Archive for the ‘patient safety’ Category

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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 if you think it’s worth the time…and remember, there’s no shame in jumping ship mid-post.

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.

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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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Staffing and Long Shifts – Some Recent Coverage

February 24, 2014

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

by patchy patch, via flickr

The March issue will soon be published and be featured on the home page of our Web site, so before the February issue is relegated to the archive section, I want to highlight two articles. Knowing that some readers of this blog may not be regular readers of AJN (I know, hard to believe), I wanted to bring them to your attention.

I don’t usually blog about my own editorials, but the February editorial (“It All Comes Back to Staffing”) has apparently resonated with many readers. I’ve received several letters and a request to reprint it from a state nursing association. (The editorial includes a portion of a poignant letter I received from a reader in response to an editorial I’d written for the December 2013 issue, “Straight Talk About Nursing,” in which I discussed missed care—that is, the nursing care that we don’t get to but is often at the heart of individualizing care.)

The February editorial ties in with a special report, “Can a Nurse Be Worked to Death?”, by Roxanne Nelson, which addresses the recent death of a nurse who was killed in a car accident while driving home after a 12-hour shift. It’s a compelling report and I urge all nurses to read this piece and to think about what it says about long shifts. Read the rest of this entry ?

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Voice of Dissension: When Nurse Teamwork and Patient Safety Diverge

January 29, 2014
ParadisiIllustrationDissension

Dissension (from the series Pareidolia), charcoal & graphite on paper, 12″ x 9,”
2012 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology. The illustration of this post is by the author.

The term “voice” gets thrown around a lot these days, usually in reference to creative content. Visual artists, writers, musicians, and actors rise to their unique place in the art world on the originality of their voice, not merely for mastery and talent.

In nursing, voice is important too. Hospitals spend a small fortune in paid staff hours for team-building meetings or retreats for nurses to smooth the rough edges of staff members, reducing friction among unit nurses with the ultimate goals of nurse retention and improved patient care. While these are admirable goals, I’m beginning to wonder if too much emphasis on team building may also diminish a nurse’s unique voice, thereby inadvertently interfering with patient safety? A team is only as strong as its individual members. Read the rest of this entry ?

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Health Technology Hazards: ECRI’s Top 10 for 2014

January 15, 2014
hazard/jasleen kaur, via Flickr

hazard/jasleen kaur, via Flickr

It’s that time of year again—the ECRI Institute has released its Top 10 Health Technology Hazards for 2014 report, and with it come new (and old) hazards to keep in mind.

Alarm hazards still posed the greatest risk, topping the list at number one for the third year running. Other repeat hazards included medication administration errors while using smart pumps (in at number two), inadequate reprocessing of endoscopic devices and surgical instruments (number six), and, at number eight, risks to pediatric patients associated with technologies that may have been designed for use in adults (such as radiology, oxygen concentrators, computerized provider order–entry systems, and electronic medical records). For an overview on these, see our posts from 2012 and 2013.

And here’s a snapshot of new hazards that made the cut, along with some of the report’s suggestions on how to prevent them.

Radiation exposures in pediatric patients (#3)

The risk: Although computed tomography (CT) scans are valuable diagnostic tools, they are not without risk, and children, who are more sensitive to the effects of radiation than adults, are more susceptible to its potential negative effects. According to the report, new empirical studies suggest that “diagnostic imaging at a young age can increase a person’s risk of cancer later in life.”

Some suggestions: The report suggests that health care providers take the following actions: use safer diagnostic options, when possible, such as X-rays, MRIs, or ultrasounds; avoid repeat scanning; and use a dose that is “as low as reasonably achievable.”

Occupational radiation hazards in hybrid ORs (#5)

The risk: Hybrid ORs, which bring advanced imaging capabilities into the surgical environment, are a growing trend. However, with these angiography systems comes exposure to radiation—a risk to both patients and OR staff.

Some suggestions: According to the report, a radiation protection program is a must. The program should include training for staff, who may not have experience with imaging technology; the use of shielding with lead aprons or other lead barriers; and monitoring of radiation levels. Read the rest of this entry ?

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The Not Good Nurse – Some Dark Holiday Reading

January 2, 2014

By Shawn Kennedy, AJN editor-in-chief

GoodNurseHaving some down time over the holidays can be a good chance to catch up on some reading. Because so much of my work entails reading manuscripts submitted to AJN about nursing practice and research, I look for my leisure reading to be something not connected to nursing.

