Background Many nurses, particularly those working in intensive care units, experience anxiety and burnout as a result of caring for patients with complex conditions and high mortality rates. This situation often leads to employee dissatisfaction and high turnover. Local Problem The purpose of this project was to reduce anxiety related to patient death among nurses in a 17-bed medical intensive care unit through the implementation of a previously developed evidence-based postdeath reflection activity called “The Pause.” Methods Unit leaders received training in the Pause. Staff nurses anonymously and voluntarily completed preintervention and postintervention surveys collecting self-reported demographic data and scores on the revised Collett-Lester Fear of Death Scale, which measures fear and anxiety about death. The intervention was performed by a trained staff member when a patient died. Quantitative data were evaluated using descriptive statistics and measures of effect size. Results A total of 38 nurses (54% of nursing staff members) completed the preintervention survey, and 22 nurses (31% of nursing staff members) completed the postintervention survey. The mean total score on the revised Collett-Lester Fear of Death Scale decreased by 15% (Cohen d = 0.53) from before to after the intervention, indicating reduced overall anxiety related to patient death among participating nurses. Conclusion Implementation of the Pause was associated with a decrease in anxiety among bedside nurses. Given the minimal cost and workload for staff members, along with the positive outcome, continuation of this intervention is recommended.
Background Chest radiography confirms initial nasogastric tube placement but is impractical for repeated verification during feeding and medication administration. Local Problem Nasogastric tube placement verification practices on the neuroscience unit delayed feedings and medication administration due to radiograph interpretation and physician order wait times. The aim of this quality improvement project was to assess feasibility, usability, and adoption of gastric aspirate pH testing and tube length measurement for ongoing nasogastric tube placement verification after initial chest radiography confirmation. Methods The Stevens Star Model of Knowledge Transformation guided this project and involved assessing relevance and feasibility of the practice change, developing an action plan, implementing the intervention, and evaluating the results. The quality improvement intervention was to use gastric aspirate pH testing along with distal tube length measurement at the nostril exit site, rather than gastric auscultation, for ongoing nasogastric tube placement verification. Results With 100% staff compliance with workflow and process measures, the project was feasible and usable. A total of 141 gastric aspirate samples were tested over 6 months. Gastric placement was confirmed (pH ≤5.5) in 131 samples. Ten of the 141 samples had a pH of greater than 5.5, indicating placement not confirmed. Postimplementation surveys indicated that staff nurses accepted the practice change. Conclusion Gastric aspirate pH testing along with tube length measurement is feasible and effective for ongoing nasogastric tube placement verification in patients with stroke and other neurological conditions. The next step is to incorporate suggested process improvements into the next practice change cycle.
Background Decreasing unplanned extubation rates in critically ill patients is an important element of care in the intensive care unit. However, most available literature on unplanned extubation addresses its prevalence, risk factors, and patient outcomes; few articles offer specific, reproducible interventions for preventing unplanned extubation. Local Problem In the adult medical intensive care unit of a large academic tertiary care hospital, the unplanned extubation rate in the last quarter of 2018 was 2.0 per 100 ventilator days, higher than the internal benchmark of 1.06 per 100 ventilator days. Methods A quality improvement project was initiated to identify patients’ risk for unplanned extubation and implement interventions according to risk level. The risk categories and associated bundled nursing interventions were created by an expert work group using available literature and data collected on the unit. The effectiveness of the interventions was tested by continually monitoring unplanned extubation rates. Results After the project’s initiation in 2019, the rate of unplanned extubations in the intensive care unit decreased from 1.307 per 100 ventilator days in 2018 to 0.344 in 2023. A 2-proportion z test revealed a significant difference in unplanned extubation rates between 2018 and 2023 (P < .001), indicating that the project implemented in 2019 effectively reduced unplanned extubation events over time. Conclusion By integrating evidence-based interventions, fostering a culture of safety, and emphasizing proper patient assessment and communication, substantial progress was made in decreasing unplanned extubation rates.
