Day 1 :
Keynote Forum
Julie Sanford
James Madison University, USA
Keynote: International collaboration to improve quality and safety in nursing education
Time : 11:20-11:50
Biography:
Julie Sanford completed her DNS in 2002 from Louisiana State University Health Sciences Center. Currently, she is a Professor and Director of the School of Nursing
at James Madison University in Harrisonburg, Virginia and has over 30 years of academic nursing experience. In 2017, she was inducted into the American Academy of
Nursing. She has worked tirelessly to increase access to higher education for educationally disadvantaged and rural nursing students. Her research interests include patient
safety, informal caregiving and the scholarship of teaching and learning. She holds multiple offices in nursing leadership and has published and presented extensively.
Abstract:
Statement of the Problem: The challenges related to patient safety in healthcare are global problems with potential negative outcomes
for patients around the world.
Methodology & Theoretical Orientation: In 2017, a global nursing consortium within the framework of the International
Network of Universities assembled faculty and 21 undergraduate and graduate nursing students at Hiroshima University in Japan.
They sought to improve international nursing education on quality and patient safety using the Quality and Safety Education in
Nursing (QSEN) competencies as a theoretical foundation. Didactic and clinical experiences at the 9-day workshop focused on
developing patient safety champions of student attendees and supporting faculty as they developed expertise in teaching strategies.
The workshop content was taught by expert faculty and included visits to community healthcare sites across the spectrum of care
and an examination of safety in the Japanese automotive and healthcare systems. Teaching strategies focused on engaged learning
principles using a deep review of a clinical case study, high fidelity simulation, team based learning and presentations. A pre-post
mixed method design was used to measure students’ perceptions of patient safety competence through the health patient safety
survey and daily reflective journaling. A paired t-test was used to evaluate whether a statically significant difference existed between
the mean questions associated with student confidence levels surrounding safe practice before and after the workshop intervention.
Significance was set at 0.05.
Findings: The results of the paired t-test were significant with 26 out of 30 questions resulting in a p value <.05. Student reflections
in their journals indicated a transformative learning experience and a deep commitment to impacting patient safety wherever they
choose to practice.
Conclusion & Significance: This workshop experience improved patient safety competence in global nursing student representatives
and developed champions prepared to improve patient safety throughout the world.
Keynote Forum
Eleni Stella Kalandranis
Memorial Sloan Kettering Cancer Center, USA
Keynote: Constant Care: A 21st Century Innovative Approach to Fall Reduction
Time : 11:20-11:50
Biography:
Eleni Stella Kalandranis a Clinical Nurse at Memorial Sloan Kettering Cancer Center for ten years and Lead of the Constant Care project is dedicated to exploring
innovative ways to increase positive patient outcomes. Her passion for patient advocacy and patient safety, in conjunction with her love for technology has developed a
visionary program. She works on an inpatient oncology unit with specialty in neurology, neurosurgery and orthopedics and is dual certified in oncology and medical surgical
nursing. She holds a Bachelor’s degree in Nursing from Pace University and a Master’s degree in Nursing Administration from Mercy College. Her education and clinical
expertise was the foundation to develop the Constant Care program.
Abstract:
Statement of the Problem: Reducing patient harm resulting from a fall is a national patient safety goal. Patient falls continue
to challenge the healthcare industry especially in inpatient units despite the implementation of evidence based practices. Video
monitoring is a practice being used in other hospitals to reduce companion cost. The video surveillance programs used are
limited by the number of patients that can be observed concurrently and do not decrease falls rate.
Methodology & Theoretical Orientation: The Constant Care program uses innovative technology to reduce falls. Constant
Care consists of using video content analytics to monitor up to 40 patients at once with supporting staff workflows focusing on
communication and staff notification. The total cost of the technology was $74,000 for a 43 bed unit.
Findings: Two units in a comprehensive cancer center had successful results from Constant Care in 2017. The pilot began on
a 43 bed inpatient adult surgical unit and a 38 bed (5 critical care beds) neurology, neurosurgery, and orthopedic unit. Since
installation both units have seen a reduction in unassisted fall rate and a decrease in companion rate patient days. This program
also resulted in zero falls with injury for six months in neuro/ortho unit. The cost benefit has also been demonstrated in the
savings of companion dollars which has surpassed the cost of program development.
Conclusion & Significance: Patient falls continue to trouble most healthcare organizations. A patient fall with injury can be
harmful and costly. Video monitoring technology with advanced video content analytics has proven successful in reducing
falls and companion costs on acute care inpatient units for the oncology population. By exploring and leveraging innovative
technology successfully pioneered in other industries, Constant Care has improved patient safety and increased patient
satisfaction.
