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LR10 / Clinical Risk Management (CRM) Practice on Nursing-led Inpatient Units (NLUs)

United Kingdom

Type of Patient Safety Practice
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Communication and documentation
Patient safety theme the SCP/clinical risk management practice is aimed at
Nursing-led inpatient units (NLUs)
Objective of the CRM practice
A systematic review assesing the effectiveness of post-acute care in NLUs for preparing patients for discharge from hospital.
Short description of the CRM practice, including any references for further information
Nusing-led unit (NLU) is an institutional setting (i.e. not patient's home) where nurses assume the care managemet function (including admission and discharge decisions) and team leadership that is usually vested in doctors for the majority of patients[3].
Innovator of the SCP, country of origin
Involved health care staff
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
UK/ nursing homes and community hospitals[4].
US/ sub-acute and transitional/progressive care services [5,6].
Summary of evidence for effectiveness, including references
In an environment where the needs of acute and non-acute patients do not compete, transfer to a NLU improves outcomes through the higher priority given to therapeutic ( as opposed to purely compensatory), rehabilitative nursing care for post-acute patients [1]. No significant difference was observed in mortality as an inpatient between NLU and usual inpatient care, thesame was obseverd in follow-up 3 or 6 months post admission[2].
However, length of stay to discharge from hospital significantly increased for patients cared for in NLUs with a weighted mean difference (WMD) of 7.37 days.
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
There is no specified text here
Summary of available information on feasibility, including references
Evidence from the UK suggests that NLU increased total resources used in the inpatient setting and altered the composition of the healthcare team and the way in which resources were used[2], pg 115.
Existing implementation tools, including references
National Service Framework for Older People[4].'
Potential for/description of patient involvement in the CRM practice, including references
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] Griffiths P, Wilson-Barnett J, Richardson G, Spilsbury K, Miller F, Harris R (2000) The effectiveness of intermediate care in a nursing-led in-patient unit. Int J Nurs Stud 37:153-161

[2] Griffiths P, Edwards M, Forbes A, Harris R (2005) Post-acute intermediate care in nursing-led units: a systematic review of effectiveness. Int J Nurs Stud 42:107-116

[3] Griffiths P, Wilson-Barnett J (1998) The effectiveness of 'nursing beds': a review of the literature. J Adv Nurs 27:1184-1192

[4] Department of Health. National Service Framework for Older People. -194. 2001. London, Department of Health.

[5] von ST, Hepburn K, Cibuzar P, Convery L, Dokken B, Haefemeyer J, Rettke S, Ripley J, Vosenau V, Rothe P, Schurle D, Won-Savage R (1997) Post-hospital sub-acute care: an example of a managed care model. J Am Geriatr Soc 45:87-91

[6] Griffiths P (1997) In search of therapeutic nursing: subacute care. Nurs Times 93:54-55

Any additional information on the CRM (e.g. implementation barriers and drivers)
The NLU is supported by weak evidence, more well-conducted trials are required to fully determine safety in the NLU compared to usual care[3].
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