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Abstract
PURPOSE AND DESIGN Postdischarge adverse drug events are a national issue, and effective inpatient instruction may help. Therefore, this intervention study examined whether using errorless teaching/learning methods including pictorial medication cards (ETL + card) improved RN teaching and patient medication adherence among persons with cognitive challenges (PWCCs). METHODS Convenience samples of RNs and PWCCs from a 24-bed rehabilitation unit provided baseline data. RNs implemented ETL + card, and postintervention data were collected. Adapted and investigator-designed instruments had preliminary reliability/validity. FINDINGS Postintervention RNs demonstrated more teaching strategies (p = .003), and teaching satisfaction rose from 0% to 50%. Minutes per teaching interaction were unchanged (p > .05). Baseline patients filled a higher number (p = .02) but a lower percentage (67%) of their prescriptions than did postintervention patients (85%). Medication dose adherence scores were unchanged (p > .05). CONCLUSIONS ETL + card improved RN teaching and possibly patient adherence. Further study is warranted. CLINICAL RELEVANCE ETL + card may help PWCCs achieve safe medication self-management.
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Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Schackow L, Lape JE. Mild brain injury education: preparing the caregiver. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2019. [DOI: 10.12968/ijtr.2018.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aim The purpose of this pre-test, post-test study was to determine if caregivers of patients diagnosed with a mild brain injury feel better prepared for the caregiving role following a single, individualised education session in the acute care hospital setting. Methods A total of 17 patients and 21 caregivers were recruited. A pre-intervention survey was used to gather baseline perceptions on preparedness, worry, and brain injury knowledge. The intervention included a review of a mild brain injury educational booklet and a caregiver handout with the patient and caregiver during a 45–60-minute session. A post-intervention survey was used to assess caregivers' perceptions following the educational session. Findings The mean Likert survey responses of the caregivers indicated an improvement in the areas of worry, preparedness for caregiving, and understanding of brain injury post-intervention. Caregivers unanimously agreed that their understanding of brain injury and ability to manage the patients' symptoms was a direct result of the intervention. Conclusions The findings from this pilot study demonstrate the benefits of a single educational session with caregivers in the hospital setting. Exploring if the educational material was used by caregivers post-discharge is warranted to further support the results.
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Affiliation(s)
- LeAnn Schackow
- Occupational Therapist, Parkview Regional Medical Center, Fort Wayne, Indiana, US
| | - Jennifer E Lape
- Associate Professor of Occupational Therapy, Chatham University, Pittsburgh, Pennsylvania, US
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Brown AM, Twomey DM, Wong Shee A. Evaluating mild traumatic brain injury management at a regional emergency department. Inj Prev 2018; 24:390-394. [PMID: 29866717 DOI: 10.1136/injuryprev-2018-042865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/14/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Emergency departments (EDs) are usually the first point of contact, and often the only medical service available, for patients with mild traumatic brain injury (mTBI) in rural and regional areas. Clinical practice guidelines (CPGs) have been created to ensure best practice management of mTBI in EDs. Adherence to mTBI CPGs has rarely been evaluated in rural and regional areas. AIM The aim of this paper was to assess a regional health service's adherence to their mTBI CPG. METHODS This was a 12-month retrospective audit of 1280 ED records of patients ≥16 years presenting with mTBI to a regional Australian ED. Case selection used the Victorian Admitted Episodes Dataset codes for suspected head injury: principal diagnosis codes (S00-T98), concussive injury recorded in diagnosis codes (S06.00-S06.05) and unintentional external cause code (V00-X59). The data were collected to determine 4-hour observation rates, CT scan rates, safe discharge and appropriate referral documentation. RESULTS Fewer people received a CT scan than qualified (n=245, 65.3%), only 45% had 4-hour observations recorded, safe discharge was documented in 74.1% of cases and 33% received educational resources. DISCUSSION/CONCLUSION Several key elements for the management of mTBI were under-recorded, particularly 4-hour observations, safe discharge and education. Acquired brain injury clinic referrals were received in overwhelmingly fewer cases than had a CT scan (n=19, 6.3%). Overall, this study suggests that the regional health service does not currently fully adhere to the CPG and that the referral services are potentially underutilised.
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Affiliation(s)
- Ashlee Maree Brown
- School of Health Sciences and Psychology, Federation University Australia, Ballarat, Victoria, Australia
| | - Dara M Twomey
- School of Health Sciences and Psychology, Federation University Australia, Ballarat, Victoria, Australia
| | - Anna Wong Shee
- School of Medicine, Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
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Carlos Patiag M, Farrar Highfield ME. RN Evaluation of Errorless Methods in Teaching Discharge Medications to Cognitively Challenged Patients. Rehabil Nurs 2017; 42:312-318. [DOI: 10.1002/rnj.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Stern RA, Seichepine D, Tschoe C, Fritts NG, Alosco ML, Berkowitz O, Burke P, Howland J, Olshaker J, Cantu RC, Baugh CM, Holsapple JW. Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments. J Neurotrauma 2016; 34:861-868. [PMID: 27112592 DOI: 10.1089/neu.2016.4475] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.
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Affiliation(s)
- Robert A Stern
- 1 Boston University Alzheimer's Disease and CTE Center; Departments of Neurology, Neurosurgery, and Anatomy and Neurobiology, Boston University School of Medicine , Boston, Massachusetts
| | - Daniel Seichepine
- 2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts
| | - Christine Tschoe
- 3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| | - Nathan G Fritts
- 2 Boston University Alzheimer's Disease and CTE Center , Boston, Massachusetts
| | - Michael L Alosco
- 4 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine , Boston, Massachusetts
| | - Oren Berkowitz
- 5 Departments of Neurosurgery and Medicine, Boston University School of Medicine , Boston, Massachusetts
| | - Peter Burke
- 6 Section of Acute Care & Trauma Surgery, Division of General Surgery, Department of Surgery, Boston Medical Center, Boston University School of Medicine , Boston, Massachusetts
| | - Jonathan Howland
- 7 Injury Prevention Center, Boston Medical Center; Department of Emergency Medicine, Boston University School of Medicine , Boston, Massachusetts
| | - Jonathan Olshaker
- 8 Department of Emergency Medicine, Boston University School of Medicine; Department of Emergency Medicine , Boston Medical Center, Boston, Massachusetts
| | - Robert C Cantu
- 9 Boston University Alzheimer's Disease and CTE Center, Departments of Neurology and Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
| | - Christine M Baugh
- 10 Boston University Alzheimer's Disease and CTE Center, Department of Neurology, Boston University School of Medicine, Boston, Massachusetts; Interfaculty Initiative in Health Policy, Harvard University , Cambridge, Massachusetts
| | - James W Holsapple
- 3 Department of Neurosurgery, Boston University School of Medicine , Boston, Massachusetts
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Stephens JA, Williamson KNC, Berryhill ME. Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2015; 35:5-22. [PMID: 26623474 DOI: 10.1177/1539449214561765] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.
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Bosch M, McKenzie JE, Mortimer D, Tavender EJ, Francis JJ, Brennan SE, Knott JC, Ponsford JL, Pearce A, O'Connor DA, Grimshaw JM, Rosenfeld JV, Gruen RL, Green SE. Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial. Trials 2014; 15:281. [PMID: 25012235 PMCID: PMC4107995 DOI: 10.1186/1745-6215-15-281] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/30/2014] [Indexed: 12/02/2022] Open
Abstract
Background Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612001286831 (date registered 12 December 2012).
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Affiliation(s)
- Marije Bosch
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
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