Keynote Forum
Maja VrabiÄ
University Rehabilitation Institute, Slovenia
Keynote: Patient safety in the rehabilitation nursing care
Time : 11:50-12:20
Biography:
Maja VrabiÄ is employed as a Registered Nurse at the University Rehabilitation Institute– SoÄa in Ljubljana (Slovenia). She has working experience in the following fields:
cooperation in the production of standards in rehabilitation nursing; web site development for the nursing and healthcare professionals in rehabilitation. She is the Co-
Author and Author of several articles. She has experience in the field of Internal Emergency Medicine. In her work, she appreciates the accuracy, responsibility, team work,
compassion, human attitude towards patients and colleagues, and quality implementation of rehabilitation nursing care.
Abstract:
A fall is every event when a patient suddenly finds himself on the floor or on another, lower surface. The fall definition
includes patients who slipped, for example, from the chair to the ground, the patients we found on the ground, although we
did not see them fall and so called "Intercepted" falls, when a nurse or an attendant restrains the patients’ fall and alleviates the
consequences of it, but puts the patient nevertheless to the ground. The consequences of falls are different and can be manifested
by personal, social and economic harm, and therefore special attention has to be dedicated to healthcare institutions. Patients'
falls are among the quality indicators, since their numbers also point to the level of quality of health care. In our department we
treat patients with neurological disorders, traumatic injuries and rheumatic diseases. In 2015, there were 292 patients, 155 men
and 137 women. The article presents a statistical overview of falls in that year. The analysis was carried out according to the
saved data of patients’ falls for the year and is systematically divided according to the indices that we enter into the computer
system. The data were divided according to age, gender, day of fall, risk assessment, category of complexity of nursing, type of
fall, causes for fall, diagnosis at patients’ admition to the department and sequential number of fall. Any fall that occurs during
rehabilitation can prolong the time of treatment of the underlying disease, breaks down the set goal in rehabilitation and causes
the patient insecurity and fear of possible recurrence. In order to reduce the number of falls and thereby increase the quality
of patient treatment in rehabilitation care, it is necessary to identify their characteristics and consider introducing possible
additional measures to prevent them.
Keynote Forum
Bo Van den Bulcke
Ghent University Hospital, Belgium
Keynote: Ethical decision-making climate in the ICU: Theoretical framework and validation of a self-assessment tool
Time : 12:20-12:50
Biography:
Bo Van den Bulcke works as a Psychologist in the ICU, Ghent University Hospital. Her expertise in understanding psychological consequences of an ICU stay for patients
and families has expanded her interest to improve team work. Also the ICU staff should focus on better communication, especially in ethical decision-making. This
instrument could help teams to focus on different aspects to improve quality of communication and thus safety of the ICU patients. This instrument is built with experts in
intensive care, geriatrics and communication.
Abstract:
Context: Literature depicts differences in ethical decision making (EDM) between countries and intensive care units.
Objectives: To better conceptualize EDM climate in the ICU and to validate a tool to assess EDM climates.
Methods: Using a modified Delphi method, we built a theoretical framework and a self-assessment instrument consisting
of 35-statements. This EDM climate questionnaire (EDMCQ) was developed to capture three EDM domains in health care:
interdisciplinary collaboration and communication; leadership by physicians and ethical environment. This instrument was
subsequently validated among clinicians working in 68 adult ICUs in 13 European countries and the United States. Exploratory
and confirmatory factor analysis was used to determine the structure of the EDM climate as perceived by clinicians.
Results: Of 3610 nurses and 1137 physicians providing ICU bedside care, 2275 (63.1%) and 717 (62.9%) participated
respectively. Statistical analyses revealed that a shortened 32-item version of the EDMCQ-scale provides a factorial valid
measurement of seven facets of the extent to which clinicians perceive an EDM climate: self-reflective and empowering
leadership by physicians, practice and culture of open interdisciplinary reflection, culture of not avoiding end-of-life decisions,
culture of mutual respect within the interdisciplinary team, active involvement of nurses in end-of-life care and decisionmaking,
active decision-making by physicians, practice and culture of ethical awareness.
Conclusions: The 32-item version of the EDMCQ might enrich the ethical decision-making climate measurement, clinicians’
behaviour and the performance of health care organizations. This instrument offers opportunities to develop tailored ICU team
interventions.
Keynote Forum
Gavin Stead
University Hospital Lewisham, UK
Keynote: Improving patient outcomes through better perioperative nutrition
Biography:
Gavin Stead is a doctor working for the NHS in London. His clinical expertise lies in general and emergency medicine with an interest in intensive care. He has a Master’s
by Research in Medical and Molecular Bioscience and Lead his own technical research project in Molecular Nanotechnology. Within the NHS he has lead numerous audits
and quality improvement projects and has published research in both Orthopaedics and Infectious Gastroenterology. He has experience working abroad in a variety of
settings including very low resource settings and refugee camps. He intends to get further experience abroad before completing a PhD and training as an Intensive Care
Anaesthetist.
