Archive for the ‘patient safety’ Category
August 22, 2011
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 doctors and nurses, nurses, professional identity, respect, what nurses really do | 2 Comments »
June 7, 2011
By Sylvia Foley, AJN senior editor
In 2008, more than 62,000 people who had undergone procedures at one of two southern Nevada endoscopy clinics were notified that “they might have been exposed to bloodborne pathogens, including hepatitis B virus, hepatitis C virus (HCV), and HIV, as a result of unsafe injection practices.” As author Lisa Black reports in this month’s CE–Original Research feature, a subsequent investigation by federal and state agencies found multiple breaches of infection control protocols. Indeed, 115 patients were found to be “either certainly or presumptively infected” with HCV through the reuse of contaminated medication vials.
Especially distressing was strong anecdotal evidence that because of a general fear of workplace retaliation, staff at the two clinics had often failed to report unsafe patient care conditions. At the request of the Nevada legislature, a study was conducted to examine Nevada RNs’ experiences with workplace attitudes toward patient advocacy activities. Black was the principal investigator. Read the rest of this entry ?
Posted in advocacy/political action, audio interviews, continuing education, ethical issues, infection control, legal issues, nurses, nursing perspective, nursing research, patient safety, public health nursing, Shawn Kennedy, AJN editor-in-chief | Tagged hepatitis C outbreak, infection control, Nevada whistleblower protection law, nursing research, patient safety, public health, Texas whistleblowers | 2 Comments »
May 27, 2011
As I walked into the exam room and introduced myself as a nurse practitioner, the patient announced she was “forced” to come to our clinic and “wasn’t allowed to see a real doctor” downtown. I was slightly taken aback. Here I was, running on time, in a pretty good mood and ready to assess and treat to the best of my abilities, and then WHAM. I took a deep breath and realized she wasn’t slamming NPs; she had a grudge against military providers, regardless of education background.
That’s from a recent post by a U.S. Air Force family nurse practitioner (NP) who’s been blogging from Afghanistan. She’s home now, and the post, about being discriminated against by a patient—not because she’s an NP, but because she’s a military provider—is worth noting as we prepare for another Memorial Day Weekend.
Memorial Day Flags/Eddie Coyote, via Flickr
Are you a nursing student, or just ready for a change in your nursing career? Curious about various nursing specialties and what they really involve? Codeblog has been running a helpful series of posts, each of which focuses on an interview with a particular type of nurse. The latest is with a cardiac catheterization lab nurse.
Nothing like a medication error to ruin everyone’s day. Lisa at In the Round has a useful post that lists the eight “rights” of medication administration.
“So there is very little, in the end, I won’t share. There are some things, however, that are beyond the pale. Here’s my short list of ten things I will never, ever tell you, my patient.” That’s from a recent post at Those Emergency Blues: “Don’t Tell Your Patient This. Or That.” Have a look and see if you agree.
Lastly, an article today on the NY Times “Well” blog summarizes the findings of a new report on the activity levels of Americans in the workplace. The basic idea is that we’re less active at work, and since we spend much of our time and energy at work, we’re also increasingly obese. Many nurses might dispute this finding if they spend their days on their feet. But it’s worth considering, as many of us prepare for a long holiday weekend full of opportunities to eat, relax, and also, yes, to get a bit of exercise—even if it’s only a matter of taking a daily walk after dinner in the lingering late May light. Or, as Sean at My Strong Medicine puts it, a little bluntly: “What Was Your Excuse for Not Exercising?”
Point taken.—JM, senior editor
Posted in nurse practitioners, nursing perspective, patient safety, writing and nursing | Tagged medication errors, Memorial Day Weekend, military nurses, nurse practitioner, obesity and work | 3 Comments »
May 25, 2011
By Sylvia Foley, AJN senior editor
There is strong evidence that a hospital’s use of a medical emergency team (MET) helps to decrease the rates of in-hospital cardiac arrests, unplanned ICU admissions, and overall hospital mortality. (A MET is similar to a rapid response team, but is typically led by a physician rather than by a nurse.)
But our understanding of such teams is incomplete. Nurse researcher Margaret Pusateri and colleagues set out to explore, in particular, the role of non-ICU staff nurses during a MET call. They wanted to better understand such nurses’ familiarity with and perceptions of the MET, and possibly, to increase the team’s effectiveness. So they sent a survey to 388 non-ICU staff nurses at a large urban teaching hospital; 131 nurses (34%) responded.
The authors report on the results in May’s CE feature (for optimum reading, open the PDF version). Among their findings:
- Nearly three-quarters of the respondents had participated in a MET call.
- The most common actions they reported taking during the call included relaying patient history, initiating the call, and documenting MET data.
- But fewer than half of the respondents agreed or strongly agreed with the statements “I feel comfortable with my role as a member of the MET” and “I know what my role as a member of the MET is.” Read the rest of this entry ?
