-like symptoms.
Current Practice in 2017: Code stroke activation with LTKW (last time known well) up to 6 hours. Inconsistent pre-notifications and pre-activations by EMS and ED. St. Cloud Hospital and Mayo Clinic Ambulance with siloed/individualized protocols for their respective health systems. Conclusion: In May 2019, after 2 years of working together our teams saw our efforts come together when Mayo Clinic Ambulance adopted and supported St.Cloud Hospital VAN (visual, aphasia, neglect) protocol to be site specific for the St. Cloud Region. Our collaboration efforts have shown when there is pre-notification and pre-activation patients are treated with a thrombolytic consistently under 45 minutes and to the operating room for a thrombectomy within 75 minutes.https://digitalcommons.centracare.com/nursing_posters/1154/thumbnail.jp
Acute Outcomes for the Full US Cohort of the FLASH Mechanical Thrombectomy Registry in Pulmonary Embolism
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Evidence supporting interventional pulmonary embolism (PE) treatment is needed. Aims
We aimed to evaluate the acute safety and effectiveness of mechanical thrombectomy for intermediate- and high-risk PE in a large real-world population. Methods
FLASH is a multicentre, prospective registry enrolling up to 1,000 US and European PE patients treated with mechanical thrombectomy using the FlowTriever System. The primary safety endpoint is a major adverse event composite including device-related death and major bleeding at 48 hours, and intraprocedural adverse events. Acute mortality and 48-hour outcomes are reported. Multivariate regression analysed characteristics associated with pulmonary artery pressure and dyspnoea improvement. Results
Among 800 patients in the full US cohort, 76.7% had intermediate-high risk PE, 7.9% had high-risk PE, and 32.1% had thrombolytic contraindications. Major adverse events occurred in 1.8% of patients. All-cause mortality was 0.3% at 48-hour follow-up and 0.8% at 30-day follow-up, with no device-related deaths. Immediate haemodynamic improvements included a 7.6 mmHg mean drop in mean pulmonary artery pressure (-23.0%; p Conclusions
Mechanical thrombectomy with the FlowTriever System demonstrates a favourable safety profile, improvements in haemodynamics and functional outcomes, and low 30-day mortality for intermediate- and high-risk PE
Turnkey Algorithmic Approach for the Evaluation of Gastroesophageal Reflux Disease After Bariatric Surgery
Get PDFBariatric surgeries are often complicated by de-novo gastroesophageal reflux disease (GERD) or worsening of pre-existing GERD. The growing rates of obesity and bariatric surgeries worldwide are paralleled by an increase in the number of patients requiring post-surgical GERD evaluation. However, there is currently no standardized approach for the assessment of GERD in these patients. In this review, we delineate the relationship between GERD and the most common bariatric surgeries: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), with a focus on pathophysiology, objective assessment, and underlying anatomical and motility disturbances. We suggest a stepwise algorithm to help diagnose GERD after SG and RYGB, determine the underlying cause, and guide the management and treatment
ICU Liberation: Early Mobility and Exercise
Get PDFThe aim of this project was to streamline and standardize the delivery of the follow up Important Message from Medicare (IMM) for IP admissions across CC and Carris-RWF in compliance with regulatory standards of care.
Key drivers identified: Site specific variation Underutilization of Epic functionality Use of data to understand performancehttps://digitalcommons.centracare.com/nursing_posters/1125/thumbnail.jp
NeuroInterventional Post-Procedure Assessment and Documentation Compliance
Get PDFPer stroke best practice guidelines, pulse and groin checks need to be completed post-neurointerventional procedure per orders. Our plan is to improve assessment and documentation of post-procedure pulse and groin checks by improving the flow of the Electronic Medical Record (EMR). By enhancing clinical documentation and improving the documentation process, nursing practice can be supported, and best patient care delivered.https://digitalcommons.centracare.com/nursing_posters/1134/thumbnail.jp
Innovative Use of EHR to Support Admission Screening for Emerging Pathogens
Get PDFCentraCare hospitals were the first in Minnesota to identify a patient with Candida auris (C. auris), an emerging pathogen. 2018 Centers for Disease Control and Prevention (CDC) and state health department recommended adoption of enhanced admission screening process to allow for early identification of patients at risk of being colonized with C. auris/Carbapenem-Resistant Organisms (CROs). C. auris, a fungus, and CROs, comprised of organisms from the Enterobacteriaceae family resistant to carbapenems, are emerging multidrug resistant pathogens. Emphasis on identification and early isolation of at-risk patients decreases risk of transmission.https://digitalcommons.centracare.com/nursing_posters/1128/thumbnail.jp
Strategies for Reducing Vascular and Bleeding Risk for Percutaneous Left Ventricular Assist Device-Supported High-Risk Percutaneous Coronary Intervention
Get PDFIn patients at high risk for haemodynamic instability during percutaneous coronary intervention (PCI), practitioners are increasingly opting for prophylactic mechanical circulatory support, such as the Impella® heart pump (Abiomed, Danvers, MA, USA). Though Impella-supported high-risk PCI (HRPCI) ensures haemodynamic stability during the PCI procedure, access-related complication rates have varied significantly in published studies. Reported variability in complication rates relates to many factors, including anticoagulation practices, access and closure strategy, post-procedure care and variations in event definitions. This article aims to outline optimal strategies to minimize vascular and bleeding complications during Impella-supported HRPCI based on previously identified clinical, procedural and postprocedural risk factors. Practices to reduce complications include femoral skills training, standardized protocols to optimize access, closure, anticoagulation management and post-procedural care, as well as the application of techniques and technological advances. Protocols integrating these strategies to mitigate access-related bleeding and vascular complications for Impella-supported procedures can markedly limit vascular access risk as a barrier to appropriate large-bore mechanical circulatory support use in HRPCI