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Enhancing Patient Safety: The Role Of Interdisciplinary Teams In Reducing Blood Culture Contamination, Austin Patrick Eisenberg, Fady M. Awad, Brian Watson, Mohammed Faris

HCA Healthcare Journal of Medicine

Background

Blood cultures are vital to diagnostic workups among many hospitalized patients, providing valuable information about bloodstream infections (BSIs), which cause roughly 250 000 deaths annually between North America and Europe. Despite advances in health care, blood culture contamination remains a substantial problem, with deleterious effects on patient mortality, patient and hospital costs, and microbial resistance. This article reviews the repercussions of blood culture contamination on the health care system and delineates evidence-based strategies to decrease contamination rates.

Methods

To reduce blood culture contamination rates, our health care facility undertook a quality improvement initiative. A task force was created, consisting …

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

A Randomized Controlled Trial Of 2% Chlorhexidine Gluconate Skin Preparation Cloths For The Prevention Of Surgical Site Infections In Adults Undergoing Spine Surgeries: Residual Reduction In Skin Bacterial Load For 4 Days, Elizabeth Card, Yaping Shi, Wuraola Adesinasi, Matt Shotwell, Nancy Wells, Elizabeth Hall, Joseph Cheng, Edward Sherwood

HCA Healthcare Journal of Medicine

Background

Surgical site infections (SSI) result in increased morbidity and mortality, prolonged recovery, longer hospital length of stay for medication or possible additional surgeries, and escalated health care costs. The purpose of this randomized controlled trial was to compare SSI rates and overall skin flora burden between those using chlorhexidine (CHG) cloths versus soap and water preoperatively in the adult spine surgery population.

Methods

Subjects were randomized preoperatively to use 2% CHG cloths versus soap and water the night before and morning of surgery prior to the operation. A skin culture was obtained at enrollment prior to any cleansing, again …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Inpatient Falls: Epidemiology, Risk Assessment, And Prevention Measures. A Narrative Review, Taylor Locklear, Jeannie Kontos, Callaham A. Brock, Alexander B. Holland, Rachel Hemsath, Anna Deal, Shannon Leonard, Carsten Steinmetz, Saptarshi Biswas

HCA Healthcare Journal of Medicine

Patient falls are a common inpatient dilemma and comprise the largest category of preventable adverse events in hospitalized patients. These events place a clinical burden on the patient, such as increased morbidity and reduced quality of life, in addition to an economic burden on the hospital system. Fall prevention strategies have the opportunity to decrease inpatient health care costs and length of stay. Several risk factors have been identified that contribute to inpatient falls and several strategies have been identified to minimize this risk. These risk factors are typically characterized as intrinsic and extrinsic factors. Intrinsic factors include characteristics such …

Nursing Informatics: The Vital Nursing Link Between Technology And Patient Care, Sherri L. Hess, Caryn Alper

HCA Healthcare Journal of Medicine

Advances in technology offer additional health care tools to improve the health of patients and efficiencies for our clinicians in innovative ways. These technologies cover a huge variety of therapeutics, ranging from wearable devices, such as insulin pumps, to robotic-assisted surgeries. Nursing informatics is firmly embedded in the use of technology to improve nursing care and science. One of the most recent developments in nursing is the exploration of virtual nursing. This paper will present the past, current, and future projections for this unique blend of nursing art and science with cutting-edge technology.

Revitalizing Emergency Rooms Nationally: Strategies And Insights, Jeffin Dejanovich, Noah Zanville

HCA Healthcare Journal of Medicine

Throughout the United States, the post-COVID-19 pandemic period has been marked by profound disruption to health care operations, coordination, and care capacity. These disruptions have been especially serious in the emergency room (ER) setting. While intensely challenging, the post-pandemic period has also presented opportunities for health care systems to approach classic challenges facing the ER with fresh eyes. In this editorial, the authors discuss key strategies being used to help revitalize ERs nationally and reflect on future challenges and directions.

