Karen K. Giuliano

University of Massachusetts Amherst | UMass Amherst · Institute of Applied Life Sciences & College of Nursing

Objective Patient safety organizations and researchers describe hospital-acquired pneumonia (HAP) as a largely preventable hospital-acquired infection that affects patient safety and quality of care. We provide evidence regarding the consequences of HAP among 2019 Medicare beneficiaries. Design Retrospective case–control study. Patients Calendar...

Purpose Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to d...

The objective of this study was to compare residual volume and time to prepare and reconstitute cefazolin using 3 different reconstitution devices while observing for use errors, participant feedback, and particulate after reconstitution. After demonstrations on the use of each device and practicing twice with each device, participants performed re...

Objective: This study was conducted to advance understanding of intravenous (IV) smart pump medication administration practices using the Baxter Spectrum IQ. The primary objective was to observe adherence with manufacturer required IV smart pump system setup at the point of care during actual clinical use. Methods: The study was conducted in a 2...

Purpose: What constitutes innovative and high-quality curricula for research-focused doctoral study is contested and must evolve with the ever-changing landscape of nursing and health care, science, and society as a whole (Hodgson, Madigan, Mishan & Montalvo, 2021). The purpose of this redesign process was to co-create and evaluate new programmatic...

In this 2019 cross-sectional study, we analyzed hospital records for Medicaid beneficiaries who acquired nonventilator hospital-acquired pneumonia. The results suggest that preventive dental treatment in the 12 months prior or periodontal therapy in the 6 months prior to a hospitalization is associated with a reduced risk of NVHAP.

Non-ventilator hospital-acquired pneumonia is associated with substantial morbidity, mortality and costs during an episode of acute care. We examined NVHAP incidence, mortality, and costs of Medicaid beneficiaries over a 5-year period (2015-2019). Overall NVHAP incidence was 2.63 per 1000 patient days, mortality was 7.76%, with excess cost per NVHA...

Aim: To understand the experience of critical care nurses when performing common, yet error-prone, programming tasks on two unfamiliar intravenous smart pumps. Design: A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods: Following completion of common intravenous programming tasks each parti...

Nonventilator hospital‐associated pneumonia has recently emerged as an important preventable hospital‐associated infection, and is a leading cause of healthcare‐associated infection. Substantial accumulated evidence links poor oral health with an increased risk of pneumonia, which can be caused by bacterial, viral, or fungal pathogens, each with th...

Secondary infusion by large-volume iv smart pump is used extensively in the acute care setting for one-time or intermittent administration of medications such as antibiotics, electrolyte replacements, and some oncology drugs. Consistent and accurate delivery of secondary medications requires a full understanding of the system and setup requirements...

To maximize the chances of survival during neonatal resuscitation, rapid assessment of HR is crucial to evaluate neonatal status and guide resuscitation interventions. Underestimating neonatal HR leads to unnecessary life-saving interventions, while overestimating neonatal HR may delay life-saving interventions. Using the most reliable and accurate...

Secondary infusion by large-volume IV smart pump is used extensively in the acute care setting for one-time or intermittent administration of medications such as antibiotics, electrolyte replacements, and some oncology drugs. Consistent and accurate delivery of secondary medications requires a full understanding of the system and setup requirements...

Executive Summary In 2020 a group of U.S. healthcare leaders formed the National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) to issue a call to action to address non–ventilator-associated hospital-acquired pneumonia (NVHAP). NVHAP is one of the most common and morbid healthcare-associated infections, but it is not tracked, reported,...

Hospitals are one of the noisiest public environments in the United States, and hospital noise is associated with disrupted sleep. This study provides insights into the noise levels produced by three commonly used medical devices for mechanical deep vein thrombosis prophylaxis: the VenaFlow Elite System, the Kendall SCD Compression System, and the...

Background: Nonventilator hospital-acquired pneumonia (NV-HAP) presents a serious and largely preventable threat to patient safety in U.S. hospitals. There is an emerging body of evidence on the effectiveness of oral care in preventing NV-HAP. Purpose: The primary aim of this study was to determine the effectiveness of a universal, standardized...

