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A recent incident involving a nurse provided valuable lessons about medication administration practices and patient safety. Informatics nurses can leverage technology to increase the safety of patients. Leaders must pre-emptively monitor compliance reports on practices that could jeopardize patient safety. Keywords: safety, technology, informatics, medication, communication, 'Nursing informatics is the specialty that transforms data into needed information and leverages technologies to improve health and healthcare equity, safety, quality, and outcomes' (American Nurses Association [ANA], 2022, p. [...]

Objective. To identify the challenges that reductions in length of stay (LOS) pose for skilled nursing facilities (SNFs) and their postacute care (PAC) patients.Data Sources/Setting. Seventy interviews with staff in 25 SNFs in eight U.S. cities, LOS data for patients in those SNFs.Study Design. Data were qualitatively analyzed, and key themes were identified. Interview data from SNFs with and without reductions in median risk-adjusted LOS were compared and contrasted.Data Collection/Extraction Methods. We conducted 70 semistructured interviews. LOS data were derived from minimum dataset (MDS) admission records available for all patients in all U.S. SNFs from 2012 to 2014.Principal Findings. Challenges reported regardless of reductions in LOS included frequent and more complicated re authorization processes, patients becoming responsible for costs, and discharging patients whom staff felt were unsafe at home. Challenges related to reduced LOS included SNFs being pressured to discharge patients within certain time limits. Some SNFs reported instituting programs and processes for following up with patients after discharge. These programs helped alleviate concerns about patients, but they resulted in nonreimbursable costs for facilities.Conclusions. The push for shorter LOS has resulted in unexpected challenges and costs for SNFs and possible unintended consequences for PAC patients.Key Words. Nursing facilities, postacute care, length of stay, Length of stay (LOS) among postacute care patients in skilled nursing facilities (SNFs) has been steadily decreasing for the past several years. Empirical studies on overall SNF LOS are scant [...]

Objective. To characterize the nature and degree of hospitals' efforts to collaborate with skilled nursing facilities (SNFs) and associated patient outcomes.Data Sources/Study Setting. Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 SNFs in eight markets across the United States in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015.Study Design/Data Collection. Semi-structured interviews with hospital and SNF staff were coded and used to classify hospitals' collaboration efforts with SNFs into high versus low collaboration hospitals, and risk-adjusted, claims-based hospital readmission rates from SNF were compared.Principal Findings. Hospital collaboration efforts were defined as establishing SNF partners, transition management initiatives, and hospital staff visits to SNFs. High collaboration hospitals were more likely to send patients to SNFs (as opposed to home, home with home health, or other PAC settings), sent a higher share of patients to high quality SNFs, and had fewer hospital readmissions from SNF sooner than did low collaboration hospitals.Conclusions. Although collaboration with SNF requires significant administrative and clinical time investment, it is associated with positive patient outcomes.Key Words. Postacute care, hospital readmission, integration, interorganizational linkage, Each year nearly four million Medicare beneficiaries are discharged from hospitals to skilled nursing facilities (SNFs) for postacute care (PAC). About 20 percent of these patients are readmitted to a [...]

The American Nurses Association's (ANA) Nursing Informatics: Scope and Standards of Practice, 2nd Edition (2015) describes informatics nurses as using creative uses of technology to improve the delivery of patient [...]

'He who fails to plan is planning to fail.' --Winston Churchill The American Nurses Association's (ANA) Nursing Informatics: Scope and Standards of Practice, 2nd Edition (2015a) describes informatics nurses as [...]

'Regardless of our title or years of experience, we can learn from each other. Through mentoring and by being open to learn we can reach our ultimate potential.'--Lily Benjamin Mentoring [...]

'When you do nothing you feel overwhelmed and powerless. But when you get involved you feel the sense of hope and accomplishment that comes from knowing you are working to [...]

By failing to prepare, you are preparing to fail. -Benjamin Franklin Planning is a critical component of the nursing process, according to the American Nurses Association (ANA) (n.d.). System downtimes [...]