Abstract:
Background: Instructing patient to be kept nil by mouth (NBM) has long been part of perioperative practice, to reduce the
risk of aspiration during induction of anaesthesia. Recent evidence suggests that the standard 6 hours for solids and 2 hours
for liquids are likely longer than necessary and prolonged fasting may cause harm. Therefore any patients being kept NBM for
longer than this time may be subject to unnecessary harm.
Objectives: To use patient’s medical notes to determine the average NBM time for patients undergoing emergency surgery at
University Hospital Lewisham.
Standards: No patient should be kept nil by mouth for longer than 6 hours prior to induction of anaesthesia.
Methods: Retrospective data was collected from patients’ paper and electronic notes. NBM time and anaesthesia induction
time were recorded. Total NBM times were analyzed and displayed graphically compared to the standard NBM time of 6 hours.
Findings: The standard was generally poorly met, as most patients remained NBM for longer than necessary. The mean NBM
time was 696 minutes (11 hours 36 minutes), nearly double the recommended fasting time.
Recommendations: Senior staff member should review NBM times as part of management plan and post take ward round. A
surgical clerking pro forma should be developed with a section specifying NBM time. All clinical staff should be educated on
dangerous of prolonged as well as insufficient NBM times. Teams sharing CEPOD list should improve communication to avoid
unnecessary fasting. Currently there is limited meaningful communication between general surgery, gynaecology, trauma and
orthopaedic and emergency surgery teams.
Keynote Forum
Hui Yang
Sichuan University, China
Keynote: Self-care agency and associated factors in patients with systemic lupus erythematosus
Biography:
Hui Yang has completed her Undergraduate degree from Jilin University, China. Now she is a graduate student of Sichuan University majoring in Nursing.
Abstract:
Purpose: The aim of this study was to estimate the level of self-care agency and explore its associated factors in patients with
systemic lupus erythematosus (SLE).
Patients and methods: In this cross-sectional study, all patients were from a tertiary general hospital between July and October
2016 in Southwest China. The self-care agency was assessed by the Exercise of Self-care Agency Scale (ESCA). Other variables
were measured by the visual analog scale (VAS), Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), the
physical component summary (PCS) and mental component summary (MCS) of 36-item Short Form Health Survey(SF-36).
Multivariate regression analysis was performed to explore the associated factors of self-care agency.
Results: A total of 123 patients were recruited. The mean score of ESCA was 86.29. In univariate analysis, self-care agency
of patients differed in gender, work status, educational level, household income monthly per capita (HIMPC) and disease
activity (P<0.05). Additionally, higher body Mass Index (BMI), higher level of fatigue and worse mental health were found in
patients with lower self-care agency (P<0.05). The stepwise multivariate regression analysis showed that men (P = 0.001), lower
educational level (P=0.003), lower HIMPC (P<0.001) and worse mental health (P<0.001) could predict lower self-care agency.
Conclusion: Patients with SLE had a middle level of self-care agency, suggesting that there is still much scope for improvement.
The lower level of self-care agency was associated with men, lower educational level, lower HIMPC and worse mental health.
Therefore, healthcare providers should develop targeted and comprehensive interventions to enhance self-care agency in
patients with SLE.
Keynote Forum
Yujie Xu
Sichuan University, China
Keynote: Progress of intervention on postoperative enteral nutrition intolerance through jejunum
Biography:
Yujie Xu has completed her Undergraduate degree from Sichuan University, China. Now she is a graduate student of Sichuan University majoring in Nursing.
Abstract:
Malnutrition is an independent risk factor for increasing the risk of death after surgery, and is also a major negative factor
affecting the clinical prognosis. Because surgical lesions often involve the digestive tract, liver, pancreas and so on, which
affect the digestion and absorption of nutrients, and increase the metabolism caused by surgical invasion, tissue damage and
trauma stress, and malnutrition is common to see. Surveys in Europe, North America and China show that the incidence
of malnutrition in patients after surgery is as high as 30%-50%. Enteral nutrition is more suitable with the physiological
structure, safe and effective, and as well as accelerates the recovery after the operation. So it is the first choice for clinical
nutrition support. Enteral nutrition through jejunum is a widely applied nutritional support therapy. However, the proportion
of inpatient receiving enteral nutrition in domestic inpatients is only 43.7% among clinical nutrition treatment, and nutritional
intolerance is one of the most important restrictive factors. Various enteral intolerance can occur anytime during feeding
process, resulting in interruption of enteral nutrition and influence on rehabilitation process. Therefore, how to accurately
assess and diagnose nutritional intolerance and take the best treatment measures to ensure that energy needs become an urgent
clinical problem which needs to be solved. We conducted the literature review aim on feeding intolerance related concepts,
incidence, influencing factors and effective interventions in clinical practice in order to guide clinical standardized treatment
of intolerance of enteral nutrition and ensure energy supply.
