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Jeongok Park,1 Sang Bin You,2 Hyejin Kim,3 Cheolmin Park,4 Gi Wook Ryu,5 Seongae Kwon,2 Youngkyung Kim,6 Sejeong Lee,6 Kayoung Lee7 1Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, South Korea; 2Yonsei University College of Nursing, Seoul, South Korea; 3Severance Hospital, Yonsei University Health System, Seoul, South Korea; 4Department of Materials Science and Engineering, Yonsei University, Seoul, South Korea; 5Department of Nursing, Hansei University, Gunpo-si, South Korea; 6College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, South Korea; 7Gachon University College of Nursing, Incheon, South KoreaCorrespondence: Kayoung Lee, Gachon University College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, South Korea, Tel +82-32-820-4227, Email kayolee@gachon.ac.krPurpose: Medication administration is a complex process and constitutes a substantial component of nursing practice that is closely linked to patient safety. Although intravenous fluid administration is one of the most frequently performed nursing tasks, nurses’ experiences with intravenous rate control have not been adequately studied. This study aimed to explore nurses’ experiences with infusion nursing practice to identify insights that could be used in interventions to promote safe medication administration.Patients and methods: This qualitative descriptive study used focus group interviews of 20 registered nurses who frequently administered medications in tertiary hospitals in South Korea. Data were collected through five semi-structured focus group interviews, with four nurses participating in each interview. We conducted inductive and deductive content analysis based on the 11 key topics of patient safety identified by the World Health Organization. Reporting followed the consolidated criteria for reporting qualitative research (COREQ) checklist.Results: Participants administered infusions in emergency rooms, general wards, and intensive care units, including patients ranging from children to older adults. Two central themes were revealed: human factors and systems. Human factors consisted of two sub-themes including individuals and team players, while systems encompassed three sub-themes including institutional policy, culture, and equipment.Conclusion: This study found that nurses experienced high levels of stress when administering infusions in the correct dose and rate for patient safety. Administering and monitoring infusions were complicated because nursing processes interplay with human and system factors. Future research is needed to develop nursing interventions that include human and system factors to promote patient safety by reducing infusion-related errors.Keywords: intravenous infusions, medication errors, medication systems, nurses, patient safety

Background: Organizational readiness for change, defined as the collective preparedness of organization members to enact changes, remains understudied in implementing sepsis survivor transition-in-care protocols. Effective implementation relies on collaboration between hospital and post-acute care informants, including those who are leaders and staff. Therefore, our cross-sectional study compared organizational readiness for change among hospital and post-acute care informants., Methods: We invited informants from 16 hospitals and five affiliated HHC agencies involved in implementing a sepsis survivor transition-in-care protocol to complete a pre-implementation survey, where organizational readiness for change was measured via the Organizational Readiness to Implement Change (ORIC) scale (range 12-60). We also collected their demographic and job area information. Mann-Whitney U -tests and linear regressions, adjusting for leadership status, were used to compare organizational readiness of change between hospital and post-acute care informants., Results: Eighty-four informants, 51 from hospitals and 33 from post-acute care, completed the survey. Hospital and post-acute care informants had a median ORIC score of 52 and 57 respectively. Post-acute care informants had a mean 4.39-unit higher ORIC score compared to hospital informants ( p  = 0.03)., Conclusions: Post-acute care informants had higher organizational readiness of change than hospital informants, potentially attributed to differences in health policies, expertise, organizational structure, and priorities. These findings and potential inferences may inform sepsis survivor transition-in-care protocol implementation. Future research should confirm, expand, and examine underlying factors related to these findings with a larger and more diverse sample. Additional studies may assess the predictive validity of ORIC towards implementation success., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Sang, Quinn, Stawnychy, Song, Hirschman, You, Pitcher, Hodgson, Garren, O'Connor, Oh and Bowles.)

