Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication

被引：38

作者：

Happ, Mary Beth ^{[1
,2
,3
]}

Sereika, Susan M. ^{[4
]}

Houze, Martin P. ^{[4
]}

Seaman, Jennifer B. ^{[2
,3
]}

Tate, Judith A. ^{[1
]}

Nilsen, Marci L. ^{[3
]}

van Panhuis, Jennifer ^{[5
]}

Scuilli, Andrea ^{[7
]}

Paull, Brooke ^{[7
]}

George, Elisabeth ^{[7
]}

Angus, Derek C. ^{[2
,5
]}

Barnato, Amber E. ^{[5
,6
]}

机构：

[1] Ohio State Univ, Coll Nursing, Columbus, OH 43210 USA

[2] Univ Pittsburgh, CRISMA Lab Clin Res Invest & Syst Modeling Acute, Dept Crit Care Med, Pittsburgh, PA USA

[3] Univ Pittsburgh, Sch Nursing, Dept Acute & Tertiary Care, Pittsburgh, PA 15261 USA

[4] Univ Pittsburgh, Sch Nursing, Dept Hlth & Community Syst, Pittsburgh, PA 15261 USA

[5] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA 15213 USA

[6] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Hlth Policy & Management, Pittsburgh, PA USA

[7] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA

来源：

HEART & LUNG | 2015年 / 44卷 / 05期

关键词：

Augmentative and alternative; communications systems; Intubation; Endotracheal; Nurses; Education; Quality of health care; SEDATION; DESIGN; GUIDELINES; RISK;

D O I：

10.1016/j.hrtlng.2015.07.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives: Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS). Background: SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown. Methods: Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated >= 2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction. Main results: 323/383 (84%) nurses completed training; their communication knowledge (p <.001) and satisfaction and comfort (p <.001) increased. ICU days with physical restraint use (p =.44), heavy sedation (p =.73), pain score documentation (p =.97), presence of ICU-acquired pressure ulcers (p =.78), coma-free days (p =.76), ventilator-free days (p =.83), ICU length of stay (p =.77), hospital length of stay (p =.22), and median costs (p =.07) did not change. Conclusions: SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use. (c) 2015 Elsevier Inc. All rights reserved.

引用

页码：408 / 415

页数：8

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