Archive for the ‘patient safety’ Category

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A QI Project to Increase Nurses’ Use of ‘Smart’ Pump Libraries

February 1, 2012

By Sylvia Foley, AJN senior editor

In January 2009 an independent community hospital in Massachusetts switched from using older, outmoded IV pumps to using “smart” pumps—pumps that have built-in computers with libraries of information on selected drugs and fluids, including predetermined concentrations and volumes with relevant administration limits. Library subsets (called profiles) contain information specific to certain patient populations or care areas. When properly implemented, these devices can be invaluable tools in reducing the risk of medication errors and improving patient safety.

Photo courtesy of Alaris

But when the hospital conducted a review, it found that smart pump libraries had been used in only 37% of all smart pump infusions done between January and June. One reason was that no “owner” had been assigned to oversee the implementation process. So the hospital’s nursing quality team (NQT) and pharmacy quality team began collaborating to find ways to increase nurses’ use of the pump libraries.

From July through October 2009 the NQT implemented several interventions. Author Andrew D. Harding describes the project as it evolved and reports on the results in this January CE feature, “Increasing the Use of ‘Smart’ Pump Libraries by Nurses: A Continuous Quality Improvement Project.” Read the rest of this entry ?

Posted in continuing education, nurses, nursing perspective, patient safety | Tagged , | 1 Comment »

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Diabetes Plus Marijuana Plus Medical Errors Minus Nursing Blogs

January 12, 2012

What’s new in health care news this week?

Diabetes everywhere. There’s an entire Health Affairs issue devoted to the topic of “Confronting the Growing Diabetes Crisis.” It looks at many interrelated issues, such as the personal financial burden of having diabetes over the course of a lifetime, whether it’s best to put scarce health care resources into focusing on prevention or treatment, models for community-based lifestyle programs for those with type 2 diabetes, the positive effects of the Affordable Care Act on giving those with diabetes access to affordable health insurance and crucial care, genetic factors related to type 2 diabetes, and a great deal more. Inevitably, many of the articles focus on type 2 diabetes, which is so closely linked to America’s obesity epidemic.

by Jorge Barrios, via Wikimedia

Joint studies. The New York Times reported this week on a large government study showing that, whatever one believes about marijuana’s psychological effects or the efficacy of its various medical uses, long-term marijuana smoking—at least one joint per day, every day of the year—does not impair lung function or contribute to the development of COPD. Will this change anyone’s mind about whether this drug is evil, a panacea for all ills, or somewhere in between? Probably not.

Unreported harm. The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services issued a report last week stating that only 14% of medical errors and other events that harm Medicare patients were reported by hospital employees. The report calls for improving reporting systems and the creation of a list of ”potentially reportable events.” According to the New York Times story on the topic, adverse events that have gone unreported include ”medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.”

Which leads us (or does it?) into nursing blogs. Many of the ones in our blogroll have been pretty silent in the past few months, or longer, and it’s not clear why. Some bloggers are taking a break, some have burned out or decided to use their time for other things (like going back to school), some have simply decided to spend more time on Facebook or sharing their thoughts by ’microblogging’ on Twitter (or are simply playing lots of Words With Friends on their smartphones). There are almost certainly many interesting new nursing blogs we don’t yet know about that are taking their places. If you know about them, please let us know. We need to take some time and do some digging. And we plan on doing a serious revision of the blogroll in the next few weeks.—JM, senior editor  

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Posted in patient safety | Tagged , , , , , , , | 5 Comments »

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Nurses Know

January 6, 2012

It happened back in 1976, but I still remember the sound of the distant ambulance. Why was I lying in the grass and the weeds? Hadn’t I been in the car, driving home from the Visiting Nurse Association along the country road?

So begins the January Reflections essay, “Nurses Know.” By Lois Gerber, it’s one patient’s vivid story of the many crucial roles that nurses played in her care—and it’s free, so have a look and let us know what you think. For those of you who write or who think you have a strong story to tell about nurses, nursing, or some aspect of health care, Reflections submission guidelines can be found here.—JM, senior editor/blog editor

Posted in nursing perspective, patient safety, writing and nursing | Tagged , , , , , | 1 Comment »

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Health Technology Hazards: Top 10 for 2012

January 5, 2012

Photo by Jasleen Kaur, via Flickr

Advances in health technology can save patients’ lives, but can also cause harm, as the recent Ecri Institute report, Top 10 Technology Hazards for 2012, reminds us. Here’s a snapshot of the hazards nurses should be focusing on, and some suggestions they give on how to prevent them.

1. Alarm hazards
The risk: With nurses being constantly bombarded by bells, it’s easy to see how alarm fatigue can set in, leading to desensitization, nurses being unable to distinguish the urgency level of alarms, and improper alarm adjusting.

