Striving for the impossible.

Mrs Kinnon has just had a knee replacement and is in a ward. She has specific ambulation and fall precautions, and needs a bed alarm at night. She has been prescribed a blood thinner and is especially vulnerable to injury.

CE: Original research: hospital system barriers to rapid response team activation: a cognitive work analysis.

Background: The goal of rapid response team (RRT) activation in acute care facilities is to decrease mortality from preventable complications, but such efforts have been only moderately successful. Although recent research has shown decreased mortality when RRTs are activated more often, many hospitals have low activation rates. This has been linked to various hospital, team, and nursing factors.

Reducing indwelling urinary catheter use in the emergency department: a successful quality-improvement initiative.

Introduction: This quality-improvement project aimed to evaluate the effectiveness of implementing multidisciplinary education and deploying utilization tools aimed at reducing the inappropriate insertion of indwelling urinary catheters (IUCs) in the emergency department. Literature supports the use of decision support tools and education as proven techniques to reduce IUC use. Few studies have implemented a multidisciplinary approach involving the use of focus groups to understand the thought processes behind deciding to place an IUC.

Improving patient care by making small sustainable changes: a cardiac telemetry unit's experience.

With the introduction of each new drug, technology, and regulation, the processes of care become more complicated, creating an elaborate set of procedures connecting various hospital units and departments. Using methods of Adaptive Design and the Toyota Production System, a nursing unit redesigned work systems to achieve sustainable improvements in productivity, staff and patient satisfaction, and quality outcomes. The first hurdle of redesign was identifying problems, to which staff had become so accustomed with various work arounds that they had trouble seeing the process bottlenecks.