A retrospective study exploring nursing sensitive interventions for patients on a skilled nursing unit in a rural Midwest hospital
View File(s)
Visitor Statistics
Visits vs Downloads
Visitors - World Map
Top Visiting Countries
Country | Visits |
---|
Top Visiting Cities
City | Visits |
---|
Visits (last 6 months)
Downloads (last 6 months)
Popular Works for Moseley, Carol-Ann by View
Title | Page Views |
---|
Popular Works for Moseley, Carol-Ann by Download
Title | Downloads |
---|
View Citations
Citations
Session presented on Monday, November 9, 2015:
Purpose and Research Questions: The purpose of this study was to assess the impact of nursing interventions on a skilled nursing unit (SNU) when a change in patient health status was identified. Patient characteristics were correlated with specific variables such as Rothman Index (RI) scores and 30-day readmission status. Nurses could then implement specific individualized interventions to improve patient outcomes. The study questions were: a) What are the characteristics of our SNU patients? and b) Can use of the RI discharge score alert the nurse to the need for increased interventions to lower the risk for 30-day hospital readmission?
Background and Significance: It is imperative that nurses use evidence based practice and research as a basis for making patient care decisions. This is especially important in the context of the rapidly changing healthcare environment of today. The SNU at our hospital was concerned about improving discharge outcomes and reducing hospital readmissions. Research studies have shown that when a patient with heart disease is admitted to a SNU that has specific nursing interventions developed for patients with heart disease, there are improved patient outcomes (Allen et al., 2011; Jacobs, 2011). This led to the idea that a study of our SNU patients would help nurses improve patient outcomes (Hain et al., 2012; Li et al., 2012). The RI software uses clinical measurements from the following four categories: nursing assessments, vital signs, laboratory results, and cardiac rhythms in an algorithm that translates to a RI score reflecting patient progress or lack of progress over time (Rothman et al., 2013). Bradley et al. (2013) concluded there was a strong relationship between the RI score at the time of discharge and unplanned readmissions within 30-days. They found cutoff points in the RI that helped the health care provider to identify patients at high risk for readmission which was considered to be the first step to reduce readmissions. Health care clinicians who use the latest RI score to individualize the patient's discharge plan may help to reduce the risk for 30-day readmissions (Yale-New Haven Hospital, 2013).
Design and Methodology: This was a retrospective study of information gathered from medical records of patients on a SNU during 2013. Variables were extracted from the medical records and sent to the principal investigator in the form of a Limited Data Set and analyzed with the statistical program SPSS Statistics Desktop, V22.0. Patients were classified into the following RI cutoff points related to their risk for 30-day readmission: high-risk (RI <70), medium risk (RI=70-79), low risk (RI=80-89), and lowest risk (RI = 90-100) (Bradley et al., 2013).
Discussion: Our SNU population had similar characteristics as populations identified in other studies, such as gender, race, education, and language. The analysis between our study group and the comparison group (Li et al., 2012) on the patient characteristics showed the following: our group of patients had a higher percentage in the <75 age group and a lower percentage in the >85 age group. Our group of patients showed a significant difference in percentage of married patients as compared to the comparison group. Our group of patients had a 29.3% of DNR orders as compared to 38.1% in the comparison group. Data analysis showed the following percentages by RI risk category for the 30-day patient readmission rate: RI high-risk group = 36.4%, RI medium risk group = 21.8%, RI low risk group = 28.6% and RI lowest risk group = 11.5%. This is comparable to the findings discussed in the Bradley et al. (2013) study.
Implication: Patient characteristics on our SNU in 2013 differed from some patient characteristics found in other studies. Prior to implementing evidence based interventions, our staff needs to look closely at how patient characteristics were applied in other studies. Nurses need to consider if a specific intervention could be used in our distinct patient population or if it needs to be modified to be effective within our population. Nurses need to identify any declining trend in the RI score and implement evidence based interventions to improve the overall patient condition as indicated by an increasing RI score. Our SNU needs to address the issue that 36.4% of our RI high-risk patients are readmitted within 30 days. An RI score in the high risk category (<70) at discharge should alert the nurse to implement interventions focused on individualized needs for health care and support services at home or an alternate health care facility. Nursing interventions should include education to promote health practices, to increase coping skills, and to ensure patient and family know when and how to contact health care providers to decrease potential 30-day readmissions.
