Blood Glucose Meters in the ICU: Quick, Useful, But Regulatory Issues Still Unresolved

By Betsy Todd, clinical editor, MPH, RN, CIC

Photo © Life in View/Science Source. Photo © Life in View/Science Source.

Many time-saving clinical technologies are available today that were unheard of at the start of my nursing career. Have we always given careful thought to how this technology is applied? A controversy about the safe use of point-of-care (POC) blood glucose meters (BGMs) in the ICU is a case in point.

Quick, minimally invasive bedside blood glucose monitoring has become the standard of care in hospitals and nursing homes. Interestingly, though, the original FDA approval of POC BGMs was for at-home use only. But the agency waived any restrictions on inpatient use, as long as staff performing the tests were properly trained and the patients were not critically ill. The use of BGMs in critically ill patients is considered “off label.”

Early in 2014, the FDA proposed new regulatory requirements for BGM use in hospitals. Apparently in response to the FDA’s proposal, the Centers for Medicare and Medicaid Services then issued a memorandum of intent to cite and even fine hospitals for the off-label use of BGMs in critical care. A huge outcry from clinicians ensued. […]

2016-11-21T13:01:19-05:00April 6th, 2016|Nursing, nursing perspective|2 Comments

Fish Safety Concerns: Navigating the Waters

Considering the conflicting advice on eating fish that has appeared in the media over the past few years, the public is undoubtedly confused. Nurses and other health care professionals will likely find themselves having to address this issue, especially with pregnant and nursing patients and parents of young children, all of whom are likely to be concerned.

–(from “To Eat Fish or Not to Eat Fish” in the February issue of AJN)

Photo by Emilio Ereza/ag e fotostock Photo by Emilio Ereza/ag e fotostock

I’ve been hearing about the unexplained illness of a good friend’s close colleague for a number of months. Dozens of costly and invasive tests have been performed to explain her malaise, headache, chronic stomach and digestion problems, fatigue, dizziness, and so on. Recently, a potential culprit was identified: mercury poisoning. I don’t know all the facts, but her mercury poisoning may well have something to do with the fact that she eats sushi at least once a week, and perhaps a lot of other mercury-containing fish as well.

What does this have to do with nursing? Maybe a lot, in terms of providing sound nutritional advice to patients who might be at particular risk for mercury poisoning, or in […]

Friday Round-Up: When ‘Natural’ Isn’t ‘Safer,’ A Student Nurse Summit, a Walking Crisis, Chronicity

Please pardon the relative quiet of this blog this week. All our in-house and far-flung occasional correspondents are otherwise engaged, it seems. Blame the nice weather, if it’s nice where you are. Our editor-in-chief, Shawn Kennedy, is in Pittsburgh at the National Student Nurses Association (NSNA) convention. She’s presenting this afternoon (I think) on the new AJN iPad app, among other things (no, we don’t yet have one for the Kindle, but that may be on the way).

Shawn should have an update on her adventures with the next generation in nursing sometime early next week. So for now, almost entirely avoiding nursing news and health care reform, here are a few items of potential interest:

The Respectful Insolence blog, in reminding us that “natural” doesn’t always mean safer, points to an AFP article that highlights research drawing a connection between a widely used herbal remedy and the unusually high incidence of urinary tract cancer in Taiwan. Says the AFP article,

A toxic ingredient in a popular herbal remedy is linked to more than half of all cases of urinary tract cancer in Taiwan where use of traditional medicine is widespread, said a US study Monday.

Aristolochic acid (AA) is a potent human carcinogen that is found naturally in Aristolochia plants, an ingredient common in botanical Asian remedies for aiding weight loss, easing joint pain and improving stomach ailments.

While the FDA issued an alert about products containing this […]

Color Me Wrong – Medication Errors and Color Coding

By Peggy McDaniel, BSN, RN

There has been a recent push by some manufacturers to promote color coding for product identification. Of course, even with the best intentions, these color-coded products have not reduced the incidence of medical errors and may actually promote errors.

The February Nurse Advise newsletter from the Institute for Safe Medication Practices (ISMP) (click here to subscribe to the newsletter) reports a medication error in which a nurse injected oral medication from an oral syringe into a Bard PowerPICC (percutaneously inserted central catheter). The PICC line is manufactured in a purple color and may have been confused with an enteral feeding system from Covidien, which is the same shade of purple. Even though the nurse was using an oral syringe, she was able to hold it up tightly enough to the open female luer of the PICC tubing to inject the oral medication intravenously. This error highlights both a “misconnection” and a color-coding confusion.

[…]

2016-11-21T13:19:14-05:00February 19th, 2010|Nursing|1 Comment

FDA Commissioner’s Letter to Health Care Professionals About H1N1 Vaccine Safety

fluIMAGEBelow we reproduce a letter from Margaret Hamburg, Commissioner of the U.S. Food and Drug Administration (FDA), to all U.S. health care professionals. It explains why the FDA (and most experts) believe the current H1N1 vaccine is as safe as any of the seasonal flu vaccines that are produced using the same process. Many nurses remain reluctant to get the vaccine, as are many patients. Some we’ve heard from have changed their minds as they’ve seen the sudden and devastating effects of this virus on patients in their hospitals. We hope this letter will provide some context for thinking about the current H1N1 vaccine, and for addressing the concerns of patients.

Dear Healthcare Professional,

I am writing first to thank you for your extraordinary efforts during the 2009 H1N1 influenza outbreak. 

As this new infectious disease sweeps through communities across the country, you must juggle your usual patient care responsibilities with a special role in influenza response.  Delays in vaccine delivery and the persistence of myths about vaccination have not made your job any easier.  Thank you for rising to this public health challenge.

I am also writing to provide information that can be helpful as you talk to patients about the 2009 H1N1 influenza vaccines — the best tools we have to prevent severe illness and death caused by the virus. 

As the […]

2016-11-21T13:21:06-05:00November 13th, 2009|Nursing|1 Comment
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