Archive for the ‘patient safety’ Category

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AJN’s August Issue: Preventing Pressure Ulcers, Strengths-Based Nursing, Medical Marijuana, More

August 1, 2014

AJN0814.Cover.OnlineAJN’s August issue is now available on our Web site. Here’s a selection of what not to miss.

Toward a new model of nursing. Despite the focus on patient-centered care, medicine continues to rely on a model that emphasizes a patient’s deficits rather than strengths. “Strengths-Based Nursing” describes a holistic approach to care in which eight core nursing values guide action, promoting empowerment, self-efficacy, and hope. This CE feature offers 2.5 CE credits to those who take the test that follows the article.

Decreasing pressure ulcer incidence. Hospital-acquired pressure ulcers take a high toll on patients, clinicians, and health care facilities. “Sustaining Pressure Ulcer Best Practices in a High-Volume Cardiac Care Environment” describes how one of the world’s largest and busiest cardiac hospitals implemented several quality improvement strategies that eventually reduced the percentage of patients with pressure ulcers from 6% to zero. This CE feature offers 2.8 CE credits to those who take the test that follows the article. And don’t miss a podcast interview with the authors (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article).

Read our Cultivating Quality column this month for another article on using evidence-based nursing practice to reduce the incidence of hospital-acquired pressure ulcers and promote wound healing. Read the rest of this entry ?

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AJN’s July Issue: Diabetes and Puberty, Getting Patient Input, Quality Measures, Professional Boundaries, More

June 27, 2014

AJN0714.Cover.OnlineAJN’s July issue is now available on our Web site. Here’s a selection of what not to miss.

Diabetes and puberty. On our cover this month, 17-year-old Trenton Jantzi tests his blood sugar before football practice. Trenton has type 1 diabetes and is one of a growing number of children and adolescents in the United States who have  been diagnosed with either type 1 or type 2 diabetes. The physical and psychological changes of puberty can add to the challenges of diabetes management. Nurses are well positioned to help patients and their families understand and meet these challenges.

To learn more more about the physical and behavioral changes experienced by adolescents with diabetes, see this month’s CE feature, “Diabetes and Puberty: A Glycemic Challenge,” and earn 2.6 CE credits by taking the test that follows the article. And don’t miss a podcast interview with the author, one of her adolescent patients, and the patient’s mother (this and other podcasts are accessible via the Behind the Article page on our Web site or, if you’re in our iPad app, by tapping the icon on the first page of the article). Read the rest of this entry ?

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ECRI’s Top 10 Patient Safety Concerns for 2014

June 20, 2014
safety

Photo © One Way Stock.

For the past few years, we’ve highlighted the ECRI Institute’s annual Top 10 Health Technology Hazards report, which provides an overview of new and old technology hazards for health care facilities to keep in mind (read this year’s post here).

Now ECRI has released a new report entitled “Top 10 Patient Safety Concerns for Healthcare Organizations.” The goal of the list, according to ECRI, is to “give healthcare organizations a gauge to check their track record in patient safety.” The list, which will be published on an annual basis, draws upon more than 300,000 patient safety events, custom research requests, and root-cause analyses submitted to the institute’s federally designated patient safety organization (PSO) for assessment. A selection from the top 10 can be found below.

Poor care coordination with a patient’s next level of care

The concern: Gaps in communication about patient care—for example, between hospital and provider, among providers, and between long-term care settings and hospitals—have been reported to ECRI’s PSO. And while it is best practice for hospitals to send a patient’s discharge information to all of a patient’s providers, this doesn’t always happen.

Some suggestions: On reason information doesn’t get passed on, according to the report, is that staff aren’t always able to identify a patient’s other providers. One strategy suggested by the report is for practices to provide current contact information, such as phone and fax numbers, on their Web sites. Electronic health records can facilitate care communication among providers, but the report stresses that organizations must establish procedures that address accessing, reviewing, and acting on the findings in those records.