Collaboration is inherent to nursing practice. It includes working with patients, families, the community, and other professional disciplines. The informatics nurse may also collaborate with informatics professionals in their organization [...]

Objective. To examine nurse practitioner (NP) and physician assistant (PA) practice in nursing homes (NHs) during 2000-2010. Data Sources. Data were derived from the Online Survey Certification and Reporting system and Medicare Part B claims (20 percent sample). Methods. NP/PA state average employment, visit per bed year (VPBY), and providers per NH were examined. State fixed-effect models examined the association between state regulations and NP/PA use. Principal Findings. NHs using any NPs/PAs increased from 20.4 to 35.0 percent during 2000-2010. Average NP/PA VPBY increased from 1.0/0.3 to 3.0/0.6 during 2000-2010. Average number of NPs/PAs per NH increased from 0.2/0.09 to 0.5/0.14 during 2000-2010. The impact of state scope-of-practice regulations was mixed. Conclusions. NP and PA scope-of-practice regulations impact their practice in NHs, not always as intended. Key Words. Medicare claims, Online Survey Certification and Reporting (OSCAR) system, scope-of-practice, physician visits in nursing homes, organization of medical staff, Nearly 1.4 million Americans live in nursing homes (NHs) (Kaiser Family Foundation 2014b), which serve postacute and rehabilitative patients and cognitively and physically impaired long-stay residents suffering from one or [...]

Objective. To examine outcomes associated with dual eligibility (Medicare and Medicaid) of patients who are admitted to skilled nursing facility (SNF) care and whether differences in outcomes are related to states' Medicaid long-term care policies. Data Sources/Collection. We used national Medicare enrollment data and claims, and the Minimum Data Set for 890,922 community-residing Medicare fee-for-service beneficiaries who were discharged to an SNF from a general hospital between July 2008 andjune 2009. Study Design. We estimated the effect of dual eligibility on the likelihood of 30-day rehospitalization, becoming a long-stay nursing home resident, and 180-day survival while controlling for clinical, demographic, socio-economic, residential neighborhood characteristics, and SNF-fixed effects. We estimated the differences in outcomes by dual eligibility status separately for each state and showed their relationship with state policies: the average Medicaid payment rate; presence of nursing home certificate-of-need (CON) laws; and Medicaid home and community-based services (FfCBS) spending. Principal Findings. Dual-eligible patients are equally likely to experience 30-day rehospitalization, 12 percentage points more likely to become long-stay residents, and 2 percentage points more likely to survive 180 days compared to Medicare-only patients. This longer survival can be attributed to longer nursing home length of stay. While higher HCBS spending reduces the length-of-stay gap without affecting the survival gap, presence of CON laws reduces both the length-of-stay and survival gaps. Conclusions. Dual eligibles utilize more SNF care and experience higher survival rates than comparable Medicare-only patients. Higher HCBS spending may reduce the longer SNF length of stay of dual eligibles without increasing mortality and may save money for both Medicare and Medicaid. Key Words. Health economics, long-term care, Medicaid, Utilization and cost of Medicare paid skilled nursing facility (SNF) care provided in a nursing home following an acute care hospitalization have been a major health policy concern. Per capita [...]

Nurses are vital players in healthcare delivery and have been participating in measures to improve the quality of patient care since Florence Nightingale used data to support hand washing. Providing safe patient care is a goal for nurses. Informatics nurses' must utilize their skills, including the collection and analysis of data, to participate in quality improvement teams. This article will introduce the role of the informatics nurse, as well as different methods used to improve the quality of care that we provide and various initiatives., According to the American Nurses Association (2015) Scope and Standards of Practice, the informatics nurse's role in quality improvement initiatives include focusing on the 'seamless integration of quality and performance [...]

Education is an important aspect of nursing. Nurses provide education to other disciplines and other nurses in addition to patients, families, and communities. Education is included in sections of professional [...]