Purpose: This pilot study aims to determine the accuracy of inpatient continuous glucose monitoring (CGM) use in critically ill patients with Diabetes in an acute care hospital.
Background: CGM use in the critical care settings remains limited. Evidence shows there are adverse outcomes for hospitalized patients with poorly controlled diabetes, such as increased risk of infection, 90-day mortality, and other complications. CGM is an alternative to point-of-care testing (POCT) with finger sticks. Finger sticks are painful for the patient and expose nurses to blood-borne pathogens and other infectious diseases. Studies demonstrate a 33% reduction in POCT when CGM technology was used to guide monitoring, reduction of hypoglycemic events with predictive alerts, and improved patient outcomes.
Methods: Dexcom sensors were placed on critically ill patients with type 1 or type 2 diabetes receiving continuous or intermittent insulin therapy between April 2023 and April 2024. POCT glucose values were used as the point of accuracy reference. CGM and POC values were matched to the closest timed CGM value and analyzed for accuracy using the mean absolute relative difference (MARD) and Clarke error grid zone analysis. Studies have found a below 15% is generally considered clinically accurate for critical care.
Results: The study included 20 patients. Paired CGM-POC readings were aggregated (n=455), MARD was 14.7%. Accuracy for POC-CGM was 98% in Clarke error grid zones A/B. We concluded that the real time monitoring of critically ill patients with a CGM has acceptable accuracy in the critical care environment. The MARD we found in our study was within the acceptable range for accuracy.
Implications for clinical practice: Hybrid use with POCT is still recommended. CGM technology has the potential to assist in monitoring patients at risk for hypoglycemic or hyperglycemic events through predictive alerts. Automatic integration into electronic medical records and financial cost analysis would be beneficial towards a more comprehensive argument for adoption in the inpatient setting.

Purpose: Escalating healthcare costs and inefficiencies in disease management programs have prompted employers to seek innovative solutions that improve quality outcomes while controlling expenses. Traditional disease management approaches lack sufficient evidence of cost reduction and often introduce additional complexity without measurable benefits. A clinical prevention information service was developed to address these gaps by empowering individuals and families to take ownership of their health decisions through evidence-based, personalized consultation.
Description: A clinical prevention information service offers a client-driven, relationship-based model emphasizing health promotion and disease prevention rather than episodic illness management. Services are delivered by highly qualified clinicians, including nurses, pharmacists, diabetic educators, a medical research librarian, and dietitians, who provide unbiased information and decision support. The approach focuses on four pillars: 1) client-driven implementation, 2) personal service built on ongoing relationships, 3) emphasis on health as human capital, and 4) expert consultation. This equips individuals with tools to manage health records, reduce redundant testing, and navigate complex care systems, fostering informed decision-making and continuity of care.
Evaluation/outcome: Evidence from a 2023 pre-/post-enrollment study of 6,589 participants in a clinical prevention information service across 35 companies demonstrated significant improvements in utilization and cost metrics. Key outcomes included a 64% reduction in lost-time costs, 46% decrease in health plan expenses, and overall cost reduction of 47%. Additional improvements were observed in diagnostic efficiency, with tests down 39%, provider visits down 36%, and diagnoses reduced by 28%. These results indicate that participation in a clinical prevention information service not only enhances quality outcomes through improved care coordination and patient engagement but also delivers a return on investment ranging from 2:1 to 5:1. Predictive risk scoring further strengthens the model by enabling early intervention for high-risk individuals, reducing the duration and severity of high-cost events.