The COVID-19 pandemic has stretched hospitals to capacity with highly contagious patients. Acute care hospitals around the world have needed to develop ways to conserve dwindling supplies of personal protective equipment (PPE) while front-line clinicians struggle to reduce risk of exposure. By placing intravenous smart pumps (IVSP) outside patient...

Purpose The 2018 UNOS heart allocation policy change prioritizes patients bridged to transplant with temporary mechanical circulatory support (tMCS). We investigated how short and medium-term survival varies by duration of pre-transplant ECMO in the pre-allocation change era. Methods We reviewed the OPTN database for adults bridged to transplant w...

Objective The primary purpose of this research was to describe nurse and pharmacist knowledge of setup requirements for intravenous (IV) smart pumps that require head height differentials for accurate fluid flow. Methods A secondary analysis of anonymous electronic survey data using a database of prerecruited clinicians was conducted. A survey was...

This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication adminis...

Objective The purpose of this study was to compare common femoral vein blood flow enhancement during external mechanical compression between the novel, non-pneumatic Recovery Force Health Movement and Compressions (MAC™) System and four currently available intermittent pneumatic compression devices. Methods The MAC device was compared to Kendall S...

Background Non ventilator hospital-acquired pneumonia (NVHAP) is now the most common HAI. The purpose was to test primary source control through reduction of germs in the mouth as a modifiable risk factor for in NVHAP prevention. Methods The 12-month study (10/1/18–9/31/19) was conducted at an 800-bed tertiary medical center. 1 medical and 1 surgi...

Smartphones have become a ubiquitous part of life, and as a result, many children are engaging with smartphones beginning in infancy. Little is known regarding the thought processes used by parents in deciding when and how to allow their infants to engage with smartphones. Using a sample of twelve parents with infants younger than one year, this qu...

A presente pesquisa estudou a revista Interações sob a ótica dos conceitos e das práticas de desenvolvimento local. Objetivou destacar e identificar os conceitos e as práticas de desenvolvimento local inseridos em 21 edições da revista Interações, da Universidade Católica Dom Bosco (UCDB), nos períodos de 2000 a 2010. O trabalho, além do seu valor...

A finalidade do presente artigo foi à análise da relação existente entre à educação e o desenvolvimento local. Aplicou-se a metodologia de pesquisa exploratória, partindo-se do método analítico, a coleta de dados ocorreu por meio de informações secundárias, pesquisas bibliográficas em artigos científicos, livros e revistas. Procurou-se evidenciar u...

In this presentation, I will share my unconventional journey, starting from my first job as a critical care staff nurse to my current role as tenure-track faculty at the University of Massachusetts Amherst, where I hold a joint position with the Institute for Applied Life Sciences and the College of Nursing. Throughout this journey, I have had many...

Although the latest research and data show decreases in many health care-associated infections, recent publications highlight the understated but significant burden of nonventilator hospital-acquired pneumonia (NV-HAP). This section presents best practices to prevent NV-HAP. Many of the tools and interventions address basic nursing care such as ora...

Purpose Some surgeries performed during the weekend have worse outcomes. Lung transplantation is frequently performed on weekends despite a lack of evidence for its safety. We hypothesized that weekend lung transplants have worse outcomes than those performed during weekdays. Methods We conducted a retrospective analysis using the Scientific Regis...

Purpose The volume of heart transplants (HTx) has increased over the past decade, with a concurrent improvement in post-transplant survival. De novo malignancies (DNM) are a known morbidity associated with immunosuppression and become particularly relevant as HTx patients are living longer. We therefore sought to characterize the development of DNM...

Leading in today’s health care organizations is extremely challenging. The speed of technology and innovation, increasingly more regulatory requirements, and the demand for value-based care, all contribute to these challenges. Many of the current approaches used to develop the leaders of today and the future fall short of what is required for succe...

Background Sepsis is a leading cause of mortality among hospitalized patients and is the most expensive condition affecting the US health care system. Pneumonia is associated with about half of sepsis cases, yet limited research has described the incidence of sepsis in the context of nonventilator hospital-acquired pneumonia (NV-HAP). Persons with...

