Development of the Followership Evaluation Instrument for Nurses: A Prospective Longitudinal Survey.

Maintaining a healthy work environment in nursing practice depends not only on the leader's skill but also on the nursing staff's followership. The study purpose is to develop a followership instrument for nurses. We developed a followership evaluation instrument using data from two surveys conducted in 2013 and 2014 and assessed its validity using a questionnaire with nurses in Japan.

Designing and testing clinical simulations of an early warning system for implementation in acute care settings.

Objectives: Conducting simulation testing with end-users is essential for facilitating successful implementation of new health information technologies. This study designed a standardized simulation testing process with a system prototype prior to implementation to help study teams identify the system's interpretability and feasibility from the end-user perspective and to effectively integrate new innovations into real-world clinical settings and workflows.

Materials And Methods: A clinical simulation model was developed to test a new Clinical Decision Support (CDS) system outside of the clinical environment while maintaining high fidelity.

Adverse diagnostic events in hospitalised patients: a single-centre, retrospective cohort study.

Background: Adverse event surveillance approaches underestimate the prevalence of harmful diagnostic errors (DEs) related to hospital care.

Methods: We conducted a single-centre, retrospective cohort study of a stratified sample of patients hospitalised on general medicine using four criteria: transfer to intensive care unit (ICU), death within 90 days, complex clinical events, and none of the aforementioned high-risk criteria. Cases in higher-risk subgroups were over-sampled in predefined percentages.

Intravenous Medication Administration Safety with Smart Infusion Pumps in the Neonatal Intensive Care Unit: An Observational Study.

Introduction: Infants in the neonatal intensive care unit (NICU) are among the most vulnerable patient populations and medication errors are a significant source of risk and harm to neonates. Smart infusion pumps have been implemented to support the safe medication administration process; however, the effect of using smart infusion pumps on medication safety in the NICU is still unclear.

Methods: We conducted an observational study with a prospective point-prevalence approach to investigate intravenous (IV) medication administration errors in the NICU at one academic medical center in the USA.

Providers' and Patients' Perspectives on Diagnostic Errors in the Acute Care Setting.

Background: Diagnostic errors (DEs) have been studied extensively in ambulatory care, but less work has been done in the acute care setting. In this study, the authors examined health care providers' and patients' perspectives about the classification of DEs, the main causes and scope of DEs in acute care, the main gaps in current systems, and the need for innovative solutions.

Methods: A qualitative mixed methods study was conducted, including semistructured interviews with health care providers and focus groups with patient advisors.

Identifying nursing documentation patterns associated with patient deterioration and recovery from deterioration in critical and acute care settings.

Objectives: Nursing documentation behavior within electronic health records may reflect a nurse's concern about a patient and can be used to predict patient deterioration. Our study objectives were to quantify variations in nursing documentation patterns, confirm those patterns and variations with clinicians, and identify which patterns indicate patient deterioration and recovery from clinical deterioration events in the critical and acute care settings.

Methods: We collected patient data from electronic health records and conducted a regression analysis to identify different nursing documentation patterns associated with patient outcomes resulting from clinical deterioration events in the intensive care unit (ICU) and acute care unit (ACU).

Nursing Documentation Variation Across Different Medical Facilities Within an Integrated Healthcare System.

The purpose of this study was to demonstrate nursing documentation variation based on electronic health record design and its relationship with different levels of care by reviewing how various flowsheet measures, within the same electronic health record across an integrated healthcare system, are documented in different types of medical facilities. Flowsheet data with information on patients who were admitted to academic medical centers, community hospitals, and rehabilitation centers were used to calculate the frequency of flowsheet entries documented. We then compared the distinct flowsheet measures documented in five flowsheet templates across the different facilities.

Information Needs and the Use of Documentation to Support Collaborative Decision-Making: Implications for the Reduction of Central Line-Associated Blood Stream Infections.

It is clear that interdisciplinary communication and collaboration have the potential to mitigate healthcare-associated harm, yet there is limited research on how communication through documentation in the patient record can support collaborative decision making. Understanding what information is needed to support collaborative decision making is necessary to design electronic health information systems that facilitate effective communication and, ultimately, safe care. To explore this issue, we focused on information needs related to central venous catheter management and the prevention of central line-associated blood stream infections.

Development and validation of early warning score system: A systematic literature review.

Objectives: This review aims to: 1) evaluate the quality of model reporting, 2) provide an overview of methodology for developing and validating Early Warning Score Systems (EWSs) for adult patients in acute care settings, and 3) highlight the strengths and limitations of the methodologies, as well as identify future directions for EWS derivation and validation studies.

Methodology: A systematic search was conducted in PubMed, Cochrane Library, and CINAHL. Only peer reviewed articles and clinical guidelines regarding developing and validating EWSs for adult patients in acute care settings were included.