Well, the book I recently read—a quick, engaging read—was about nursing, sort of. The book was Charles Graeber’s The Good Nurse: A True Story of Medicine, Madness and Murder, the story of nurse-turned-serial-killer Charles Cullen. While I find the title to be a bit sensationalist, the book is not. There’s no real answer as to why Cullen did what he did—Cullen apparently had a miserable childhood, was often a target of bullies, had failed marriages and made many suicide attempts to gain sympathy or attention. Graeber doesn’t really seek to answer the why of what Cullen did but instead focuses on his behavior and relationships.

The chilling aspect of the story is how easy it was for Cullen to get away with his killing through the use of essential technology relied on by nurses for the care of hospital patients. The medication and computer systems that he manipulated to cover his tracks also eventually allowed an intrepid nurse colleague to help police prove their case—only a nurse knowledgeable about the day-to-day use of the systems could uncover the wayward patterns.

But the real issue that comes through is how hospitals, fearing litigation, would simply dismiss Cullen when other nurses voiced concerns about his practice, allowing him to find work elsewhere and become someone else’s problem. That’s something I think many nurses might relate to—I certainly can. I worked with a couple of nurses early in my career who, when we reported to the administration that there were consistent errors in the narcotic count or missing medications when they were working, were given a chance to resign or be fired. Neither was ever reported to the board of nursing. Read the rest of this entry ?

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When There’s a Disconnect Between Good Nursing Practice and Reality

December 6, 2013

Recently I spoke with other nurses about our personal experiences with hospitalization and those of family members, and the conversation turned to disappointment with nursing practice and nursing care. In fact, whenever I’ve asked, every colleague has disclosed a similar experience. Some say that they’d never leave a family member alone in a hospital.

We need to acknowledge that there is a disconnect between what we know to be good practice and what is often the reality—even in facilities with Magnet accreditation. There are far too many instances in which nursing practice is substandard.

shawnkennedyThis is a heads-up about Shawn Kennedy’s editorial in this month’s issue of AJN, excerpted above. You should read it. The article, “Straight Talk About Nursing,” is free. There are no easy answers to the issues it raises. That’s all the more reason to discuss them openly.

In AJN, we often focus on examples of best practices and insightful, compassionate, engaged care. And we get that there are many institutional obstacles that undermine nurses in their attempts to provide quality care to patients. But even so, we’d be remiss to pretend we don’t hear about, and sometimes personally experience, care that simply falls short. This is scary, at least to me. Patients depend on nurses in so many ways. So have a look at the article and let us know your thoughts, as a nurse or as a patient.—Jacob Molyneux, senior editor

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Scrubs on the Street: Big Concern?

November 20, 2013
This colorized 2005 scanning electron micrograph (SEM) depicted numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, commonly referred to by the acronym, MRSA; Magnified 2390x. CDC/via Wikimedia Commons

This colorized 2005 scanning electron micrograph (SEM) depicted numerous clumps of methicillin-resistant Staphylococcus aureus bacteria, commonly referred to by the acronym, MRSA; Magnified 2390x. CDC/via Wikimedia Commons

By Shawn Kennedy, AJN editor-in-chief

Last week I came across this article on the Reporting on Health blog from the Annenberg School of Communications and Journalism at the University of Southern California. It discusses one woman’s campaign to get hospital health care providers to stop wearing scrubs outside of the hospital. She wants people to photograph the ‘offenders’ and send the photos to hospital administrators. She’s concerned that the clothing will pick up infection-causing bacteria in the community and spread infection to weak, immunocompromised patients.

Wearing uniforms outside of the clinical setting has been debated on and off for years. Here’s an excerpt from an editorial comment that appeared in the March 1906 issue of AJN (you can read the full article for free as a subscriber):

AJNArchiveExcerptNursesonStreet

So again, the concern was about bringing bacteria into the environment of sick people. Recently, though, the concerns have evolved to include as well the reverse scenario: bringing resistant hospital bacteria home. (See a nurse’s follow-up post at Reporting on Health for a good summary of some current issues.)

As one person quoted in the initial post about this idea of “outing” people in scrubs outside the hospital points out, evidence remains inconclusive on whether bacteria on clothing is at play in causing infections. (One of its links includes a 2007 evidence review that notes the following: “The hypothesis that uniforms/clothing could be a vehicle for the transmission of infections is not supported by existing evidence.”) Aside from our pretty universal agreement as to the need for the strict compliance observed in the OR, how concerned should we be about hospital personnel wearing uniforms from home to hospital and home again, perhaps doing errands along the way?

I asked AJN’s infection control consultant, Betsy Todd, MPH, RN, CIC, about any recommended standards around this. She replied, “There’s just the AORN standards for OR wear. We long ago stopped worrying about leaving our work shoes in our lockers; and I think, despite the periodic microbiologic surveys of ties, coat sleeves, etc., the general idea still is that no links have been shown between organisms on clothing and the spread of infection.”

