Are Your PCA Pumps Accurate, and Working?

Device malfunction happens.

After orthopedic surgery several years ago, I awoke in the PACU to find nurses working frantically on one side of my stretcher. Simultaneously, I realized that my leg hurt. A lot. And with another moment’s awareness—awake enough now for my nurse’s brain to begin to kick in—I understood that all of the activity concerned my PCA pump.

neeta lind/flickr creative commons

One of the nurses noticed that I was stirring. “Your pump has malfunctioned. We can’t get the replacement to work. A third pump is on the way. I’m so sorry!”

The scramble for a replacement, and then another, probably lasted less than five minutes, but it was a pretty wild ride. My deep breathing in an attempt to control the pain gave me something to focus on, but it was a pretty weak effort up against bone pain in the immediate post-op period. I’m grateful that my nurses—there were at least three involved at that point—regarded the pump failure as an emergency.

But operator errors are more common.

Needless to say, then, I was particularly interested in a new study that appears in this month’s AJN. In “Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study,” Yoonyoung Lee and […]

2019-04-10T09:29:43-04:00April 10th, 2019|Nursing, nursing research, patient experience, Patients|0 Comments
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‘We Request Your Quiescent Contribution’: Predatory Publishers Are Absurd, But Not Funny

Multiple daily solicitations.

The screenshot below shows an excerpt from an email our editor-in-chief recently received. Editors at AJN receive multiple emails daily from mysterious publishers soliciting them for article submissions, important roles on editorial boards, or as conference speakers. If it weren’t alarming, it would be flattering. We’re not scholars and experts in sub-specialties of botany or engineering, in fossil fuel geology, neurosurgery, or, for that matter, microbiology. Our advice on such topics might well be dangerous, or at least irrelevant and wrong.

Some open access journals are highly respected in their fields; the journal that sent this letter also bills itself as open access, but if it contains legitimate articles on microbiology, and I’m not saying it doesn’t, they may find themselves with strange bedfellows.

Despite obvious warning signs, some authors are not deterred.

It’s impossible to keep ahead of the flood of such emails, most of which are characterized by typographical oddities and peculiar juxtapositions of tone. There are many other tell-tale signs of predatory publishers, most of which have little or no oversight from real content experts and no editing or filtering of content (one must simply pay a fee to be published or attend a conference).

But what’s most worrisome about this trend is that their strategy of casting […]

2019-02-28T11:46:34-05:00February 28th, 2019|Nursing, nursing research, writing|0 Comments
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Protocol to Reduce Hospital-Acquired Pneumonia Improves Outcomes, Lowers Costs

Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to […]

2019-02-06T09:10:07-05:00February 6th, 2019|Nursing, nursing research|0 Comments
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Workplace Violence Training: Beyond Tabletop Exercises 

Breaking the rules of ordinary nurse behavior.

Have you ever thrown a fire extinguisher at a hospital visitor?

In this issue, “Workplace Violence Training Using Simulation” describes how one Ohio health system employs classroom learning, hands-on defense techniques, and simulated violence scenarios to prepare staff for potentially violent situations, including the presence of an active shooter.

Part of this training involves learning how to break the rules of ordinary behavior. This is hard for nurses, because it’s so ingrained in us to protect and never to harm. Grabbing a fire extinguisher to throw at someone, even if that person is holding a gun, is not the initial reaction most of us would have in this situation.

“People often freeze or panic in response to acts of aggression, assault, or other violence, including shots fired,” note authors Robin Brown and colleagues. The remarkable workplace violence training that they have developed at their hospital aims to empower staff to respond effectively in dangerous situations. Key points of discussion include learning to

  • recognize the potential for violence in a patient or visitor,
  • identify our own behaviors that may trigger a person who already is upset,
  • and perhaps most importantly, overcome our panic and take action.

[…]

2018-10-12T10:25:56-04:00October 12th, 2018|Nursing, nursing research|0 Comments
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Who’s Listening to Hospitalized Patients with Hearing Impairment?

In my early years in nursing, attention to patients’ hearing deficits was a big deal. It was assumed that we couldn’t properly care for someone if that person couldn’t hear us. Every admission assessment included an appraisal of the patient’s hearing: “Hears ticking watch eight inches from each ear,” or “hears quiet conversation at three feet without difficulty,” or “patient states deaf in right ear,” or some other specific description.

When hearing difficulties were evident, a sign was prominently posted over the head of the bed, a note in red ink was written in the Kardex (those quick-reference summaries of key points on all patients that were updated daily), and a special label was affixed to the front of the (paper) chart.

A communication impediment, often ignored.

Why don’t we do these things anymore? I see little indication that the needs of a hearing-impaired patient are a clinical priority. The deficit is not noted on the whiteboards that seem to be standard issue in patients’ rooms today. As a hospital visitor, I watch with dismay as staff fail to acknowledge acutely obvious hearing impairments.

A family member has tumor-induced hearing loss in one ear, and I explain on every admission that people need to speak up when addressing him. I ask them to make use of his intact […]

2018-06-12T12:53:06-04:00June 12th, 2018|Nursing, nursing research, patient experience|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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