Archive for the ‘patient safety’ Category

h1

Nursing Homes Need Nurses

September 4, 2014

By Amy M. Collins, managing editor

nursing home

Photo by Ulrich Joho, via Flickr.

Recently, the Association of Health Care Journalists (AHCJ) released updated nursing home inspection data, which is “derived from a large file that is split up for easier use by members.” (Members get a data set containing three years of the most severe deficiencies found during inspections, as well as current ratings assigned by the Centers for Medicare and Medicaid Services [CMS]. To register for membership and gain access to more detailed information, click here.)

A news release put out by AHCJ based on their analysis of these ratings isn’t pretty. The latest number of deficiencies recorded by the CMS (which range from “isolated incident of actual harm” to “widespread immediate jeopardy to resident health or safety”) has reached 16,806.

Medicare ratings themselves have also been called into question in a recent article suggesting that nursing homes with the highest ratings may be gaming the system. Despite these ratings being the gold standard in the industry, the data they are based upon on is largely self-reported by the nursing homes and not verified by the government. Often, details such as fines and other enforcement actions by the state, as well as complaints filed by consumers with state agencies, are left out.

Could part of the problem be there aren’t enough nurses in nursing homes? An article in the New York Times states that, in evaluating Nursing Home Compare, the American Association of Nurse Assessment Coordination estimates that at least 11.4% of nursing homes don’t have RNs available around the clock (since data is self-reported, this could be higher). Yet studies show that care is improved when there are more RNs in nursing homes. (We published a 2005 original research study that found that increasing the amount of time that RNs spend with long-stay nursing home residents reduces pressure ulcers, hospitalization, and urinary tract infections.)

Anecdotally, I can say that I am sometimes dismayed by what I’ve seen in the nursing homes my grandmother has been in. There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever. I’ve spoken with nurses and nurses’ assistants working in these homes, and staff-to-resident ratio is always a common complaint of those working there. In my grandmother’s current home, residents are piling in by the dozen, while the number of staff seems to remain the same. Read the rest of this entry ?

h1

AJN’s September Issue: Anaphylaxis at School, Central Line Care, EBP, More

August 29, 2014

SeptemberAJN’s September issue is now available on our Web site. Here’s a selection of what not to miss.

It’s back-to-school time, and on our cover this month is a photo of Head Start nursing supervisor Travia Williams weighing a student in the program’s classroom at Cocoa High School in Brevard County, Florida. The program provides enrolled children with screening, physicals, and other health care services.

According to the National Association of School Nurses, a third of all school districts in the United States have reduced nursing staff and a quarter don’t have any nurses at all. Yet there is the potential for more emergencies in school now than ever, with school nurses treating increasingly complex medical conditions and chronic illnesses. For more on the important role school nurses play in handling these health emergencies, see the In Our Community article, “Emergency Anaphylaxis at School.” And don’t miss a podcast interview with the author (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).

Applying EBP to Practice. Despite the recognized importance of evidence-based practice (EBP), there continues to be a gap between the emergence of research findings and their application to practice. In this month’s original research article, “Staff Nurses’ Use of Research to Facilitate Evidence-Based Practice,” the authors used an online survey to determine to what extent RNs in an acute care multihospital system used research findings in their practice. Several barriers to such use were revealed, including lack of time and resources. This CE feature offers 3 CE credits to those who take the test that follows the article. Read the rest of this entry ?

h1

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 ?

h1

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 ?

h1

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 ?

h1

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 ?

h1

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 ?

Follow

Get every new post delivered to your Inbox.

Join 935 other followers

%d bloggers like this: