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To evaluate the acceptability and feasibility among nurses of Decubitus Risk Prediction Alerts based on Artificial Intelligence (DRAAI), and to assess the feasibility of the implementation plan.
A process evaluation of a pilot implementation study using mixed methods.
Acceptability and feasibility of DRAAI among nurses from three general wards in a university hospital was assessed via questionnaire. The tailored implementation plan included thirteen strategies distributed over six domains, such as facilitation, continuous evaluation, and educational sessions. Adaptations, acceptability, and feasibility were recorded in field notes.
Fifty-five nurses completed the questionnaire and valued DRAAI's predictions, believing these could contribute to pressure ulcer (PU) prevention. Some initially faced challenges distinguishing between PU risk and PU detection. Most found it feasible to integrate DRAAI into their workflow. Adaptations included adding PU preventive measures to educational sessions and sharing frequently asked questions and answers. Overall, implementation efforts were feasible. DRAAI generated PU risk predictions for 428 unique admitted patients; 128 (30%) patients received at least one at-risk prediction. Regarding fidelity, nearly 80% (101/128) of at-risk predictions were followed by a nursing care plan.
Ongoing involvement and clear communication were crucial for successfully integrating AI into nursing workflows. Although some nurses were concerned that DRAAI might miss at-risk patients, they continued to independently identify at-risk patients.
Implementation of DRAAI served as a prompt for nurses to focus more on PU prevention. While DRAAI shows promise in improving PU prevention, future research is needed to evaluate its clinical impact.
Addressed the challenge of identifying patients at risk for developing pressure ulcers. Demonstrated feasibility and acceptability of implementing AI in clinical practice. Highlighted the need for ongoing support and communication for successful implementation.
None.
Standard for Reporting Implementation Studies (StaRI).
To explore barriers and facilitators for reducing low-value home-based nursing care.
Qualitative exploratory study.
Seven focus group interviews and two individual interviews were conducted with homecare professionals, managers and quality improvement staff members within seven homecare organizations. Data were deductively analysed using the Tailored Implementation for Chronic Diseases checklist.
Barriers perceived by homecare professionals included lack of knowledge and skills, such as using care aids, interactions between healthcare professionals and general practitioners creating expectations among clients. Facilitators perceived included reflecting on provided care together with colleagues, clearly communicating agreements and expectations towards clients. Additionally, clients' and relatives' behaviour could potentially hinder reduction. In contrast, clients' motivation to be independent and involving relatives can promote reduction. Lastly, non-reimbursement and additional costs of care aids were perceived as barriers. Support from organization and management for the reduction of care was considered as facilitator.
Understanding barriers and facilitators experienced by homecare professionals in reducing low-value home-based nursing care is crucial. Enhancing knowledge and skills, fostering cross-professional collaboration, involving relatives and motivating clients' self-care can facilitate reduction of low-value home-based nursing care.
Implications for profession and patient care: De-implementing low-value home-based nursing care offers opportunities for more appropriate care and inclusion of clients on waitlists.
Addressing barriers with tailored strategies can successfully de-implement low-value home-based nursing care.
The Consolidated Criteria for Reporting Qualitative Research checklist was used.
No patient or public contribution.
To assess self-reported practices and knowledge of nurses and prescribers (i.e., physicians and nurse practitioners) on intravenous fluid therapy, and to evaluate how this is documented through a clinical documentation review.
Multicentre cross-sectional study, between April 2022 and July 2022, across 13 wards from four Dutch hospitals.
A survey study was conducted to assess self-reported practices related to intravenous fluid therapy. A 12-item questionnaire evaluated knowledge. To gain insights into documentation practices, a retrospective chart review was performed. Data analysis involved descriptive statistics, with group differences analysed using the chi-squared test or Fisher's exact test, as appropriate.
Three hundred and four healthcare professionals completed the questionnaire (92% nurses). The majority of prescribers (n = 20/25; 80%) expected that nurses would start, stop or change intravenous fluid therapy. Overall, the median number of correct answers to knowledge questions was eight (IQR 7–9, range 0–12); four participants (1%) answered all knowledge questions correctly. Knowledge about the composition of sodium chloride 0.9% solution was limited. Analysis of patient charts revealed that 54% (196/362) received intravenous fluids, most commonly 0.9% sodium chloride infusion (168/195; 86%), although the indication was described in 3% (6/196). Thirty-one percent (61/196) of patients received intravenous fluids to keep the vein open (< 30 mL/h).
The study identified shared responsibility, a knowledge gap, and limited documentation concerning intravenous fluids. Prescribers expect nurses to adjust intravenous fluids without consulting a prescriber, which aligns with what nurses do, although they are not legally authorised. Given the limited documentation of the indication for intravenous fluids, it is plausible that several patients received intravenous fluids unnecessarily.
The perceived shared responsibility presents an opportunity to develop a protocol engaging both prescribers and nurses, aiming to guide more targeted infusion therapy.
Reducing unnecessary infusions to keep-the-vein-open can help eliminate low-value care.
CROSS guideline.
No patient or public contribution.
FreshRSS 