Becker's Hospital Review

35 QUALITY IMPROVEMENT & MEASUREMENT How UCHealth hospitals lowered death rates for alcohol withdrawal patients in the ICU By Anuja Vaidya A program to better care for intensive care unit patients experiencing alcohol withdrawal has helped three University of Colorado Health hospitals lower death rates. Typically, for alcohol withdrawal cases in the ICU, hospitals use heavy sedation, sometimes putting patients on a ventilator. However, this can lead to several potential complications, such as pneumonia, delirium or damage to vocal cords. e program, developed by Kristen Boettcher, RN, an ICU nurse at UCHealth Poudre Valley Hospital in Fort Collins, Colo., focuses on alleviating symptoms. Providers begin treatment by using lorazepam (a sedative) and monitor the patient every 15 minutes for several hours until symptoms are under control. e provider can adjust dosage as the treatment continues, and potentially switch to phenobarbital (another type of sedative). Ms. Boettcher also switched up the scoring system traditionally used to determine the severity of a patient's withdrawal symptoms. Instead of using the Clinical Institute Withdrawal Assessment for Alcohol, the program incorporates the Alcohol Withdrawal Clinical Assessment scale. e program was first piloted in spring 2018 in the ICUs at UCHealth Medical Center of the Rockies in Loveland, Colo., and UCHealth Poudre Valley Hospital. It is now a standard of care for alcohol withdrawal patients at the two hospitals. e program has since been expanded to UCHealth Greeley (Colo.) Hospital. e new program has decreased rates of intubation and ventilator use at the three hospitals, as well mortality rates. Patients are also transferred out of the ICU 19 hours earlier, on average, since the program was implemented. Ms. Boettcher received the 2019 National Magnet Nurse of the Year Award, in the empirical outcomes category, for her work on this program. n Nurse-led program improves care for older patients, study finds By Gabrielle Masson A nurse-led education and consultation program created at New York University improves care quality and patient safety for patients over age 65, according to a study published Nov. 4 in The Gerontologist. NYU's Rory Meyers College of Nursing in New York City created the Nurses Improving Care for Healthsystem Elders program to help or- ganizations improve care for older adults. The program now involves 580 acute care hospitals and nursing homes in the U.S., Singapore, Canada and Bermuda. The program provides resources and practice models for nurses to improve patient- and family-centered care for older adults. Researchers analyzed 43 articles about NICHE from six databases between January 1992 and April 2019, involving a total of 12,254 patients and more than 50,000 nurses and healthcare professionals. The analysis revealed that specialized older adult care, a key feature of NICHE, increased care quality and patient safety, while lowering complications and length of stay. Improvements were also noted in specialized geriatric care education and consultation, as measured by perceptions of the geriatric care environment and aging-sensitive care delivery. The study authors said the findings are promising but more research on patient outcomes and the impact on healthcare professionals is needed to further improve care for older patients. n Depressed physicians tied to more medical errors, study finds By Mackenzie Bean P hysician well-being is a crucial component of patient safety, as depressed physicians are more likely to make medical errors, according to a study published in JAMA Network Open. For the study, researchers from University of Michigan Medical School in Ann Arbor systematically reviewed 11 peer-reviewed stud- ies involving 21,517 physicians. All studies examined the association between physician depressive symptoms and perceived or observed medical errors. Depressed physicians were 1.95 times more likely to make medi- cal errors than their peers. Researchers also found a link between medical errors and subsequent depressive symptoms in physicians, pointing to a bidirectional relationship between the two factors. "The bidirectional associations between physician depressive symp- toms and perceived medical errors verified by this meta-analysis sug- gest that physician well-being is critical to patient safety," the study's authors concluded. n

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