Infection Prevention: The Small But Mighty Teams In Health Care, E. Jackie Blanchard

HCA Healthcare Journal of Medicine

Infection prevention is a team within health care facilities and systems whose members are vital to reducing and mitigating patient harm secondary to infectious disease. Infection preventionists are subject matter experts who reside in the quality department and are responsible for multiple areas beyond infectious disease spread. They assist nursing teams, employee health programs, and epidemiologists in decreasing the spread of illness. They are widely under-recognized, though they have a significant impact on the overall stability of the health care system and the communities they serve.

A Historical View Of Nursing Research At Hca Healthcare, Jane D. Englebright

HCA Healthcare Journal of Medicine

HCA Healthcare has been a pioneer in evidence-based practice (EBP) in nursing for over 20 years. Nursing leaders overcame 2 major challenges, generating useful data to inform practice and disseminating EBP across their vast network. These challenges were overcome by using data outside the electronic health record (EHR) while advancing the standardization of data within the EHR. Standardizing data had a significant impact on nurse-led research, leading to improvements in patient outcomes and changes in practice including medication dispensing, patient fall reporting, and scheduling guidelines. This retrospective shares some of these important innovations in nursing practice.

The Future Of Nurse-Led Research: The Road Ahead, Sammie Mosier

HCA Healthcare Journal of Medicine

Nursing as a profession is full of innovation. From nurse-led research and new technology to emerging models of care, nurses continue to blaze trails and take steps to improve patient care. As one of the largest employers of nurses in the United States, HCA Healthcare has an obligation to produce research and evidence-based practices to pave the way for the future of nursing practice and potentially change how care is delivered. In this editorial, HCA Healthcare’s chief nurse officer describes her vision for the future of nurse-led research and examines how education, partnerships, and technology facilitate the road ahead for …

Inspiring And Supporting Nurses’ Scholarly Works Through A Special Issue Highlighting Nursing-Sensitive Indicators, Sammie Mosier, Elizabeth Card, Caryn Alper

HCA Healthcare Journal of Medicine

Nursing represents the largest discipline in health care, with just over 5 million nurses in the United States, and the discipline is under increasing pressure to make evidence-based decisions in the delivery of patient care. This special issue of the HCA Healthcare Journal of Medicine can inspire and support nurses’ scholarly work with an eye to dissemination in peer-reviewed medical journals. This issue highlights nursing’s contributions to improving patient outcomes through nurse-sensitive indicators, with the hope of elevating the quality of tomorrow’s health care.

You're Sending The Wrong Message: Sexual Favoritism And The Workplace, Paige I. Bernick

Tennessee Journal of Law and Policy

No abstract provided.

Fixing A Broken System: Reconciling State Foreclosure Law With Economic Realities, Yianni D. Lagos

Tennessee Journal of Law and Policy

No abstract provided.

Federal Rules Of Evidence 413, 414, And 415: Fifteen Years Of Hindsight And Where The Law Should Go From Here, Bryan C. Hathorn

Tennessee Journal of Law and Policy

No abstract provided.

A Statistical Look At The Supreme Court's 2009 Term, John M. Schleb Ii, Colin Glennon, Hemant Sharma

Tennessee Journal of Law and Policy

Whether a change in membership occurs or not, every Supreme Court term presents a unique set of controversies and decisions for legal scholars to examine. Herein, we offer a discussion of the Court's recently completed 2009-2010 term. Rather than analyzing specific opinions in detail (as many have already done), we generate a comprehensive statistical analysis of justice voting behavior for the term. In particular, we examine consensus and division on the Court, the ideological tenor of the term, voting alignments among the justices, the production of opinions, and the Court's overall ideological spectrum based on individual voting patterns. Ultimately, we …

Front Matter

Tennessee Journal of Law and Policy

No abstract provided.

Contents

Tennessee Journal of Law and Policy

No abstract provided.

A Clinical Case Of A Right Eyelid Multilobulated Lesion: Invasive Sebaceous Carcinoma Masquerading As Chalazion, Tyler Van Auken, Erin Reese, Martin Nguyen, Reece Fletcher, Peyton Collias, David Webb

Marshall Journal of Medicine

Sebaceous carcinoma (SC) is a rare and aggressive malignancy of the sebaceous glands, most commonly arising from the eyelid. The general presentation of SC varies, resulting in delayed identification and frequent misdiagnosis. Clinicians should include SC in a differential diagnosis when a patient presents with an eyelid lesion. Undiagnosed and untreated SC can have detrimental outcomes; therefore, early diagnosis and treatment are imperative to decrease mortality and morbidity.