Purpose: Although research has explored the occupational hazards experienced by nurses working overnight, the unique challenges faced by nocturnal nurse leaders during off-hours remain understudied. This study specifically addresses the distinct difficulties encountered by nurse leaders on the night shift and synthesizes evidence-based recommendations on how organizational leaders can support them.
Description: Healthcare organizations rely on nurse leaders to maintain clinical and administrative oversight during night shifts, often under conditions of reduced support and heightened operational strain. The foundational importance of a healthy work environment (HWE)—anchored in standards like authentic leadership, true collaboration, skilled communication, effective decision-making, appropriate staffing and meaningful recognition cannot be understated. Yet the nightshift application of these principles remains inconsistent. A review of the literature reveals a systemic failure to adapt organizational norms to nocturnal work, imposing daytime expectations that exacerbate health and performance risks.
Nocturnal leadership is associated with disrupted circadian rhythms, chronic sleep debt, increased risks of cancer, cardiovascular disease, and cognitive impairment. 12-hour shifts are linked to fatigue and burnout and psychosocially, nocturnal leaders also face isolation and diminished social support. To mitigate these risks, appropriate staffing is necessary to ensure nocturnal nurse leaders can maintain 10-hour recovery periods between shifts. Also, scheduled naps in a designated quit space must be supported by organizational leadership.
Evaluation: Authentic leadership is vital for reducing burnout. Recognition of nocturnal leadership must be meaningful, with acknowledgement and equitable celebration practices. Nocturnal leaders, i.e., nursing supervisors, operate with high autonomy during resource-scarce hours. Organizations must provide clear escalation protocols and training to build confidence in crisis management skills and decision-making ability. Undermining the decisions of nocturnal leaders should be discouraged. To combat isolation, vertical collaboration through shared governance and opportunities for career growth that do not require a change in work hours is crucial.
Finally, prioritizing health is essential. Organizations should offer education on chronobiology, access to exercise and mindfulness spaces onsite and fresh and healthy food options overnight, and equip computer workstations with blue light filters.
To enhance the well-being and effectiveness of nocturnal nurse leaders, healthcare organizations must implement targeted strategies across staffing, leadership, decision-making, communication, and wellness. Collectively, these measures will foster resilient and empowered nocturnal nurse leadership.

Background: Within the electronic health record (EHR) there are several tools that function based on previous documentation and patient demographics. These are known as clinical decision tools (CDTs). CDTs such as our practice advisories (OPAs) create recommendations for patient care for the nurse that is patient-specific and specific to this moment in the patient’s care. These tools help guide nursing plans of care to improve patient health outcomes.
Objective: The goal of this study was to increase nurse engagement with the emergency department (ED) sepsis OPAs within four weeks of providing focused training to nurses in the ED. Engagement for this study is defined as documenting in the OPA, whereas disengagement is defined as dismissing the OPA.
Method: A three-step approach was used in this study to obtain both qualitative and quantitative data with 50 ED nurses working at three free-standing EDs. First, a pre-education survey was used to obtain ED nurses’ comfort and understanding of the ED sepsis OPAs in the electronic health record (EHR). Second, focused education on the functionality and how to interact with the ED sepsis OPAs was provided to ED nursing staff as part of staff meetings. Third, a post-education survey was used to obtain ED nurses’ comfort and understanding of the ED sepsis OPAs in the EHR.
Results: Pre- and post-education survey data was collected and analyzed using Microsoft Forms and Microsoft Excel. ED nurses expressed a 100% increase in comfort level with the ED sepsis OPAs. ED nurses expressed a 240% increase in understanding of the ED sepsis OPAs. OPA engagement data was validated and pulled directly from the EHR prior to education and each week post education. Engagement with the tool increased by 63% over five weeks across three free-standing EDs.
Conclusions: Engagement and ED nursing workflows have seen improvement with the focused education on the ED sepsis OPAs, as the alerts are firing less often now that nurses understand their responsibility when it does fire. This study provides immense value to the practice of nursing, as it has reduced alert fatigue and increased knowledge in using tools within the EHR efficiently and effectively and has the potential to improve patient outcomes. Nurses are resourceful, but additional focused education on the proper use of the tools within the EHR is an ongoing need.