Failure to adequately manage behavioral health patients in acute care settings

The concern: Despite the fact that patients’ mental health needs must be addressed in addition to their clinical needs when presenting in an acute care setting or ED, events reported to ECRI’s PSO suggest this isn’t always the case. Of particular concern is the incidence of patient violence in these settings. Read the rest of this entry ?

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Time to Get Serious About ‘Handshake-Free’ Health Care?

June 2, 2014

By Shawn Kennedy, AJN editor-in-chief

Tombstone handshake, from Mel B, via Flickr.

Tombstone handshake, from Mel B, via Flickr.

Last month in JAMA, Mark Sklansky and colleagues wrote a Viewpoint column, “Banning the Handshake From the Health Care Setting.” The article explored the idea and its feasibility, while acknowledging the importance of such rituals as handshakes in human interaction. In the end, the authors argued that it’s an idea we might need to start taking more seriously.

Is this an antisocial idea? That’s debatable, but it would certainly be a good step towards reducing transmission of infections—and one that’s probably long overdue.

It’s well known that pathogens are easily transmissible from health care workers’ hands, even if they practice hand hygiene in between seeing patients. But as the authors remind us, heath care workers are notoriously bad at doing so—they cite research showing that “compliance of health care personnel with hand hygiene programs averages 40%.”

And it’s no better in ambulatory care settings—an original research article we published in March 2013 that measured hand hygiene compliance by health care workers in an ambulatory care clinic found that, even after a campaign to improve adherence, compliance (as measured by direct observation) had only improved to between 32% and 51% at one-month follow-up. The introduction of alcohol-based hand sanitizers helped, but they aren’t effective against all pathogens, including C. difficile and some noroviruses

Bacteria have been shown to live on many surfaces—computer keyboards, telephones, uniforms, and even paper (see our December 2011 research article, “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands”). If a conscientious nurse charted on a paper chart or entered a patient’s vital signs into the electronic record after providing care but before washing hands, bacteria could be transmitted to whoever next picked up the chart or used the keyboard. Then that person might shake hands with a family member or colleague, and so on, and so on . . .

Read the rest of this entry ?

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Nurses Join Fight Against Counterfeit Medicines

May 30, 2014
Hidden-in-Fake-Meds-2-1024x1809

Click infographic to enlarge

“Fight the Fakes” is a scary article in the June issue of AJN about counterfeit medicines and the role the International Council of Nurses (ICN) has taken in the Fight the Fakes campaign to inform the public about just how common the problem is and how dangerous it can be. Here’s the opening paragraph:

In February 2012, a cocktail of salt, starch, acetone, and a variety of other chemicals was delivered to 19 U.S. cancer clinics, instead of a vital chemotherapy medication they were expecting. Earlier this year, the Daily Mirror reported on black market abortion tablets that are being sold online to young teenage girls too scared to tell their parents they’re pregnant. The pills can kill if the wrong dose is taken.

The article is by David Benton, chief executive officer of the ICN, and Lindsey Williamson, the organization’s publications director and communications officer. Below is a brief blog post they sent us to give readers an idea of what’s at stake—but we hope you’ll also go ahead and read their article, which raises issues that should concern us all as patients or health care professionals.—JM, senior editor

Fake medicines are a global problem: they are reported in virtually every region of the world. Fake medicines may include products with the wrong ingredients, without active ingredients, with insufficient quantities of active ingredients, or with fake packaging. How common are fake medicines? The problem of counterfeit drugs is known to exist in both developed and developing countries. However, the true extent of the problem is not really known, since no global study has been carried out. Counterfeiting of medicines can apply to both branded and generic drugs, prescription and over-the-counter medicines, as well as to traditional remedies. Read the rest of this entry ?

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“One Day He Breaks Your Arm, and Then . . .”: How Nurses Can Help Rural Survivors of Intimate Partner Violence

May 7, 2014
Photo by Damien Gadal, via Flickr.