Venous thromboembolism (VTE) is a leading cause of mortality during the perioperative period, with individuals who have undergone hip and knee arthroplasty at the highest risk for VTE. The American College of Chest Physicians recommends 35 days of postoperative thromboprophylaxis and the use of intermittent pneumatic compression (IPC) therapy for m...

Background: Given the shortage of donor organs in pediatric heart transplantation (HTx), pretransplant risk stratification may assist in organ allocation and recipient optimization. We sought to construct a scoring system to preoperatively stratify a patient's risk of one-year mortality after HTx. Methods: The United Network for Organ Sharing da...

Background: The Institute for Safe Medication Practices (ISMP) describes high alert medications (HAM) as medications that represent a heightened risk of patient harm when used in error. IV smart pumps with dose error reduction systems (DERS) were created to help address medication administration errors. Compliance with DERS provides a measure of h...

Background: Hospital-acquired pneumonia is now the number one hospital-acquired infection. Hospitals have addressed ventilator-associated pneumonia; however, patients not on a ventilator acquire more pneumonia with significant associated mortality rates. Local problem: In our hospital, non-ventilator-associated pneumonia was occurring on all typ...

Purpose: The purpose of this study was to measure the prevalence of incontinence-associated dermatitis (IAD) among incontinent persons in the acute care setting, characteristics of IAD in this group, and associations among IAD, urinary, fecal, and dual incontinence, immobility, and pressure injury in the sacral area. Design: Descriptive and corr...

Background There is an emerging body of evidence which supports that non-ventilator hospital-acquired pneumonia (NV-HAP) contributes to prolonged hospital stays, is associated with significant patient morbidity/mortality, and occurs in approximately 0.5–1% of all hospital admissions. Pneumonia is a known risk factor for sepsis, and the Agency for H...

Background: Nonventilator hospital-acquired pneumonia (NV-HAP) is among the most common hospital-acquired infections. The purpose of our study was to quantify the incidence and influence of NV-HAP in the United States using a national dataset. Methods: The 2012 US National Inpatient Sample dataset was used to compare an NV-HAP group to 4 additio...

Objective: The purpose was to add to the body of knowledge regarding the impact of interruption on acute care nurses' cognitive workload, total task completion times, nurse frustration, and medication administration error while programming a patient-controlled analgesia (PCA) pump. Background: Data support that the severity of medication adminis...

Background: Although intravenous (IV) smart pumps with built-in dose-error reduction systems (DERS) can reduce IV medication administration error, most serious adverse events still occur during IV medication administration. Sources of error include overriding DERS and manually bypassing drug libraries and the DERS. Methods: Our purpose was to us...

Inadvertent perioperative hypothermia is estimated to affect 70% of surgical patients and is associated with adverse clinical outcomes, lengthened hospital stays, and increased costs. To better understand the current level of nursing knowledge on this subject since the release of the “Guideline for prevention of unplanned patient hypothermia,” we c...

Surveillance and monitoring each represent a distinct process in patient care. Monitoring involves observation, measurement, and recording of physiological parameters, while surveillance is a systematic, goal-directed process based on early detection of signs of change, interpretation of the clinical implications of such changes, and initiation of...

Aims: To characterise and identify nationwide trends in suicide-related emergency department (ED) visits in the USA from 2006 to 2013. Methods: We used data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2013. E-codes were used to identify ED visits related to suicide attempts and self-inflicted injury. Visits were character...

BACKGROUND: An academic medical center with 57 primary and specialty clinics within a four county area has 14 autoclaves and 17 areas using high level disinfection (HLD) in outpatient settings. Clinic staff are expected to remain competent in sterilization processes , though it is not a primary function in their busy work day. Ensuring each staff m...

Objective: The purpose of this study was to better understand the relationship between nurse staffing and 30-day excess readmission ratios for patients with heart failure in the top US adult cardiology and heart surgery hospitals. Background: Heart failure is the most common cause of hospitalization for patients older than 65 years and is the mo...

More than a decade ago, the introduction of smart I.V. pumps with drug libraries and dose error reduction systems (DERS) provided a means of reducing I.V. medication infusion errors that hadn’t been previously available. However, even with the availability of smart pumps, errors continue to occur in every clinical setting. A 2005 study found a stag...