Evaluating readiness for discharge from the intensive care unit (ICU) is a critical aspect of patient care. Whereas evidence-based criteria for ICU admission have been established, practical criteria for discharge from the ICU are lacking. Often discharge guidelines simply state that a patient no longer meets ICU admission criteria. Such discharge criteria can be interpreted differently by different healthcare providers, leaving a clinical void where misunderstandings of patients' readiness can conflict with perceptions of what readiness means for patients, families, and healthcare providers. In considering ICU discharge readiness, the use and application of ethical principles may be helpful in mitigating such conflicts and achieving desired patient outcomes. Ethical principles propose different ways of understanding what readiness might mean and how clinicians might weigh these principles in their decision-making process. This article examines the concept of discharge readiness through the lens of the most widely cited ethical principles (autonomy [respect for persons], nonmaleficence/beneficence, and justice) and provides a discussion of their application in the critical care environment. Ongoing bioethics discourse and empirical research are needed to identify factors that help determine discharge readiness within critical care environments that will ultimately promote safe and effective ICU discharges for patients and their families., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To review, evaluate, and synthesize existing literature on how health status changes were measured using the Outcome and Assessment Information Set (OASIS)., Design: Systematic review., Setting and Participants: Studies were included if they examined the health status of adult patients at 2 or more time points using OASIS, which is a comprehensive assessment tool mandated for home health (HH) patients., Methods: A systematic search was conducted in PubMed, CINAHL, Embase, and Scopus. The methodological quality of the included studies was appraised using the National Institutes of Health quality assessment tool., Results: The initial search yielded 1587 citations, resulting in 27 eligible studies published between 2005 and 2022. All included studies were retrospective cohort studies, with overall quality ranging from good to fair. These studies primarily targeted patients with heart failure, with sample sizes between 40 and 6,637,497 and mean ages of 61.2 to 82.4 years. OASIS version C was the most used version, comparing health status at admission and discharge. Patient health status outcomes encompassed functional (n = 24), physiological (n = 6), emotional/behavioral (n = 4), and cognitive (n = 2) outcomes. Various techniques were employed for scale standardization, compositing individual scores, measuring changes, and reporting outcomes. The predominant methods for assessing change included the corrected Likert scale for standardization, composite change scores for change calculation, and continuous outcomes for reporting., Conclusion and Implications: Researchers have used OASIS to assess patient health status changes in functional, physiological, emotional/behavioral, and cognitive outcomes during the HH episode. Variations in OASIS items and assessment methods across studies have been observed. Our findings underscore the need to standardize item application in research, enabling researchers to synthesize evidence effectively and enhance understanding of patient recovery and HH services. For policymakers and health care providers, these insights could inform resource allocation, care planning, and tailored interventions, ultimately improving health care quality and efficiency., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2024 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

In a previous study, sepsis was noted as a diagnosis on the home health record only 4% of the time for 165,000 sepsis survivors transitioning from hospital to home health care in America. If sepsis and other conditions are not clearly documented in the transitional care record this can lead to unpreparedness, missed, care, and poor patient outcomes. Our implementation science study discovered a source of this problem regarding the sepsis documentation in 16 hospitals referring to five home care agencies. Together, researchers, hospital, and home care personnel developed and implemented two information technology solutions to address this deficit in seven hospitals. The automated method was more readily adopted and effective in improving information transfer between hospital and home health care.

The use of healthcare information technology (HIT) is vital for storing and exchanging health information during patient transitions, playing a significant role in care coordination for sepsis survivors. The critical role of HIT was evident during the pre-implementation phase of a study to implement an evidence-based protocol supporting the timely transition of sepsis survivors to home health and outpatient care. Through 61 semi-structured interviews involving 91 stakeholders, over half of the 33 identified themes were related to HIT. Notably, electronic health record (EHR) alert systems led to over-capture and alarm fatigue. Efficient information transfer during HHC referral highlighted the need for improved EHR access. The study underscores HIT's importance and potential while emphasizing the need for collaborative policy and interface development to promote effective transitions in care.

Objectives: This review aimed to assess characteristics of telehealth in pain management for adult patients with chronic pain and their family care partners and review current evidence of the effectiveness of telehealth for pain management. Based on the Revised Symptom Management model, this review identified types of chronic pain management strategies and symptom management outcomes delivered by telehealth. Methods: We conducted a systematic review of four electronic databases, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Embase, using combinations of keywords, including "telehealth," "caregivers," and "pain." Only interventions delivered online, including websites, mobile applications, phone calls, and videoconferencing, were included. To accurately characterize the features of each telehealth pain intervention, we employed a standardized checklist. Additionally, a summary table of the evidence was created. Results: We analyzed 17 studies that met the inclusion criteria, of which 14 were randomized controlled trials, 1 was a cohort study, and 2 were qualitative cohort studies. We grouped interventions based on content of the intervention for pain management (education, psychotherapy, reporting and consultation, and multicomponent intervention). The quality rating of studies was mostly moderately strong. Findings of interventions' effectiveness were showing heterogenous effects on variables, possibly due to different pain measurements and varying follow-up times. Significance of Results: Telehealth interventions can potentially increase access to care for patients with chronic pain and their families in a limited resource area. Telehealth technology is a feasible tool that may enhance clinicians' pain management efforts for patients with chronic pain and their family care partners. The results of this review can be used to guide telehealth pain assessment and evaluation for care partners, clinicians, and researchers and inform the design of future telehealth systems.

