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Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically.
To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation.
Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days.
At baseline, there were a mean (± standard deviation) of 0.32 ± 0.25 electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years.
Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.
Accumulating evidence suggests that social contexts in early life have important and
effects on childhood psychopathology. Spurred by the lack of an explicit operational definition
that could guide the study of such effects, we define a social context operationally as “a
set of interpersonal conditions, relevant to a particular behavior or disorder and external to, but
shaped and interpreted by, the individual child.” Building on this definition, we offer a
series of recommendations for future research, based on five theoretically derived propositions:
(a) Contexts are nested and multidimensional; (b) contexts broaden, differentiate, and deepen
with age, becoming more specific in their effects; (c) contexts and children are mutually
determining; (d) a context's meaning to the child determines its effects on the child and
arises from the context's ability to provide for fundamental needs; and (e) contexts should
be selected for assessment in light of specific questions or outcomes. As reflected in an
increasingly rich legacy of literature on child development and psychopathology, social contexts
appear to influence emerging mental disorders through dynamic, bidirectional interactions with
individual children. Future research will benefit from examining not only statistical interactions
between child- and context-specific factors, but also the actual transactions between
children and contexts and the transduction of contextual influences into pathways of
biological mediation. Because adverse contexts exert powerful effects on the mental health of
children, it is important for the field to generate new, more theoretically grounded research
addressing the contextual determinants of psychological well-being and disorder.
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