The use of evidence-based medical practice has become the standard for health care decision-making. Thus, it has become increasingly important for medical device manufactures to provide evidence for the efficacy of their products. As new products, services, and solutions are developed, it is important to perform a stakeholder analysis to assess cli...

This paper presents an overview of the health care system, current and anticipated health care challenges, and the potential for medical technology to address the health care needs of the People's Republic of China. The implications of these topics for the modification of current strategies or development of new technologies to address the current...

Surveillance is a nursing intervention that has been identified as an important strategy in preventing and identifying medical errors and adverse events. The definition of surveillance proposed by the Nursing Intervention Classification is the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision ma...

Recent attention has focused on comparative effectiveness research (CER) to determine the clinical effectiveness and safety as well as the economic impact of health care interventions, including health care reform legislation that provides for new funding to develop the infrastructure to support CER. The demand for CER will significantly impact the...

Clinical decision support systems are intended to improve patients' care and outcomes, particularly when such systems are present at the point of care. Protocol Watch was developed as a bedside clinical decision support system to improve clinicians' adherence to the Surviving Sepsis Campaign guidelines. This pre/post-intervention pilot study was do...

Most standard bedside monitors in critical care settings display multiple clinical parameters and do not provide directional signaling to alert clinicians to relevant changes in physiologic parameters. The complexity of information may delay identification of clinical changes and initiation of interventions. Clinical decision support system (CDSS)...

A working understanding of the major fundamentals of statistical analysis is required to incorporate the findings of empirical research into nursing practice. The primary focus of this article is to describe common statistical terms, present some common statistical tests, and explain the interpretation of results from inferential statistics in nurs...

The details of digital recording and computer processing of a 12-lead electrocardiogram (ECG) remain a source of confusion for many health care professionals. A better understanding of the design and performance tradeoffs inherent in the electrocardiograph design might lead to better quality in ECG recording and better interpretation in ECG reading...

A number of factors can lead to the development of health care–associated infections in the hospital setting, including increasing patient acuity levels, chronically ill and acutely ill patients who harbor antibiotic-resistant bacteria, and frequent use of broad-spectrum antibiotics. Health care–associated infections can significantly impact patien...

To assess the predictive value for the early detection of sepsis of the physiological monitoring parameters currently recommended by the Surviving Sepsis Campaign. The Project IMPACT data set was used to assess whether the physiological parameters of heart rate, mean arterial pressure, body temperature, and respiratory rate can be used to distingui...

h4> The Mini-Mental State Examination (MMSE), originally designed to screen for dementia, is an instrument currently used extensively to assess cognitive status in clinical and community settings. This descriptive study compares standard MMSE scores to MMSE scores adjusted for age and education in a sample of 414 elderly Black and White women livi...

Sepsis is a multifaceted and complex medical condition that consumes a vast array of critical care resources and creates an exceptionally difficult clinical challenge for critical care clinicians. As a result, many initiatives over the past decade have been set in motion with the goal of improving the clinical care of patients with sepsis. This art...

Sepsis is a multifaceted and complex medical condition that consumes a vast array of critical care resources and creates an exceptionally difficult clinical challenge for critical care clinicians. As a result, many initiatives over the past decade have been set in motion with the goal of improving the clinical care of patients with sepsis. This art...

An unprecedented amount of data from a variety of disciplines containing variables of interest to nursing are available to nurse researchers. In response, the use of large data sets is emerging as a legitimate method that can help facilitate the translation of knowledge to practice. To explore the spectrum of methodological issues and practical app...

To assess the clinical performance of 3 new-generation pulse-oximetry signal-processing software systems (Philips FAST, Masimo SET, and Nellcor N-3000) during ambulation after open-heart surgery. Prospective, convenience sample. Cardiac surgical progressive care unit in a 629-bed, not-for-profit, tertiary-care teaching hospital. Status post-cardiac...

A pulse oximetry (SpO2) knowledge survey was conducted with 551 experienced critical care nurses at the 2002 American Association of Critical Care Nurses National Teaching Institute in Atlanta, GA. Results of this survey indicated an increased level of knowledge about SpO2 technology and monitoring compared to that reported in previous studies. The...