Study Aim: This study aims to describe the transition-in-care work process for sepsis survivors going from hospitals to home health care (HHC) and identify facilitators and barriers to enable practice change and safe care transitions using a human factors and systems engineering approach., Background: Despite high readmission risk for sepsis survivors, the transition-in-care work process from hospitals to HHC has not been described., Methods: We analyzed semi-structured needs assessment interviews with 24 stakeholders involved in transitioning sepsis survivors from two hospitals and one affiliated HHC agency participating in the parent implementation science study, I-TRANSFER. The qualitative data analysis was guided by the Systems Engineering Initiative for Patient Safety (SEIPS) framework to describe the work process and identify work system elements., Results: We identified 31 tasks characterized as decision making, patient education, communication, information, documentation, and scheduling tasks. Technological and organizational facilitators lacked in HHC compared to the hospitals. Person and organization elements in HHC had the most barriers but few facilitators. Additionally, we identified specific task barriers that could hinder sepsis information transfer from hospitals to HHC., Conclusion: This study explored the complex transition-in-care work processes for sepsis survivors going from hospitals to HHC. We identified barriers, facilitators, and critical areas for improvement to enable implementation and ensure safe care transitions. A key finding was the sepsis information transfer deficit, highlighting a critical issue for future study., Application: We recommend using the SEIPS framework to explore complex healthcare work processes before the implementation of evidence-based interventions.

Background: Intravenous (IV) medication is commonly administered and closely associated with patient safety. Although nurses dedicate considerable time and effort to rate the control of IV medications, many medication errors have been linked to the wrong rate of IV medication. Further, there is a lack of comprehensive studies examining the literature on rate control of IV medications. This study aimed to identify the attributes of errors, facilitators, and barriers related to rate control of IV medications by summarizing and synthesizing the existing literature., Methods: This scoping review was conducted using the framework proposed by Arksey and O'Malley and PRISMA-ScR. Overall, four databases-PubMed, Web of Science, EMBASE, and CINAHL-were employed to search for studies published in English before January 2023. We also manually searched reference lists, related journals, and Google Scholar., Results: A total of 1211 studies were retrieved from the database searches and 23 studies were identified from manual searches, after which 22 studies were selected for the analysis. Among the nine project or experiment studies, two interventions were effective in decreasing errors related to rate control of IV medications. One of them was prospective, continuous incident reporting followed by prevention strategies, and the other encompassed six interventions to mitigate interruptions in medication verification and administration. Facilitators and barriers related to rate control of IV medications were classified as human, design, and system-related contributing factors. The sub-categories of human factors were classified as knowledge deficit, performance deficit, and incorrect dosage or infusion rate. The sub-category of design factor was device. The system-related contributing factors were classified as frequent interruptions and distractions, training, assignment or placement of healthcare providers (HCPs) or inexperienced personnel, policies and procedures, and communication systems between HCPs., Conclusions: Further research is needed to develop effective interventions to improve IV rate control. Considering the rapid growth of technology in medical settings, interventions and policy changes regarding education and the work environment are necessary. Additionally, each key group such as HCPs, healthcare administrators, and engineers specializing in IV medication infusion devices should perform its role and cooperate for appropriate IV rate control within a structured system., (© 2023. The Author(s).)

Background: The purpose of this study was to confirm whether fully-immersive virtual reality instrumental activities of daily living training is safe and feasible for people with mild dementia., Methods: The virtual reality program contents include simulation of instrumental activities of daily living training. Feasibility was assessed by means of responses to a self-report satisfaction questionnaire and the Simulator Sickness Questionnaire; and by analyzing the level of participants' immersion. Researchers assessed the instrumental activities of daily living scores, cognitive functioning, and mood changes pre- and post-intervention., Results: A total of seven participants with mild dementia were recruited. The mean immersion score was 50.42±7.89 points, and the mean adherence was 83.71±6.10 points. Overall, the participants found the activities satisfying. Six participants experienced negligible side effects and one exhibited moderate side effects. After the training, the instrumental activities of daily living scores improved significantly (P=0.042). Performance on the Word List Delayed Recall test and Trail Making Test B showed improvements in all participants., Conclusions: Fully-immersive, virtual reality-based, instrumental activities of daily living training is feasible for people with mild dementia and provides them with a high level of satisfaction and immersion. This program can help improve their capacities to carry out activities of daily living, their cognitive functioning, and mood. However, further research is needed for fully-immersive virtual reality instrumental activities of daily living training before it can be considered as a treatment option in people with mild dementia.

An intelligent control system has been designed using the single chip and the related circuit, and with the assemble language. It is connected with the common X-ray units to control the exposure dose. The result shows that three parameters for radiography are well controlled by the intelligent control system, and auto-radiography is realized.