Posted in continuing education, nurses, nursing perspective, nursing research, patient safety | Tagged evidence-based practice, medical emergency teams, MET, nursing research, patient safety, rapid response teams | 1 Comment »
April 15, 2011
The next day, as I prepared my medication tray with shaking hands, two physicians sat at the nurses’ station, talking too loudly as they discussed the medication error and wondered which nurse had made it. Overhearing them, I turned to confess, feeling like a marked woman. They muttered something in my direction, shook their heads, and quickly returned to their charting.
That’s an excerpt from fairly late in “Roger’s Angst,” the Reflections essay in the April issue of AJN. It explores the crippling shame, anxiety, and self-doubt that good nurses can feel when they make mistakes. And it suggests that no one, however conscientious they may be, is free from error in a long career—though few ever reveal their little secrets, even if we might all gain from the knowledge. A touchy subject, to say the least; we hope you’ll read the entire essay and consider weighing in with your own experience. Anonymous comments are, as always, fine.—JM, senior editor/blog editor
Posted in ethical issues, nursing perspective, patient safety, professional identity, writing and nursing | Tagged blood type, medical error, medication error, nurse | 4 Comments »
February 25, 2011
Image via Wikipedia
By Maureen Shawn Kennedy, AJN editor-in-chief
You may not remember February 11, 2010, all that well, but it’s a date nurse Anne Mitchell will never forget. It was the date she was acquitted of all criminal charges in a case that garnered widespread coverage not only in the nursing world (see our October 2009 report) but in the general media (see the New York Times article). Mitchell was the Texas nurse criminally prosecuted for filing a complaint with the Texas Medical Board against a physician for unsafe and substandard practices (that board did agree with her). She and a colleague found themselves embroiled in a nightmare in which they were fired, arrested, and indicted. (Charges were eventually dismissed against Vicki Galle and only Mitchell went to trial.)
The case raised questions about a nurse’s professional and legal duty to safeguard patients—and about the strength of whistleblower protections (Texas has a whistleblower protection law).
In a “what goes around comes around” scenario, this past February those who pressed the charges—the sheriff (who was a patient, friend, and business partner of the physician); the Winkler County attorney; the former hospital administrator; and the physician—were all indicted by a grand jury. Ironically, the indictment was partially for misuse of official information, the same charge they had brought against the nurses.
On February 18, I interviewed Mitchell, Galle, and another colleague, Naomi Warren, who also wrote a letter of complaint accompanying their letter to the Texas Medical Board but wasn’t prosecuted. In the interview (you can listen to the two-part podcast on our Web site, on the podcast collection page called “Conversations.”) Their description of what this experience did to their lives is chilling. Even so, their commitment to their patients is unyielding, and they say they would make their complaint against the physician again without question.
I hope nursing faculty will highlight this case and these courageous nurses to their students.
Posted in audio interviews, ethical issues, legal issues, media depictions of nursing, nursing perspective, patient safety, professional identity, Shawn Kennedy, AJN editor-in-chief | Tagged cleared, Indictment, nurse, patient safety, whistleblower, Winkler County Texas | 1 Comment »
February 17, 2011
By Shawn Kennedy, AJN editor-in-chief
By Alan Cleaver/via Flickr
I saw the following headline this week: “LA woman dies in her cubicle at work; body is not discovered until the following day.” The article said it was unclear how she had died. I hope it was at the end of the day after everyone had left; I really hope they don’t find out that she died midday, amidst coworkers who were going about their business. Maybe they were so busy that they never noticed the silence from her cubicle.
This story reminded me of two articles I read recently. One was an article that will be published in the Emerging Infections department in our March issue, which goes live at the end of next week on ajnonline.com. “The Contact Precautions Controversy” examines the issues around placing patients on contact precautions and in isolation—an approach that many hospitals use almost routinely for some patients. (We covered this issue in a news piece last July as well.) Recent studies are raising questions about this practice and the risks to these patients, who often have fewer interactions, get less care, and may feel neglected because health care providers limit contact.
The other article is one that’s in the headlines now. The Boston Globe ran a story about an investigation into patient deaths that came about as a result of alarm fatigue. Alarm fatigue is a growing problem—health care workers are often bombarded with so many alarms that the sounds fade into background noise and critical incidents are missed. Having a monitor that sounds an alarm to alert nurses to a problem—traditionally a source of reassurance for patients—doesn’t necessarily mean someone will respond when you’re in need.
Nurses are the sentinels in hospitals, the ones patients rely on for safe passage through a hospital stay. Our patients can’t afford for us to be on autopilot, rushing to get tasks done without thinking and without being aware of what’s going on. Patients depend on our ability to look past the obvious and recognize the subtle, insidious changes that matter. This isn’t being dramatic—it’s a very real fact of what we do, and we can’t ever forget it. Read the rest of this entry ?