However, she further notes the following: “I always tell nurses that the first thing they should do when they get home is get out of their uniforms before hugging kids or the dog. I suspect the risk is bigger in this direction—more superbugs likely to be riding home with us than riding into the hospital with us.”

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A Report from the ANA Safe Staffing Conference

November 11, 2013

Katheren Koehn, MA, RN, AJN editorial board member and executive director of MNORN (Minnesota Organization of Registered Nurses), reports from last week’s ANA conference on staffing held in Washington, DC.

staffiing

Click image for source page at ANA staffing site.

The ANA Safe Staffing Conference ended on Saturday. There were almost 700 registered nurses from all over the country in attendance—nurses in management, direct care, and leadership—all gathered to try to discover new strategies for how to solve the most challenging issue in nursing: safe staffing.

Not a new issue. This has long been the most challenging issue for nursing. Teresa Stone, editor of Poems from the Heart of Nursing: Selected Poems from the American Journal of Nursing, told me that, as she was searching the archives of 113 years of AJN issues for her book, she found that staffing issues were a frequent theme. Today, as the work of nurses has become more complex, the need to create sustainable solutions to ensuring appropriate staffing is our most critical issue—hence the ANA Staffing Conference.

The body of evidence supporting the idea that appropriate nurse staffing makes a difference in saving patients’ lives has grown exponentially in the past 20 years. This evidence—paired with the new federal financial incentives for hospitals to improve patient outcomes and experiences—makes it seem inevitable that increasing nurse staffing would be the next step. But decreases in Medicare reimbursement rates, along with caution about future finances related to some aspects of health care reform, are in fact making hospital purse strings tighter than ever. Nurses continue to beg to be taken out of the “room and board” costs and to be seen as an asset. But instead, they are often seen as a major expense that can be reduced for the sake of the bottom line. If this impasse is to be brokered, it will demand new thinking and new communication.

A focus on innovation. Past ANA president Barbara Blakeney, now innovations specialist at the Center for Innovation in Care Delivery in the Institute for Patient Care at Massachusetts General Hospital in Boston, asked attendees to be innovative in our solutions to the problems of staffing. She taught us about the five “discovery skills” of innovators:  associating, observing, experimenting, questioning, and networking. For example, innovators are extremely good at networking with smart people with whom they have little in common but from whom they can learn.

Blakeney also reminded us that in this time of wanting everything to be based on evidence, we also have to allow for discovery and creation of new practices. One of the processes she recommends for innovation at the hospital unit level is the rapid-cycle improvement process used by the Transforming Care at the Bedside (TCAB) initiative. In addition, she emphasized that anyone at the unit level can potentially lead change. Leadership’s role is to make the environment safe for trying new things—for innovation. Read the rest of this entry ?

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Finding the Calm: A Nurse-Led QI Project to Reduce Patient Agitation

October 4, 2013

By Sylvia Foley, AJN senior editor

Photo by Lanny Nagler, courtesy of Hartford Hospital

Photo by Lanny Nagler, courtesy of Hartford Hospital

For many people, “going to hospital is rather like going to an alien planet,” as the British cartoonist and book illustrator Sir Quentin Blake once observed—it’s a very stressful experience taking place in an unfamiliar environment. For some, the experience of hospitalization can trigger or worsen agitation. In the October CE “Decreasing Patient Agitation Using Individualized Therapeutic Activities,” author Christine Waszynski and colleagues report on a nurse-led quality improvement project that demonstrated promising results. Here’s a short summary.

OVERVIEW: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observa­tion by designated “sitters.” These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. The authors created a tool that allowed continuous observers to identify a patient’s abilities and interests, and then offer such activities to the patient. Data were collected using a scale that measured patient agitation before, during, and after these activities. The authors found that during the activities, 73% of patients had decreased levels of agitation compared with baseline, and 64% remained less agitated for at least one hour afterward.

The intervention appeared effective in reducing levels of agitation in selected patients who were receiv­ing continuous observation on nonpsychiatric units at a large, urban level 1 trauma center. Many patients ex­pressed gratitude for the diversion from their health issues. Further investigation into the effectiveness of this intervention and its impact on the use of medications or restraints is warranted.

The authors note that even the act of com­pleting the tool—the Personal Approach Form—was a valuable part of the intervention, because it “helped the observers to engage patients in conversation and aided in patients’ recall of positive experiences.” The Personal Approach Form is available through a link in the article.

To learn more, read the article (it’s free online), and listen to our podcast with two of the authors. And if you’ve cared for agitated patients or served as a sitter, please share your thoughts in the comments.

 
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