This is the case of a 71-year-old male referred by his primary care physician to the ophthalmologist for an inflamed, multilobulated lesion on his right upper eyelid. The patient was initially diagnosed …

Industrial Explosion Survival After Presenting To A Rural Hospital: A Case Report, Carol L. Wright Becker, Roger Tillotson, William Krantz, Brad End, Stephanie Rellick, Emily Nutter

Marshall Journal of Medicine

Explosions can lead to numerous injuries.¹ Studies show that trauma mortality increases by 14% when patients are treated at rural hospitals compared to non-rural facilities.² A 43-year-old male arrived at a rural hospital with injuries from an explosion, where only a single board-certified emergency physician was on duty. The patient's polytrauma was severe, resulting in bilateral orbital compartment syndrome and Cushing's triad. Remarkably, he survived these extensive injuries. Despite the limitations of rural healthcare, such as restricted equipment, medications, and longer transfer times, rural emergency physicians should remain optimistic and help guide future management. This high-acuity, low-frequency trauma …

Long-Term Survival After Metastatic Pancreatic Cancer, Joshua Keefer, Mark Cooper, Toni Pacioles, Amanda Arrington

Marshall Journal of Medicine

Pancreatic adenocarcinoma is an aggressive cancer with poor outcomes regardless of resection and treatment. The 5-year survival rate is less than 10%. Even with proper resection of the primary tumor, there remains a high likelihood of recurrence within 20 months. This is the case of a patient who was diagnosed with pancreatic adenocarcinoma 7 years ago. This patient underwent resection of the primary tumor along with chemotherapy and radiation. Two recurrences, located in the lung, have both been resected. This case highlights the importance of prompt resection and regular surveillance to monitor for additional metastases.

A Rare Case Of Visual Symptoms Due To Isotretinoin Therapy, Mouhannad Azzouz, Patrick Duffy, Safiyyah Nomani, Conner Funke

Marshall Journal of Medicine

Isotretinoin has been a long-standing medication used to treat acne, with a gradual increase in the dose during therapy. A typical treatment course lasts 4-6 months.¹ It has been shown to inhibit sebaceous gland functioning and keratinization.­² The most common adverse effects include xerostomia, cheilitis, dry nose, and sun sensitivity. Less common adverse effects include itching, irritation, hair thinning, dry eyes, rash, muscle aches, and joint pain.² There has also been reported increased depression and suicidality as a result of Isotretinoin treatment.² Notably, the black box warning on Isotretinoin is in its potential to cause severe …

Standing Systolic Blood Pressure: Insights From Heartful Living, Anand Chockalingam

Marshall Journal of Medicine

No abstract provided.

Representing Agricultural Enterprises: Ethical Concerns, John Dillard

Tennessee Journal of Law and Policy

No abstract provided.

Agricultural Technology, Mike Buschermohle, John Dillard

Tennessee Journal of Law and Policy

No abstract provided.

Issues In Tennessee Agricultural Law & Policy, Julie Bowling, Theresa Denton, Rhedona Rose

Tennessee Journal of Law and Policy

No abstract provided.

Agritourism, Csas, And Direct To Consumer Sales, Julie Bowling, Rob Holland, Cari Rincker

Tennessee Journal of Law and Policy

No abstract provided.

National Agricultural Law Update, Cari Rincker

Tennessee Journal of Law and Policy

No abstract provided.

Welcome

Tennessee Journal of Law and Policy

No abstract provided.

Contents

Tennessee Journal of Law and Policy

No abstract provided.

Employment Law: Smith V. Rock-Tenn. Services: Employer Held Liable For Same-Sex Sexual Harassment In The Workplace, Kaitlyn Dean

Tennessee Journal of Law and Policy

No abstract provided.