References: Allen, L. A., Hernandez, A. F., Peterson, E. D., Curtis, L. H., Dai, D., Masoudi, F. A., Bhatt, D. L., Heidenreich, P. A., & Fonarow, G. C. (2011). Discharge to a skilled nursing facility and subsequent clinical outcomes among older patients hospitalized for heart failure. Circulation Heart Failure, 4, 293-300. Doi:10.1161/CIRCHEARTFAILURE.110.959171 Bradley, E. H., Yakusheva, O., Horsitz, L. I., Sipsma, H., & Fletcher, J. (2013). Identifying patients at increased risk of unplanned readmission. Medical Care, 51, 761-766. Hain, D. J., Tappen, R., Diaz, S., & Ouslander, J. G. (2012). Characteristics of older adults rehospitalized within 7-30 days of discharge: Implications for nursing practice. (2012). Journal of Gerontological Nursing. 38 : 32-44. Jacobs, B. (2011). Reducing heart failure hospital readmissions from skilled nursing facilities. Professional Case Management, 16, 18-24 .Li, Y., Cai, X., Yin, J., Clance, L. G., & Mukamel, D. B. (2012). Is higher volume of postacute care patients associated with a lower rehospitalization rate in skilled nursing facilities? Medical Care Research and Review, 69 , 103-118. Retrieved from http://mcr.sagepub.com/content/69/1/103 DOI: 10.1177/1077558711414274 Rothman, M., Rothman, S. & Beals, J. (2013). Development and Validation of a Continuous Measure of Patient Condition Using the Electronic Medical Record. J Biomed Inform: 46(5), 837-848. Wagner, L., & LaPorte, M. (December 2012). SNFs and hospitals team up to reduce readmissions. Provider: p. 11. Yale-New Haven Hospital. (2013). Rothman Index powerful tool for early detection of subtle patient changes. The Bulletin, 36 (7), 1-2.
43rd Biennial Convention 2015 Theme: Serve Locally, Transform Regionally, Lead Globally.
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository, unless otherwise noted.
Type | Presentation |
Acquisition | Proxy-submission |
Review Type | Abstract Review Only: Reviewed by Event Host |
Format | Text-based Document |
Evidence Level | N/A |
Research Approach | N/A |
Keywords | Nurse Sensitive Indicators; Patient Outcomes; Patient Characteristics |
Name | 43rd Biennial Convention |
Host | Sigma Theta Tau International |
Location | Las Vegas, Nevada, USA |
Date | 2015 |
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
All permission requests should be directed accordingly and not to the Sigma Repository.
All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Related items
Showing items related by title, author, creator and subjects.
-
A retrospective study of the impact of educational intervention on the use of the Rothman Index System on patient outcomes
Phillips, Penny; Shepherd, Marilyn; Jochem, Kathleen; Moseley, Carol-Ann (2016-03-21)Session presented on Monday, November 9, 2015: Background & Significance: The Rothman Index (RI) provides a tool to continually track and trend the patient's condition based on data extracted from the Electronic Health ... -
The relationship between nursing skill mix, nurse sensitive patient outcomes and patient satisfaction
Schwab, Natalie R.; Foreman, Stephen; King, LuAnn; Parcetic, Michelle (2016-06-09)Literature Review: Hospitals are the largest components of the United States healthcare system, and are encountering pressure to provide better quality care and reduce cost. The Patient Protection and Affordable Care Act ... -
A comparative analysis of demographic and academic characteristics and NCLEX-RN passing among urban and rural campus students in a Midwest associate degree nursing program
Nacos-Burds, Kathleen J.A retrospective study was initiated to determine: (1) the predictive relationship between demographic and academic variables and NCLEX-RN success; and (2) if there were significant differences between urban and rural nursing ... -
A phenomenological exploration of international nurse's motivation and experiences in pursuing a master's degree in nursing in the United States
Amann, Carol Ann; Diener, Elizabeth J. (2016-03-21)Session presented on Monday, November 9, 2015: Educational preparation of nurse educators is crucial to advancement of the profession of nursing globally. Most nurses seek to extend formal education in their country of ... -
Effects of a mindfulness-based intervention on resilience in registered nurses caring for hematology patients
Kopp, Erin; Pavlish, Carol L.; Pieters, Huibrie C.; Lee, Eunice; Lewis, Mary AnnExploration of the impact of a mindfulness-based intervention (MBI) on resilience in a population of registered nurses caring for patients with hematologic malignancies. Discussion of the improvement seen in resilience ...