Posts Tagged ‘nurses’

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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 ?

Posted in patient safety | Tagged , , , , , , , | Leave a Comment »

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On Protocols, Shortcuts, and the Unforgettable Smell of Ether

November 9, 2011

By Linda Johanson, EdD, RN, associate professor of nursing at Appalachian State University, Boone, NC

In nursing school my professors warned us of the dangers of taking shortcuts when performing procedures. They cautioned that deviations from protocols could lead to serious error. I had to learn this lesson the hard way, and although it’s been about 30 years since I made this mistake, I still remember the occasion like it happened yesterday.

The patient was in ICU bed #10, a glassed-in isolation room across from the nursing station. He was in his mid-60s, but he was mentally handicapped, so he appeared and acted younger. He was in the unit recovering from a respiratory arrest, and on the day I was caring for him he was still intubated, but breathing spontaneously.

by james bowe, via flickr

I was completing an assessment on him when the charge nurse called to me from the nursing station, and I stuck my head out the door to see what she wanted. She told me there was a new order to remove the patient’s indwelling urinary catheter. I checked my pockets for a 10 mL syringe to perform the procedure but didn’t find one.

When I complained about having to go all the way to the supply room to collect one, the charge nurse queried, “Well, you have scissors, don’t you? You can just cut the catheter with them. The balloon will deflate, and it will pull right out. I’ve done it a hundred times.”

Cut the catheter? I had never heard of that before, but I was a relatively new nurse, so I hadn’t been exposed to a lot of things yet. Of course I had scissors right in my pocket, and I got them out. Was this an example of one of those unacceptable shortcuts we’d been warned about in nursing school? It would sure be quicker and easier than running all the way to the supply room.

I approached the patient, who although unable to comprehend what was happening, seemed to regard me with a trusting expression. I exposed the catheter and opened my scissors to a spot about one inch from its point of entry. I hesitated for one brief second, then snipped the tube. I gave the catheter a little tug, and the patient winced. The tube stayed firmly in place, the balloon obviously fully inflated. Read the rest of this entry ?

Posted in nursing perspective | Tagged , , , , , , | 8 Comments »

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Changes in Latitude: Comparing Health Care Systems with Nurses Down Under

October 26, 2011

By Peggy McDaniel, BSN, RN, who writes the occasional post for this blog and currently works as a clinical liaison support manager of infusion in Australia, New Zealand, and Asia Pacific.

latitude lines/ wikimedia commons

I recently found myself sitting on a boat, enjoying a “sausage sizzle,” dressed as a pirate no less. In Australia, a party that includes barbecued meat usually includes sausage; thus the name. The pirate theme was an added bonus. As an American and a nurse, I was pleasantly surprised to find myself seated at the same table as two Australian nurses. What were the chances of that? The conversation that evening gave me some insight into the Australian health care system, which I am just getting familiar with.

Comparing health care systems. Once we all realized we were experienced nurses and shared the belief that quality patient care should always be the primary focus of health care, the conversation turned to cost. In Australia, there is a public health option that all Australians can access. It is paid for by taxes. If you choose to do so, you can also purchase a private plan to supplement this public option. I have yet to determine what part, if any, employers play in paying for health care or private insurance. However, a sick Australian will always get care and not incur a lifetime of debt for that care within their public health care system.

My fellow nurses were amazed to hear that in the U.S., you may not have health insurance for a variety of reasons. One of the nurses purchases private insurance as a “backup” to public care. She used this coverage for an elective procedure, chose her own surgeon and private hospital, and was able to schedule the procedure in a timely manner. This same nurse admitted that if you need a new hip or knee and you only have public coverage, you may have to wait for up to a year. However, if you have cancer and need treatment, it will start promptly after diagnosis, whether or not you have private insurance or not.

Both nurses asserted that the care for acute and emergent issues is of high quality in the public hospitals. They were able to give me examples of how the system works, from a personal and work perspective.

As in the U.S., hospitals here in Australia are struggling with the rising costs of health care. The public hospitals in each state utilize their group buying power to purchase supplies and equipment, which helps keep costs down. The private hospitals often have a bit more polish and shine, but all the hospitals strive to give Australians high quality care and the nurses I’ve met are passionate about that goal.

Imitate the American system? One of the nurses I chatted with exclaimed, “Our politicians keep telling us that we should be more like the American system, but I think that’s a mistake. What do you think?” Admittedly, I have much to learn about Australian health care, but so far I have to agree with her. As an American who has gone without health insurance because I was rejected due to preexisting conditions and was not employed full-time, I thought this system sounded pretty reasonable. The Australian nurses certainly felt that anything less would be unacceptable. Read the rest of this entry ?