It is important that as we implement new technologies within our healthcare organizations we remain in tune with our clinicians and their workflows. The formation of the nursing professional governance (NPG) at our healthcare organization has allowed us to understand the ever-changing needs of our nursing staff and ensure that our documentation and integrated technologies align with their workflows. In 2024, our healthcare system identified the need to evolve its nursing governance model to align with evidence-based practices. The nursing professional governance (NPG) framework was established to promote nursing excellence through accountability, autonomy, and authority in decision-making. NPG empowers nurses to take professional ownership of their practice, demonstrating their value in healthcare delivery.
Our clinical informatics council (CIC) plays a crucial role in streamlining nursing documentation by decreasing documentation burden, increasing efficiencies, and reducing redundancies. However, with the introduction of NPG, decision-making authority became a new and necessary mindset. The CIC, comprised of analysts, informaticists, and nurses, meets monthly to tackle the burden of documentation.
Each year, CIC members propose changes for consideration to the council who review the proposals. To support this process, Project RED (Reduce Epic Documentation) was launched to improve documentation efficiency. Guiding principles were established to inform decision-making and prioritize efforts. One key principle is to decline requests for adding documentation elements that primarily serve auditing purposes. In 2024, the CIC approved 42 improvements and rejected 5 requests. At Project RED's inception nurses unanimously voted to implement Alaris pump interoperability with Epic to automate input and output documentation. The council also decided to enable copy-forward functionality to reduce redundancy in the documentation. In addition, training on utilizing macros was provided. These initiatives have resulted in saving 13 million clicks in 2024, and ongoing efforts continue to expand the impact.
The value of a structured, system-wide nursing representation has become increasingly evident. CIC nurses are deeply committed to reducing documentation burden and carefully weighing the implications of proposed documentation changes. One example of this impact is the integration of the workload acuity (WLA) group into CIC. The WLA's purpose is to meet monthly to review the rules that comprise the workload acuity system. The WLA system is a scoring system within Epic that assigns an acuity score to each patient. Our organization utilizes this score as a way to help make nursing assignments. The workload acuity group routinely reviews the rules to ensure the rule's accuracy. Previously, the WLA task force had limited representation and participation, with decisions being made by a small group despite affecting over 1,500 nurses. Recognizing this gap, the determination was made to embed WLA decisions as a standing CIC agenda item, setting a goal to review 60 rules annually. While the transition required training and a steep learning curve for members, we have reviewed 56 rules since WLA integrated with CIC. With sustained momentum, the council is optimistic about meeting its annual goal.
Through the NPG CIC, nurses are empowered to drive changes that enhance efficiency, reduce burdens, and elevate nursing practice.

Background/significance of problem: Advancements in cancer treatment have increased the number of survivors with unique needs requiring effective long-term care. Knowledge about cancer survivorship and survivorship care needs is not widespread and reliable cancer survivorship care knowledge is not readily available. These two challenges impact the ability of patients to identify and address their long-term and self-care needs. The literature suggests integrating technology, specifically web-based tools, as a viable approach to address these challenges.
Clinical question/project purpose: In adult patients receiving chemotherapy for breast cancer, does implementing a web-based platform to deliver survivorship care information affect their survivorship care knowledge and perceived quality of life? This project aimed to evaluate the effectiveness of implementing a web-based information portal to improve survivorship care knowledge of patients receiving chemotherapy.
Search of literature/best evidence: The CINAHL, NCDB, EBSCOhost, Medline, Cochrane, Science Direct, and PubMed databases from to 2019-2024 were searched using the following key terms: cancer survivorship, survivorship care plan, technology in cancer survivorship, digital health technology, supportive care, post-cancer treatment, technology and survivorship care education, and survivorship education. The literature review yielded 20 peer-reviewed articles encompassing various research methodologies, including scoping reviews, randomized controlled trials, meta-analyses, systematic reviews, consensus studies, descriptive studies, cohort studies, and cross-sectional studies.
Clinical appraisal of literature/best evidence: Examining the available evidence points to the following key findings: 1) digital health solutions have led to improvements in continuous monitoring, symptom control, and quality of life; 2) a structured information website can reduce unmet information needs; 3) the importance of technology-delivered survivorship care interventions and contribution to self-management, and 4) rural cancer survivors have the highest demand for information, potentially benefiting from community-based survivorship care and support.
Integration into practice: Currently, Aspirus Cancer Care – Wausau has a survivorship program only available to patients with breast cancer who have completed chemotherapy. Information is shared verbally with patients during their survivorship care visit, and they are given a printed packet of information. However, no similar program exists for other cancer types and no information or education related to survivorship care is shared. The information that these other patients received was only related to their prescribed treatment. For this project, survivorship care information will be an additional component of the patient’s education. Because the resources are web-based, the information is available at any time, can be accessed even after the patients’ clinic visit, and is easier to update for staff.
Evaluation of evidence-based practice: A comparative analysis of the pre- and post-intervention survey results on cancer survivorship care knowledge and perceived quality of life will be conducted. The mean differences in responses before and after the intervention will be compared using data from the EuroQol 5 dimension 5 level (EQ5D5L) questionnaire. Survey responses will be analyzed to determine whether access to web portal information influences participants’ understanding of survivorship care and whether there is a noticeable change in their self-reported quality of life.