Posted in nursing perspective, nursing research, patient perspective, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged alarm fatigue, Boston Globe, contact precautions, infection control, investigation, isolation in hospitals | 4 Comments »
February 1, 2011
By Sylvia Foley, AJN senior editor
Never to lie . . . by flickrohit, via Flickr
Picture this: “Mimi,” an 18-year-old Brazilian girl who speaks little English, arrives in your ED with injuries sustained in a beating. She’s accompanied by an older man who refuses to leave her side and who intercepts and answers questions directed at Mimi. The ED physicians and nurses treat Mimi’s injuries and release her back to this man’s care. Maybe you feel uneasy, but what can you do? Maybe the man really is her uncle; maybe he’s just being overprotective.
In fact, Mimi is a victim of human trafficking, and the man who brought her to the hospital is both her pimp and her trafficker. And you and your colleagues just missed a chance to intervene on her behalf. Unfortunately, you’re not alone. In “The Role of the Nurse in Combating Human Trafficking,” a February CE feature, author Donna Sabella notes that clinicians who encounter victims of human trafficking often don’t realize it, and many such chances to intervene are lost. Sabella, a nursing professor active in helping such victims, hopes to change this. Read the rest of this entry ?
Posted in advocacy/political action, audio interviews, children's health, continuing education, human rights, nurse practitioners, nurses, nursing students, patient safety, practice tips | Tagged human trafficking, labor trafficking, modern slavery, sex trafficking | 1 Comment »
January 17, 2011
Image via Wikipedia
By Maureen ‘Shawn’ Kennedy, AJN editor in chief
On January 13, news from Texas let nurses everywhere take heart that, sometimes, the system works. According to a report by the Odessa American, the Winkler County, Texas, officials, Sheriff Robert Roberts and attorney Scott Tidwell, who had filed charges against whistleblower nurses Anne Mitchell and Vicki Galle, have been indicted on felony charges of misuse of official information. The hospital administrator who fired the two nurses, Stan Wiley, was also indicted. For more on the story, which we’ve kept a close eye on since October 2009 in our news reports and on this blog, see this ABC World News article; the Texas Nurses Association also has an archive of the case.
In a separate civil suit against the county, Mitchell and Galle were awarded $750,000. Very excellent.
Why is this so exciting and significant? The case outcome supports nurses who raise concerns about unsafe patient care and upholds the nurse’s right—duty, really—to advocate for patients. Hopefully, the nurses’ victory and the award from the civil suit will give pause to those who think they can intimidate nurses who are acting on good conscience and within legal and ethical boundaries.
Kudos to the courts for realizing who the real criminals are.
Posted in ethical issues, legal issues, media depictions of nursing, nursing perspective, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged ethics, nurse, Odessa American, whistleblower, Winkler County Texas | 3 Comments »
December 1, 2010
Hospital Bed-2/Timm Suess, via Flickr
Peggy McDaniel, BSN, RN, is an infusion practice manager and occasional blogger
As a nurse working in the quality improvement and patient safety arena, I’m not surprised that the title of a recent article at Fierce Healthcare got my attention: “Hospitals Are Bad for Your Health.” The article highlights a recently released report from the Department of Health and Human Services Office of Inspector General based on a study of Medicare patients discharged in 2008. Among other things, it revealed that “44% of adverse or temporary harm events were clearly or likely preventable.” The usual culprits were to blame:
- infections
- medication errors
- surgery-related errors
- patient care issues
Most of these have been previously labeled as “never events” by the Centers for Medicaid and Medicare Services (CMS), and currently hospitals are not being reimbursed for the costs incurred if one or more of these happen to a patient while in the hospital. CMS was the first to implement such a pay-for-performance model—and major insurance companies have followed their lead.
In recently published NEJM study, 63% of the adverse events reported in the hospitals studied were deemed preventable. This study was disheartening because we recently passed the 10-year anniversary of the release of the Institute of Medicine’s Report, “To Err is Human,” (pdf) and now know that real progress to reduce harm to patients has been moving at a snail’s pace.
As I blogged here previously, there have been some pockets of significant improvement, such as the implementation of checklists. That said, we have a long way to go to reduce the occurrence of preventable harm to our patients. This statement from the article I began this post with, that “hospitals kill an estimated 180,000 people a year due to adverse events,” should get your attention. It certainly kept me reading.
I also hope it is a call to action for nurses, since we are often the last stop before a medication or treatment touches a patient. Read the rest of this entry ?
Posted in infection control, nursing perspective, patient safety | Tagged CMS, deaths, Institute of Medicine, IOM report, medical errors, Medicare, patient safety, preventable adverse events, To Err is Human, United States Department of Health and Human Services, what can nurses do to promote safety in their hospitals? | 3 Comments »