Posted in health care reform, international nursing, nursing perspective | Tagged , , , , , | 36 Comments »

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Domestic Violence Screening Matters

October 12, 2011

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

I am a nurse. I am a doctoral candidate and a writer. I am a domestic violence survivor. I lived for years with fear and uncertainty—will this be a good day, a day of laughter and affection? Or a brutal day of fists and humiliation? Like many women experiencing domestic violence, I hid it from my family and friends. In fact, I even hid it from myself. I couldn’t see myself as a battered woman, wouldn’t accept that I was that kind of person. But domestic violence doesn’t happen to a certain kind of woman—it happens to anyone, rich or poor, college educated or high school dropout, urban and rural, of every ethnicity. We—you and I—all are the faces of domestic violence.

Just ask. October is National Domestic Violence Awareness Month. How many of your patients have you asked about domestic violence this month? Or any month? Twenty? Ten? None? Screening matters. One of every four women you see has experienced domestic violence. Research tells us that women will talk about it when asked by a provider that they feel cares and can be trusted. They will leave an abusive situation when they feel supported and resources are available to them. Read the rest of this entry ?

Posted in advocacy/political action, human rights, patient perspective | Tagged , , , , | 5 Comments »

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What One Thing Will Make Today Better for You?

September 12, 2011

As I entered Mr. Ricker’s room, I remembered that the night nurse had mentioned that his wife had been with him overnight. I knocked very lightly and opened the door a crack. The two of them were cuddled up closely in the bed.

“What One Thing Will Make Today Better for You?” That’s the title of the Reflections essay in the September issue of AJN, in case you thought a genie had materialized out of the steam from your afternoon coffee mug. A simple question, but one that author Susan Goff has used since the 1970s with her patients. Sometimes the answer is surprising—that is, sometimes we shouldn’t assume we know what patients want . . . or need. Sometimes, in the case of the patient she describes in this essay, there’s something that should trump NPO. We hope you’ll read the essay and let Susan know your thoughts in our comments section below.—JM, senior editor


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

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Remembering 9/11: Nurses Were There

September 9, 2011

By Shawn Kennedy, editor-in-chief

AJN September cover: 'America the Beautiful,' copyright Charles Kaiman

One can find many commemorative events for the 10th anniversary of 9/11 being held in those places (New York City, Washington, DC, and Shanksville, Pennsylvania) where planes hit, and in other cities as well. Some are appropriate and done well and others are (at least to me) over-the-top and tactless—like one New York City radio station playing tapes of the confusion and chaos from first responder radio transmissions; families and friends of victims don’t need to hear that and think of what their loved ones were going through in their final moments.

How we saw it then. AJN’s offices are located in New York City. In 2001, we could see the burning World Trade Center from our windows and we wrote about about our experiences and thoughts. We knew nurses would be in the forefront of responding to help, so we reached out to nurses here in New York and in the Washington, DC, area in order to report on what nurses there were doing. And we also carried a Viewpoint essay, in which one of our Muslim colleagues reported on the backlash that she was experiencing and made a plea for tolerance.

Our current coverage. In planning this September issue, we wanted to acknowledge the events in some way—hence our cover (thumbnail illustraton above) by artist and nurse Charlie Kaiman, who witnessed the events (see also his artwork from 2001 conveying that experience; click “View Full Text” at the link) and subsequently moved out of New York City; the guest editorial by disaster preparedness expert Tener Goodwin Veenema, who takes stock of nursing’s readiness; and an AJN Reports story by former managing editor Joy Jacobson, who revisited several nurses who were directly involved in or whose careers were changed by the events of 9/11.

The nurses who died. As we reflect on how the events 10 years ago changed our country and our lives, we should remember the nurses who died that day. For a few of them, it was a matter of happenstance and bad timing. For most of them, it was because they were doing their job—whether as a company health nurse or as a  firefighter or police officer—but they were nurses all.

Nurses Killed on September 11

Touri Bolourchi, 69, retired nurse, passenger aboard United Airlines Flight 175

Lydia Bravo, 50, occupational health nurse at Marsh & McLennan Companies, Inc.

Ronald Bucca, 47, fire marshal, New York City Fire Department

Greg Buck, 37, firefighter, New York City Fire Department, Engine Company 201

Christine Egan, 55, community health nurse visiting from Winnipeg, Manitoba, Canada

Carol Flyzik, 40, medical software marketing manager, passenger aboard American Airlines Flight 11

Debra Lynn Fischer Gibbon, 43, senior vice president at Aon Corporation

Geoffrey Guja, 47, lieutenant, New York City Fire Department, Battalion 43

Stephen Huczko, 44, police officer, Port Authority of New York and New Jersey Police Department

Kathy Mazza, 46, captain, Port Authority of New York and New Jersey Police Department, and commanding officer, Port Authority Police Training Academy

Michael Mullan, 34, firefighter, New York City Fire Department, Ladder Company 12

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Posted in art and nursing, disaster care, nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | 8 Comments »

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Patient Privacy and Company Policy: What Nurses Should Know About Social Media

August 26, 2011

Should you be able to have an online discussion about hospital policies that aren’t working or are unfair? What if the point of your discussion is to improve working conditions or to troubleshoot and not to cast an uncomplimentary light on your employer? Right now, the answer is “good question.”