Photo by Damien Gadal, via Flickr.

 By Sylvia Foley, AJN senior editor

“Imagine for a moment that your husband or boyfriend is regularly assaulting you, and often tells you that ‘nobody cares.’ Now imagine that you live in an isolated rural community. The nearest health care services are 75 miles away—and you can’t get there because he removes the car battery to keep you from driving . . . One day he breaks your arm, and then he drives you to that distant hospital. Will the nurses recognize what is happening? Will there be a chance for you to tell them?”

In this month’s CE feature, “Intimate Partner Violence in Rural U.S. Areas: What Every Nurse Should Know,” Amanda Dudgeon and Tracy Evanson explain why it’s important for nurses in all practice settings to understand the particular issues that rural survivors face and how to address them. (Most, though not all, victims of intimate partner violence are women; this article focuses primarily on female survivors.) Here’s a brief overview.

Intimate partner violence is a major health care issue, affecting nearly 6% of U.S. women annually. Multiple mental and physical health problems are associated with intimate partner violence, and billions of health care dollars are spent in trying to address the consequences. Although prevalence rates of intimate partner violence are roughly the same in rural and nonrural areas, rural survivors face distinct barriers in obtaining help and services. Because rural women routinely access health care services in nonrural as well as rural settings, it’s essential that all providers understand the issues specific to rural survivors. Routine screening for intimate partner violence would create opportunities for women to disclose abuse and for providers to help victims obtain assistance and support that may keep them safer. This in turn would likely decrease serious health sequelae and lower health care costs. This article describes the unique aspects of intimate partner violence in rural populations. It also describes a simple screening tool that can be used in all settings, discusses ways to approach the topic and facilitate disclosure, and addresses interventions; relevant resources are also provided.

That simple screening tool is the Abuse Assessment Screen, which consists of just five questions and can be performed in minutes. To learn more, read the article, which is free online, and listen to our podcast with one of the authors. As always, we invite you to share your thoughts and experiences in the comments.

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Codeine Overused in Children: Alternatives Exist for Hard-to-Manage Pain

April 23, 2014

By Jacob Molyneux, senior editor

According to a story at MedlinePlus, a study in Pediatrics has found that codeine is still prescribed too often to children during ER visits, though it’s known that a small but significant subset of children metabolize the painkiller far more rapidly than do other children, leading to potentially dangerous results. As AJN‘s February CE article on treating the often severe and stubborn posttonsillectomy pain in children noted, there are other effective and safer options for children in pain, such as hydrocodone in combination with acetaminophen, as well as some non-opioid analgesics. Here’s a brief overview of the article:

Tonsillectomy, used to treat a variety of pediatric disorders, including obstructive sleep apnea, peritonsillar cellulitis or abscesses, and very frequent throat infection, is known to produce nausea, vomiting, and prolonged, moderate-to-severe pain. The authors review the causes of posttonsillectomy pain, current findings on the efficacy of various pharmacologic and nonpharmacologic interventions in pain management, recommendations for patient and family teaching regarding pain management, and best practices for improving medication adherence.

There’s often no perfect answer in pain management, but it helps to know the full range of available strategies, their safety, and how well they work. As with all CE articles, this one is free.

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A Tale of Two Dangerous Products

April 21, 2014
Holding On / D'Arcy Norman, via Flickr

Holding On / D’Arcy Norman, via Flickr

Amanda Anderson, BSN, RN, CCRN, works in critical care in New York City and is enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration.

There are two news stories I’ve been chewing on lately. One made it to the front page of my New York Times almost every day for a while, and the other I saw just once in the paper’s international news section several weeks ago.

The blockbuster story involves a single company that covered up a problem with an important part in one of its products. Ten years passed and a number of people died before they finally informed the public about the problem. The products with the flawed part have now been recalled, and the company is embroiled in an investigation and likely to face lawsuits and massive fines.