Unique Patient-Reported Hospital Safety Concerns With Online Tool: MySafeCare.

Background: Hospitalized patients and their care partners have valuable and unique perspectives of the medical care they receive. Direct and real-time reporting of patients' safety concerns, though limited in the acute care setting, could provide opportunities to improve patient care.

Methods: We implemented the MySafeCare (MSC) application on six acute care units for 18 months as part of a patient-centered health information technology intervention to promote engagement and safety in the acute care setting.

Use, Perceived Usability, and Barriers to Implementation of a Patient Safety Dashboard Integrated within a Vendor EHR.

Background: Preventable adverse events continue to be a threat to hospitalized patients. Clinical decision support in the form of dashboards may improve compliance with evidence-based safety practices. However, limited research describes providers' experiences with dashboards integrated into vendor electronic health record (EHR) systems.

Mining clinical phrases from nursing notes to discover risk factors of patient deterioration.

Objective: Early identification and treatment of patient deterioration is crucial to improving clinical outcomes. To act, hospital rapid response (RR) teams often rely on nurses' clinical judgement typically documented narratively in the electronic health record (EHR). We developed a data-driven, unsupervised method to discover potential risk factors of RR events from nursing notes.

Unsupervised Machine Learning of Topics Documented by Nurses about Hospitalized Patients Prior to a Rapid-Response Event.

Background: In the hospital setting, it is crucial to identify patients at risk for deterioration before it fully develops, so providers can respond rapidly to reverse the deterioration. Rapid response (RR) activation criteria include a subjective component ("worried about the patient") that is often documented in nurses' notes and is hard to capture and quantify, hindering active screening for deteriorating patients.

Objectives: We used unsupervised machine learning to automatically discover RR event risk/protective factors from unstructured nursing notes.

Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.

Objective: The objective of this paper is to share challenges, recommendations, and lessons learned regarding the development and implementation of a Patient Safety Learning Laboratory (PSLL) project, an innovative and complex intervention comprised of a suite of Health Information Technology (HIT) tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting at a large academic center.

Materials And Methods: The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project: problem analysis, design, development, implementation, and evaluation. Implementation challenges and recommendations were derived from direct observations and the collective experience of PSLL study personnel.

Identifying nurses' concern concepts about patient deterioration using a standard nursing terminology.

Objectives: Nurse concerns documented in nursing notes are important predictors of patient risk of deterioration. Using a standard nursing terminology and inputs from subject-matter experts (SMEs), we aimed to identify and define nurse concern concepts and terms about patient deterioration, which can be used to support subsequent automated tasks, such as natural language processing and risk predication.

Methods: Group consensus meetings with nurse SMEs were held to identify nursing concerns by grading Clinical Care Classification (CCC) system concepts based on clinical knowledge.

CONCERN Factorial Design Survey (FDS) Methods Test: Using REDCap as a Survey Platform.

We assessed the feasibility of using REDCap as a factorial design survey (FDS) platform. REDCap lacks randomization and automation functionality, requiring the development of a workaround. A template survey was created containing all vignettes, copied for each survey instance and edited to hide unwanted content.

Intravenous Infusion Administration: A Comparative Study of Practices and Errors Between the United States and England and Their Implications for Patient Safety.

Introduction: Intravenous medication administration is widely reported to be error prone. Technologies such as smart pumps have been introduced with a view to reducing these errors. An international comparison could provide evidence of their effectiveness, including consideration of contextual factors such as regulatory systems and local cultures.

Fall Prevention Self-Management Among Older Adults: A Systematic Review.

Context: Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors.

Patients as Partners in the Hospital Setting: Engagement Methods in Research, Quality Improvement and Beyond.

Benefits have been demonstrated when patients and family members have been meaningfully engaged in all stages of research beginning with topic generation. When this engagement is done well, research becomes more relevant to those receiving health services, and there is an increased sense of accountability and transparency provided. However, health informatics researchers have not consistently used patient and family member engagement methods despite their many potential benefits.

Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study.

Introduction: Intravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.

A Multi-hospital Before-After Observational Study Using a Point-Prevalence Approach with an Infusion Safety Intervention Bundle to Reduce Intravenous Medication Administration Errors.

Introduction: We previously found a high rate of errors in the administration of intravenous medications using smart infusion pumps.

Objectives/design: An infusion safety intervention bundle was developed in response to the high rate of identified errors. A before-after observational study with a prospective point-prevalence approach was conducted in nine hospitals to measure the preliminary effects of the intervention.

Identifying Information Resources for Patients in the Intensive Care Unit and Their Families.

Background: Providing information to patients in intensive care units and their families is challenging. Patients often are admitted unexpectedly and experience stress and uncertainty. One source of stress has been identified as unclear, uncoordinated, or inconsistent communication and information.