Missed treatment delay documentation during stroke alerts negatively affects stroke quality metrics. By using the sociotechnical model for HIT by Sittig and Singh, delay-related data elements are standardized and embedded into the neurology stroke scales form, routinely completed by resident physicians during stroke alerts. Structured fields allow for greater efficiency in provider-required stroke documentation. Early results show improved documentation rates, improved performance in tracked stroke quality metrics, enhanced data integrity, and provide actionable insights for reducing treatment delays while facilitating a future transition from a data abstraction to a data extraction process.

Purpose and rationale: Pressure injuries are a significant health risk, often leading to prolonged lengths of stay, increased costs, and higher morbidity and mortality rates. A pressure injury risk assessment is one component of a comprehensive skin integrity program. The purpose of the quality improvement project was to determine whether the EVARUCI scale provided a higher level of predictive validity in identifying the risk of hospital-acquired pressure injuries in the intensive care unit (ICU) compared to the Braden scale following the Iowa model.
Synthesis of evidence: Pressure injury rates occur in the ICU at a higher rate due to the complexity of the location and acuity of the patients and hospital-acquired pressure injuries (HAPI) continue despite the widespread adoption of evidence-based preventive programs. An accurate risk assessment is critical to implementing timely patient-specific preventative measures. Pressure injuries have a substantial impact on the quality of life for patients, including pain and depression, leading to further clinical deterioration, prolonged hospitalization, increase in cost, and potential for mortality. Patients with at least one pressure injury have more than double the length of stay and a five-fold increase in the risk of mortality. The utilization of the Braden scale in the ICU is reported to have high sensitivity and low specificity, leading to an overestimation of pressure injury risk.
Practice change and implementation strategies: The EVARUCI scale was created as a paper-based form and the score was assessed and calculated daily at multidisciplinary rounds in collaboration with the primary nurse. Patient demographics and additional risk variables including the Braden score were collected using the electronic medical record.
Evaluation: In the EVARUCI score, the higher the score, the higher the risk, compared to the Braden score in which the lower the score, the higher the risk. 129 patients were included in the sample, and 17 (13%) obtained a HAPI. The mean EVARUCI score for HAPI patients was 16.5 and 11.3 for patients with no HAPI. The mean Braden score for HAPI patients was 12.1 and 15.3 for patients with no HAPI. The Braden scale predicted 17 (100%) of patients who obtained a HAPI in the at-risk category or higher but only 9 (53%) in the high-risk category and 1 (6%) in the very high-risk category. The EVARUCI scale predicted 17 (100%) patients who obtained a pressure injury in the high-risk category.
Conclusions and implications for practice: The Braden scale was shown to be a validated tool for assessing the risk of pressure injury, but it lacked specificity in the ICU-specific risk factors. The Braden scale over-identified patients at risk, increasing the resources utilized. The EVARUCI scale and the Braden scale demonstrated predictive validity in the critical care setting, but the EVARUCI scale provided greater specificity.
The EVARUCI scale was implemented in the Cerner EMR for ICU specific risk stratification.

Variability in continuous infusion titration documentation has been a persistent compliance concern within acute care settings. Misalignment between electronic health record (EHR) order configurations, nursing documentation practices, and updated organizational policies created inefficiencies, forced workarounds, and increased risk of noncompliance with accreditation standards. To address these gaps, a standardized titration block charting workflow was designed and implemented across multiple facilities to streamline documentation, align with regulatory expectations, and support clinician efficiency.

Purpose: As part of the core competencies for professional nursing education, all nurses have a responsibility to advocate for equitable access to information technology and to help patients optimally use technology to engage in care.
Description: There are many factors that need to be considered to promote digital inclusion. However, there is not a single tool that exists to ensure that a digital solution is equitable.
Evaluation/outcome: A framework for digital inclusivity created and an informatics inclusionary toolbox were created to help nursing students ask questions to determine if a proposed technology solution is inclusive. The toolbox was incorporated into the required undergraduate nursing informatics course.