Original Research: Alarm Fatigue: Exploring the Adaptive and Maladaptive Coping Strategies of Nurses.

Background: To improve patient safety, hospitals use alarm notification systems to increase nurses' real-time situational awareness of a patient's condition. Such alarms are critical to nurses' clinical decision-making and prioritization, thus helping to improve patient care and care efficiency. But the frequent and often simultaneous ringing of alarms, including many that are false, nonemergent, or nonactionable, has led to overwhelm, alarm distrust, and desensitization, resulting in alarm fatigue.

Beyond the Bedside: Decoding Patient Profiles for Smarter Virtual Patient Observation.

Background: Emerging evidence suggests that virtual patient observation (VPO) may help promote patient safety.

Purpose: The purpose of this study was to examine and describe the demographic and clinical characteristics of patients who incurred VPO.

Methods: A retrospective analysis was conducted.

Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study.

Background: Changes in healthcare delivery were required during the first year of the COVID-19 pandemic.

Objective: The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting.

Method: A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts.

Original Research: Patient Perception of Fall Risk in the Acute Care Setting.

Purpose: Hospitals are implementing a variety of fall prevention programs to reduce the fall rates of hospitalized patients. But if patients don't perceive themselves to be at risk for falling and don't adhere to fall prevention strategies, such programs are likely to be less effective. The purpose of this study was to describe the perceptions of fall risk among hospitalized patients across four acute care specialty services.

One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol.

Background: Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied.

Objective: The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol.

Implementation of an Interdisciplinary AACN Early Mobility Protocol.

Background: Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components.

Methods: A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted.

The Use of Physical Therapy ICU Assessments to Predict Discharge Home.

Objectives: To establish cutoff values for making recommendations for discharge to the home setting using standardized physical therapy assessments.

Design: Retrospective study.

Setting: Five ICUs at a large academic medical center.

Implementation of Fall Preventions Over the Past 15 Years: Impact on Inpatient Injury and Insights for the Future.

Background: Hospital fall rates have changed minimally with preventive measures; however, the effect on injury rate is unclear.

Purpose: The purpose was to determine whether fall-related injuries have changed over time.

Methods: A retrospective comparison was done of 1134 adult inpatient falls in 2017 to 1235 falls in 2001-2002 for injury and fall circumstances.

Evaluation of Sensor Technology to Detect Fall Risk and Prevent Falls in Acute Care.

Background: Sensor technology that dynamically identifies hospitalized patients' fall risk and detects and alerts nurses of high-risk patients' early exits out of bed has potential for reducing fall rates and preventing patient harm. During Phase 1 (August 2014-January 2015) of a previously reported performance improvement project, an innovative depth sensor was evaluated on two inpatient medical units to study fall characteristics. In Phase 2 (April 2015-January 2016), a combined depth and bed sensor system designed to assign patient fall probability, detect patient bed exits, and subsequently prevent falls was evaluated.

Subclinical Peroneal Neuropathy: A Common, Unrecognized, and Preventable Finding Associated With a Recent History of Falling in Hospitalized Patients.

Purpose: Identification of modifiable risk factors for falling is paramount in reducing the incidence and morbidity of falling. Peroneal neuropathy with an overt foot drop is a known risk factor for falling, but research into subclinical peroneal neuropathy (SCPN) resulting from compression at the fibular head is lacking. The purpose of our study was to determine the prevalence of SCPN in hospitalized patients and establish whether it is associated with a recent history of falling.

Anatomy of Inpatient Falls: Examining Fall Events Captured by Depth-Sensor Technology.

Background: Sensor technology offers a new way to identify patient movement, detect falls, and automatically alert health care staff when falls occur. The information gained from analyzing actual fall events can be beneficial in developing individualized fall prevention strategies, informing nursing staff about the nature of falls, and identifying opportunities to make the patient care environment safer.

Methods: A six-month performance improvement pilot was conducted at Barnes-Jewish Hospital (St.

The occurrence of antibodies to heparin-platelet factor 4 in cardiac and thoracic surgical patients receiving desirudin or heparin for postoperative venous thrombosis prophylaxis.

Introduction: This randomized, exploratory study compared the incidence of heparin-dependent antibodies associated with subcutaneous (SC) desirudin or heparin given for deep-vein thrombosis prophylaxis following cardiac and thoracic surgery.

Materials And Methods: Adult patients scheduled for elective cardiac or thoracic surgery received desirudin 15 mg SC twice daily or unfractionated heparin 5000 units SC thrice daily. Duration of thrombosis prophylaxis was determined by the treating physician.

Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center.

Background: Obstructive sleep apnea (OSA) affects approximately 20% of US adults, of whom about 90% are undiagnosed. While OSA may increase risk of perioperative complications, its prevalence among surgical patients is unknown. We tested the feasibility of screening surgical patients for OSA and determined the prevalence of undiagnosed OSA.

A randomized study in diabetic patients undergoing cardiac surgery comparing computer-guided glucose management with a standard sliding scale protocol.

Objective: The aim of this study was to compare a standard insulin protocol with a computer-guided glucose management system to determine which method achieves tighter glucose control.

Design: A prospective, randomized trial.

Setting: A cardiothoracic intensive care unit (ICU) in a large academic medical center.

Mild hypercapnia after uncomplicated heart surgery is not associated with hemodynamic compromise.

Objective: The aim of this study was to examine the effects of small changes in PaCO(2) on hemodynamic parameters after uncomplicated heart surgery with cardiopulmonary bypass.

Design: This was a prospective, randomized crossover study.

Setting: A large academic medical center.

Clostridium difficile in cardiac surgery: risk factors and impact on postoperative outcome.

Background: Clostridium difficile-associated diarrhea (CDAD) is a potentially preventable and often troublesome gastrointestinal complication after cardiac surgery.

Methods: A retrospective study was performed of 8,405 cardiac surgery patients at two institutions between January 1997 and August 2004. Preoperative cardiac risk factors, perioperative factors including blood product transfusion, antibiotic utilization, and postoperative morbidity and mortality were recorded.

Use of the Patient State Index (PSI) to assist in the diagnosis of perioperative neurological injury and brain death.

We present a series of three postoperative cases that were admitted to a cardiothoracic intensive care unit (ICU) after major surgery. Due to the possible presence of residual postoperative neuromuscular blockade after surgery, a processed electroencephalograph (EEG) was applied prior to starting sedation. This was markedly abnormal in all three cases, and not in keeping with the residual anesthesia.

Low-dose intrathecal morphine does not delay early extubation after cardiac surgery.

Purpose: This study was designed to examine the efficacy of low-dose intrathecal morphine (ITM) on extubation times and pain control after cardiac surgery.

Methods: 43 patients undergoing elective cardiac surgery were enrolled in this prospective, randomized, double-blind placebo controlled trial. Patients were given a pre-induction dose of ITM (6 microg x kg(-1) per ideal body weight in 5 mL normal saline, group ITM) or 5 mL of intrathecal normal saline (group ITS).

Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery.

Background: The purpose of this study was to describe our institutional experience in using inhaled prostacyclin as a selective pulmonary vasodilator in patients with pulmonary hypertension, refractory hypoxemia, and right heart dysfunction after cardiothoracic surgery.

Methods: Between February 2001 and March 2003, cardiothoracic surgical patients with pulmonary hypertension (mean pulmonary artery pressure >30 mm Hg or systolic pulmonary artery pressure >40 mm Hg), hypoxemia (PaO(2)/fraction of inspired oxygen <150 mm Hg), or right heart dysfunction (central venous pressure >16 mm Hg and cardiac index <2.2 L.