The far less publicized story is about a growing body of research exposing a problem that results in similar levels of harm. Unlike in the first story, the crucial ‘part’ that affects the product’s safety is human labor—and the detrimental effect of mismanagement of this labor is likewise injury or death. The link between the product flaw and its effects is well established, but there has been no public outcry, product recall, or lawsuit. The story barely made it past the gates of major media, and although the evidence linking this problem to dire results is strong, few industry players are acting on it. Read the rest of this entry ?

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Recent Nurse Blog Posts of Interest, Inhaled Insulin, a Note on Top Blogs Lists

April 4, 2014

By Jacob Molyneux, AJN senior editor/blog editor

Here you will find some links to nursing blog posts, a look at this week’s Affordable Care Act health exchange enrollment numbers, and a couple of items of interest about new treatments or studies, plus a note on blogs that award other blogs badges. A grab bag, so bear with me…

crocus shoots, early spring, I think/ via Wikimedia Commons

crocus shoots, early spring, I think/ via Wikimedia Commons

At the nursing blogs:

RehabRN has a post about a friend who was bullied by a nurse of much higher authority in the same hospital. Such stories, if true, are always upsetting. What can you do but take it when the power differential is so great?

At the INQRI blog (I’m not going to tell you what the initials stand for except that it has something to with quality, research, and nursing), there’s a post about why stroke survivors need a team approach to palliative care.

Megen Duffy (aka Not Nurse Ratched) has a really very good post at a site she sometimes blogs for. I already shared it via a tweet yesterday, but it deserves more. It’s called “Nursing Will Change You.”

At Infusion Nurse Blog, there’s a post addressing IV solution shortages (now happening on top of shortages of some common and necessary drugs due to a variety of reasons). It gives some practical steps clinicians and organizations can take to conserve and is definitely worth a quick look.

A sweet little post called “Nursing Sisters” is at Adrienne, {Student} Nurse. It’s about how nurses help each other out, starting right from the beginning in nursing school.

Read the rest of this entry ?

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Three Nurses and a Doctor Go Sailing – Some Notes on Communication Style

March 24, 2014

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Untitled from the series, Pareidolia. Charcoal and graphite on paper, 12" x 9," by julianna paradisi

Untitled from the series, Pareidolia. Charcoal and graphite on paper,
12″ x 9,” by julianna paradisi

There’s an old joke about the personality differences among nurses of different specialties. It goes like this:

A medical–surgical nurse, an ICU nurse, an ER nurse, and a doctor go sailing. The doctor stands at the bow of the boat and shouts to the nurses, “Trim the sail!”

The med–surg nurse asks, “How do you want it?”

The ICU nurse replies, “I’ll trim, okay. But I’m doing it my way.”

The ER nurse shouts back at the doctor, “Trim the sail yourself!”

ICU style. The joke is a generalization, of course. However, I was a pediatric intensive care nurse once upon a time, and I have to admit that the ICU nurse characterization resonates with my own experience. Like the nurse in the joke, I always have an opinion, and rarely mind sharing it. In the ICU, if another nurse, a physician, a pharmacist, or respiratory therapist didn’t agree, conversation ensued. My colleague, equally opinionated, would state her or his position. Data was consulted, and then, more often than not, consensus occurred.

And I often learned something from sharing information. It made me a better nurse. I learned to dig in on a position only if patient safety or my license was at risk. Everything else was pretty much negotiable, face-to-face. From this perspective, our ICU team was similar to a marriage—it would have been unrealistic to expect there would never be disagreement within our team. In fact, if there was never disagreement, someone probably wasn’t being honest about her or his feelings—an approach that can lead to passive-aggressive behavior.

I don’t know if it’s because I no longer work in ICU, or if nursing culture in general has changed, but lately I’ve noticed some confusion about the difference between open, honest communication and bullying. There’s a difference. Read the rest of this entry ?

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