Some suggestions: According to the report, a facility should look at the big picture, examining the entire alarm environment when setting up an alarm-management system. Alarm notification and response protocols should be developed to ensure that each alarm will be recognized, that the appropriate caregiver will be notified, and that the alarm will be promptly addressed. Policies should also be established to control alarm silencing, modification, and disabling.

2. Radiation exposure
The risk: High levels of radiation used during radiation therapy can cause serious harm if errors occur, including damage to normal tissue and organs. And despite radiation levels being lower in diagnostic settings, the increasing number of patients undergoing diagnostic radiography may reveal more risks in the future.

Some suggestions: The report suggests that adequate staffing levels may be a place to start. For radiation therapy, standard checklists should be developed for each step of patient treatment, and standard patient treatment procedures should be documented and followed. For CT scanning, radiation doses used should be as low as reasonably achievable while maintaining acceptable image quality.

3. Medication errors using infusion pumps
The risk: Mistakes such as mistyping data or entering it into the wrong field can have major adverse effects, including death. The use of “smart” pumps has helped, but preventable errors—such as misprogramming—can still occur.

Some suggestions: The report suggests hospitals should develop appropriate drug libraries for clinical areas that use infusion pumps, with standardized concentrations of drugs and solutions. Facilities should also get “buy-in” from staff members who will be using the system before and during purchasing of the system. Infusion pump technology safeguards should be emphasized, and noncompliance with safety systems should be addressed immediately. For more on smart pumps, read the CE feature “Increasing the Use of ‘Smart’ Pump Drug Libraries by Nurses: A Continuous Quality Improvement Project,” in AJN’s January issue (link pending in next day).

4. Needlestick and other sharps injuries
The risk: Exposure to bloodborne pathogens such as hepatitis B virus, hepatitis C virus, and HIV.

Some suggestions: Facilities are recommended to assess injuries and current practices to determine where and when these injuries occur most often. Using the data, an action plan should be developed and implemented. Some aspects of the plan could be ensuring adequate training of personnel and obtaining supplier support for in-service training on the use of protective devices. Read the rest of this entry ?

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Say It Ain’t So: Another ‘No’ on the Cookie Dough

December 12, 2011

Photo by AlexiUeltzen, via Flickr.

By Karen Roush, MS, RN, FNP-C, AJN clinical managing editor

I admit it. For me, the best part of baking chocolate chip cookies is eating the raw dough. I know there’s a risk for a food-borne illness, but it’s hard to resist at least one mouthful—well, maybe two—of that combination of brown sugar, butter, and chocolate chips. Now, just in time for the holiday baking season, there’s even more evidence that taking that bite is not such a great idea.

A recent study by Neil and colleagues found that a 2009 outbreak of Escherichia coli was associated with eating raw cookie dough: 77 people across multiple states came down with an E. coli O157:H7 infection. The researchers found the common exposure was to a  ready-to-bake, prepackaged cookie dough that the patients had eaten raw. They believe the most likely culprit in the dough was contaminated flour. (The researchers note that flour has been implicated in food-borne Salmonella and E. coli outbreaks in the past.)

So, when educating patients about safety this holiday season, remind them that food products meant to be cooked or baked should never be eaten raw. As for me, this holiday I think I’ll head to the bakery and stay out of temptation’s way.

What other holiday safety tips have you got for patients?

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Posted in clinical managing editor, infection control, Karen Roush, patient safety, Uncategorized | Tagged , | 1 Comment »

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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Posted in health information technology (HIT), nursing students, patient safety | Tagged , , , , , | 2 Comments »

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Bad Economy Breeds a New Era of Discontent Among Nurses

September 26, 2011

By Shawn Kennedy, AJN editor-in-chief

Nurses are taking to the picket lines, again. On Sept 22, an estimated 23,000 nurses in California struck at Kaiser Permanente facilities and also at Sutter Health hospitals and Children’s Hospital Oakland. The one-day strike was organized by the California Nurses Association/National Nurses United (CNA/NNU) to protest what they say are unfair rollbacks to nurses’ health coverage and retirement benefits, and was also intended as a show of support for striking coworkers.

But it’s not just U.S. nurses who are engaging in job actions—for example, in the United Kingdom, the 400,000 member Royal College of Nursing is contemplating the first strike in its nearly 100-year history and is soliciting the views of its members as to what action should be taken. The issue is nurses’ pensions and job cuts—according to Nursing Standard, “almost 10,000 NHS [National Health Service] posts in England alone have been earmarked for cuts.”

The poor economy is putting pressure on hospitals and health systems everywhere to reduce costs. One way to do this, of course, is to make cuts in what is traditionally the biggest expense in running the hospital—nursing. While this is a quick fix to the bottom line, it’s also one that doesn’t solve the problem. In fact, evidence shows that inadequate nurse staffing is linked to poor outcomes, which ultimately cost more in the long term—for the patients, for the health care system, and for nurses, who must deal with the burden of short staffing.

Let us know—how are things in your workplace?