Keynote Forum
Fauzia Shakeel
Johns Hopkins All Children’s Hospital, USA
Keynote: Decreasing inappropriate use of anti-reflux medications by standardizing gastroesophageal reflux disease (GERD) management in the NICU
Biography:
Fauzia Shakeel is a Neonatologist and Assistant Professor of Pediatrics. Johns Hopkins School of medicine and quality lead for maternal fetal neonatal institute at Johns
Hopkins all children’s Hospital in St. Petersburg, FL Her clinical interest and focus is on Nutritional care for neonates and improve clinical outcomes in NICU. She is
Chairman of nutrition sub-committee and also leads the short bowel and intestinal rehabilitation program at Johns Hopkins All Children’s Hospital. Her main passion is
quality improvement and she is Physician champion for several quality improvement initiatives at local and regional level and led many process improvement opportunities
within the NICU and throughout the hospital. She is the hospital faculty advisor for maintenance of certification (MOC) part 4 for American board of pediatrics (ABP)
certification. She has received the 2015 Faculty Teacher of the Year Award presented by the Office of Graduate Medical Education, Johns Hopkins Medicine All Children’s
Hospital; and the 2016 Clinical Excellence Armstrong Award for Excellence in patient quality & Safety from Johns Hopkins School Medicine.
Abstract:
in management of signs, symptoms, and complications associated with GERD in the NICU, with no evidence to support an
empiric trial of anti-reflux medications. Premature infants have weakly acidic reflux rather than acidic reflux, and inappropriate
use of acid suppressive medication has been linked to adverse clinical outcomes, like necrotizing enterocolitis and sepsis.
Standardization decreases variations in practice, and the risk for medication errors, while improving patient outcomes.
Methodology: Retrospective chart review of EMR data extracted electronically from the clinical surveillance tool TheraDoc,
provided baseline data regarding the use and dosage of anti-reflux medications. A multidisciplinary group of providers
developed evidence-based GERD management guidelines with an algorithm. The guidelines outlined definitions for GERD
symptoms, non-pharmacological measures for neonatal patients until they reach 37 weeks corrected gestational age (CGA)
and criteria for appropriate intervention and testing prior to initiation of anti-reflux medications. Our primary outcome was to
reduce inappropriate use of anti-reflux medications, related to timing of initiation of medication, dosing and GERD testing in
neonatal patients. Secondary outcomes were appropriate timing for GERD testing with PH probe and 24-hour multi-channel
impedance test and use of recommended formula change or other feeding strategies as needed. All three classes and doses
of GERD medications including H2 receptor antagonist, proton pump inhibitors (PPI) and prokinetics were monitored for
all patients admitted to the NICU. Project process improvement measures included, development of GERD management
algorithm for preterm infants, GERD order sets and GERD education sheet for staff and parents. Electronic GERD order
sets with correct dosing for medication were developed for all providers and GERD education sheets for staff and parents
were provided. Multiple Plan-Do-Study-Act (PDSA) cycles allowed for effective implementation, with staff education on use
of algorithm at bedside and monthly multidisciplinary group meetings to address deviation from guidelines and removal of
barriers. Education and communication plan was developed for physicians, advanced practice providers and bedside nursing
Data shared monthly and drill down conducted if management deviated from algorithm and feedback provided to staff.
Results: Implementation of standardized GERD management guidelines in NICU decreased the overall use of GERD
medications in all neonates from 15% to 2.8% and in preterm newborns less than 37 weeks (CGA) from 19.3% to 0% (Figure
1). Individualized use of each class of anti-reflux medications including H2 receptor antagonists, proton pump inhibitors and
prokinetics decreased from 7.2%, 12%, and 2.7% to 0%, respectively, for all categories. . The PPI lansoprazole was identified as the
most frequently used GERD medication for patients under 37 weeks gestational age (GA) at the time GERD medications were
initiated .With revision of EMR medication dosing and introduction of GERD order sets, incorrect dosing of lansoprazole was
decreased from 55% to 0% .The standardized guidelines and algorithm promoted effective testing and eliminated unnecessary
use of anti-reflux medication. The overall rate of NEC and late-onset sepsis also showed significant decrease in trend from 6.4%
and 13.8% to 4.3% and 8.9% respectively.
Conclusion: Our project demonstrated that standardizing clinical management guidelines in NICU provided best practice
GERD management strategies for a complex patient population and significantly reduced inappropriate use of dangerous antireflux
medications. Evidence-based guidelines and electronic order sets promoted basic testing, while eliminating incorrect
dosing, leading to improved patient safety and outcomes. There was reduced in hospital length of stay from 89days to 42 days
to date with substantial impact on cost savings (85% reduction) from decreased use in PPI.