If you’re a nurse or health care worker of any sort, if you sometimes use one or more of the many available social media options (Facebook, blogging, Twitter, etc.), if you’re worried about what it’s OK for you to do or say online, if you have a job or are thinking of looking for one, we strongly suggest you take a look at this month’s iNurse column in AJN (quoted above).

In it, Megen Duffy, RN, aka blogger Not Nurse Ratched, considers such issues as the following:

  • hospital social media policies (always read them; some are surprisingly restrictive)
  • HIPAA and potential issues raised by blogging about aspects of work
  • the ways your social media history may be mined by HR departments at prospective employers
  • the reasons why she strongly believes that social media isn’t going away and has many potential benefits, despite various well-publicized pitfalls—and why nurses need to let their input be known so that social media policies will be sane and balanced

And, since this is social media, we hope you’ll let us know your thoughts, in the form of comments. Maybe Megen will even weigh in, if you really get her attention.—Jacob Molyneux, senior editor

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Posted in ethical issues, legal issues, professional identity, social media | Tagged , , , , , | 6 Comments »

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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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Fecal Impaction and Dementia: Knowing What to Look For Could Save Lives

August 4, 2011

By Amy M. Collins, associate editor

Photo by Sevda Cordier-Dirikoc / GE Healthcare, via Flickr*

Last October, I wrote a blog post about my grandmother, who is 85 and suffering from the first stages of Alzheimer’s disease, and about the failure of many providers to assess and treat the underlying cause of a sudden and extreme acceleration of her dementia symptoms (mania, agitation, and violence, along with nonstop, nonsensical talking).

The post generated a slew of comments on both the blog and Facebook, with over 20 nurses suggesting the probable cause for her symptoms to be fecal impaction or urinary tract infection. They were right. But several physicians and specialists had been shockingly wrong, diagnosing her with everything from closet alcoholism to VERY-late-onset bipolar disorder.

My grandmother did, in fact, have a severe fecal impaction, finally diagnosed—after several weeks of family turmoil—by a nurse in an ED. She was treated, and within a few weeks her symptoms slowly dissipated. I’m happy to say that she’s now back to her sweet and gentle self, with no memory of the episodes she herself would have deemed crazy.

Although her Alzheimer’s symptoms are still heartbreaking (she recently introduced me to a fellow assisted-living resident as her ‘special friend’ instead of her granddaughter), she isn’t agitated, hallucinating, accusing people of stealing, or showing other signs of the previous mania. At a recent family visit, she spoke of her plans to attend a luau at her facility, and requested a grass skirt!

Chronic constipation in the elderly isn’t a rare occurrence, especially in patients with dementia, but unfortunately the outcome may not always be as favorable as in the case of my grandmother. Our August CE by Leah Craft and Joseph A. Prahlow, “From Fecal Impaction to Colon Perforation,” describes the case of a woman in her 70s, nonverbal and suffering from Alzheimer’s disease, who developed a fecal impaction and eventually died. Read the rest of this entry ?

Posted in nursing perspective | Tagged , , , , , | 1 Comment »

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Getting Osteoarthritis on Nurses’ Radar

July 27, 2011
Osteoarthritis of the left knee. Note the oste...

Osteoarthritis of the left knee. Image via Wikipedia

By Shawn Kennedy, AJN editor-in-chief—Louise Murphy, an epidemiologist at the Centers for Disease Control and Prevention (CDC) gave these stunning statistics to an audience gathered in the conference center at the Hospital for Special Surgery in New York City last week:

  • Twenty-seven million U.S. adults (pdf) suffer from osteoarthritis (OA), mostly in the hands, hips, and knees.
  • Data from the National Ambulatory Medical Care Survey 2006–2007 showed that OA was the reason for 12.3 million visits to primary care providers, 85 thousand ED visits, and 921 thousand hospitalizations in 2009.
  • In 1997, there were 400,000 total knee or total hip replacements; that number had increased to 900,000 by 2009.
  • One study put lifetime risk by age 85 at one in two for knee arthritis (two in three for obese individuals), and one in four for arthritis of the hip.

The audience included over 45 nurses, physicians, physical therapists, and other health professionals. We met July 14 and 15 to identify what keeps patients from accessing health services and from getting evidence-based care for OA. This ‘state of the science” project is a collaboration among AJN, the Hospital for Special Surgery, and the National Association of Orthopaedic Nurses.

The missing nursing perspective. In 2010, the CDC and the Arthritis Foundation published “A National Public Health Agenda for Osteoarthritis,” which details a three-year plan to reduce the disease burden of OA by promoting evidence-based treatment to delay onset or reduce progression of the disease. What became apparent was the absence of nursing participation in this effort. While there are many nurses who do provide care for patients with arthritis, that care is usually at the point where patients are having joint replacement surgery, or it’s incidental to other care patients are seeking. Read the rest of this entry ?

Posted in nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , | Leave a Comment »

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