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Posted in advocacy/political action, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 6 Comments »

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Caring for Suicidal Children in the ED

September 1, 2011

By Sylvia Foley, AJN senior editor

Emergency lights #5, by DrStarbuck via Flickr

Suicidal children and adolescents are often first seen in EDs. At Children’s Hospital Boston (CHB) recently, a boy we’ll call J.J. was one of them. Still in elementary school, he had just started a new school year. J.J. has Asperger’s syndrome (a disorder on the autism spectrum), and new situations are difficult for him. His classmates were teasing him, and it was escalating: one boy reportedly threatened to kill J.J. for being “weird.” Despite efforts by J.J.’s parents and the school to address the situation, J.J. became increasingly depressed and fearful. As September CE authors Alexis Schmid and colleagues explain,

On the morning of the ED visit, as the family members were starting their day, J.J. had gone into the kitchen, found a butcher knife, and held it to his throat. His mother walked in and saw him. Although J.J. willingly surrendered the knife to her, she said she was “rattled to the core.”

Schmid was the ED nurse on J.J.’s case that day (all three authors work at CHB). In “Care of the Suicidal Pediatric Patient in the ED: A Case Study,” the authors describe the course of J.J.’s care and what they did to keep J.J., his family, and the hospital staff safe as the day progressed. Read the rest of this entry ?

Posted in audio interviews, children's health, continuing education, nurses, patient safety, practice tips, school nurses | Tagged , , , , , , | Leave a Comment »

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Hurricane Aftermath

August 29, 2011

Hurricane Irene, by D. Fletcher via Flickr

By Shawn Kennedy, MA, RN, AJN editor-in-chief

Well, Hurricane Irene has come and gone in the northeast United States. While it certainly destroyed property, downed power lines, and caused flooding, many are thinking that we escaped the worst, since Irene morphed from a hurricane into a tropical storm when it made landfall in Long Island, New York.

This is not to diminish the tragedy that it caused—in loss of life (CNN reports 25 Irene-related deaths)  and destruction of property.  And I sympathize with those who experienced flooding or lost power. Cooking, showering, and basic daily activities become major challenges and require ingenuity, creativity, and sometimes a touch of genius. While initially this merely seems inconvenient, after a few days it’s exhausting. I’m sure there will be many households without power for weeks, judging from some local news reports.

An important potential health hazard that wasn’t covered in depth on the news is walking or wading in flood waters in shorts and bare feet or flip-flops. Flood waters often contain contaminants from storm drains and sewers, including raw sewage (as one news reporter discovered only after he was covered in it). Debris, sharp objects, and even power lines may be hidden underwater, as well as ditches or drains (47-year-old postal worker Ronald Dawkins, from Orange, New Jersey, was killed when he tried to wade through rising water to a postal facility where he worked and stepped into a hidden drainage creek).

The Centers for Disease Control and Prevention offers a guide to preventing illness after a disaster and also has information for how to stay safe while cleaning up after flooding. Check it out and spread the word.

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Posted in disaster care, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged | Leave a Comment »

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The Perception Treadmill: Has Nursing’s Status Really Gone Anywhere?

August 22, 2011
a Treadmill

Treadmill/Image via Wikipedia

By Margaret Gallagher, BSN, RN. Margaret is a cardiovascular nurse currently working in Georgia. Her last post for this blog was “Return on Investment: A Mother Makes Her Wishes Clear.”

Usually, it’s nice to share stories among friends you haven’t worked with in a while. However, I haven’t been able to let go of one such recent conversation.*

“You want to know what really burns me?” asked Lisa, a long-time nurse, as I sipped my coffee. “The rumors had been going around for a while that the residents get an incentive if the patients’ coag levels stay within therapeutic range. You know that John and I go way back; I decided to just flat out ask him.”

I listened attentively, expecting that Lisa and John’s friendship wouldn’t keep the attending MD from laughing her out of the ICU for this one.

Lisa glowed like an electric oven coil. “John told me it was true, and with a straight face! How dare they! All the residents do is click on ‘heparin protocol’ in the computer when the patient’s admitted. We draw the labs, follow the protocols, and titrate the drip around the clock until the patient is transferred, but they get the bonus. Does that stink or what?”

I couldn’t help but think back to my very first code. It was three states away and nearly three decades ago. For those who’ve never worked in a teaching hospital, July is when the interns, residents, and fellows promote up to their next year’s tasks. In our surgical step-down unit, that meant that the intern paged to the code had been employed as a doctor for all of 36 hours. He appeared, breathless from the stairs, at the code already in progress. Turning to Penny, the charge nurse, he gasped, “I’ve never done this before.”

Penny calmly handed him the chart, open to the orders pages, and her pen. “Write down everything I say as a list,” she replied. Penny ran the code from start to finish, successfully resuscitating the patient. The intern thanked us, signed “his” orders, and left the unit (with her pen). Read the rest of this entry ?

Posted in legal issues, nursing perspective, patient safety, professional identity | Tagged , , , , | 2 Comments »

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