Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.

Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.

Undocumented errors.

Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.

And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, and while some […]

2017-10-04T09:57:24-04:00October 4th, 2017|Nursing, nursing students, patient safety|2 Comments
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Palliative Care: Often Overlooked in the ‘Acute’ Setting

Does this description of a patient sound familiar to you?

“… a 91-year-old man diagnosed with moderate Alzheimer’s disease, hypertension, and benign prostatic hypertrophy whose change in mental status has prompted hospitalization from a long-term care facility…. This is his third admission in five months with similar symptoms; each time he was given IV fluids and sent back to the long term care facility within a few days.”

Figure. Photo © Photofusion Picture Library / Alamy Stock Photo.

With minor adjustments in age, gender, and the exact illnesses involved, this paragraph describes patients that I cared for on a regular basis in a large medical center. I always found such patients frustrating, and sad. I was frustrated because it seemed all we could do was “patch them up,” send them back to the nursing home, and wait for their inevitable return; and sad because there seemed so little quality of life to reach for.

In AJN’s September issue (“Palliative Care in […]

2017-10-02T08:33:17-04:00October 2nd, 2017|Nursing|1 Comment
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AJN in October: Nursing Student Errors, Septic Shock Resuscitation, the Ethics of Workarounds, More

The October issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Original Research: Exploring How Nursing Schools Handle Student Errors and Near Misses

The authors investigate nursing school policies and practices for reporting and tracking student errors and near misses. The first part of a two-part series.

CE: Assessing Patients During Septic Shock Resuscitation

How to integrate capillary refill time and skin mottling score into the perfusion reassessment after initial fluid resuscitation—as recommended by revisions to the Surviving Sepsis Campaign six-hour bundle.

Obesity and Sexual Dysfunction: Making the Connection

Obesity affects patients’ general health, but does it affect their sexuality? A review of the evidence on obesity and sexual functioning, plus nursing considerations for addressing weight-loss strategies with patients.

Workarounds Are Routinely Used By Nurses—But Are They Ethical?

How nurses can be creative problem solvers without resorting to workarounds that may be ethical in intent yet potentially harmful in their consequences.

[…]

2017-09-29T08:30:14-04:00September 29th, 2017|Nursing|0 Comments
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Hospital Closings Hit Rural Communities Hard, But Aren’t Inevitable

Photo by Taylor Sisk/North Carolina Health News

Community hospitals across the country have been closing in recent years. Reasons given include system consolidations, rising costs of care, Medicare reimbursement issues, and changing models of health care delivery. Few hospital closures are welcomed by patients or employees, but those that take place in rural areas, where there may not be another hospital for many miles, often affect the local community with particular severity.

A double hit for local economies.

Not only do hospital closings in rural areas make access to health care a challenge, sometimes forcing local residents to drive many miles for care. But—as this month’s AJN Reports points out (“Will Rural Community Hospitals Survive?“)—rural hospital closings also have a ripple effect on a local economy, meaning lost jobs as well as lost revenue for ancillary businesses in the area.

Hospital that innovate may survive.

Despite current pressures, some rural hospitals are finding new ways to thrive. As the article describes in greater detail, hospital “survival strategies” include partnerships and “becoming increasingly creative with providing services,” including expanding the use of telehealth. […]

2017-09-26T09:45:27-04:00September 26th, 2017|Nursing|0 Comments
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A Closer Look at Preventing C. Diff Transmission

Clostridium difficile/ CDC

It’s estimated that Clostridium difficile (C. diff) causes about 450,000 infections and 15,000 deaths each year. Recently, on Facebook, AJN’s question of the week asked about isolation precautions for patients with C. diff. Most readers could not provide the correct answer to the multiple choice question.

In this month’s issue, “Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow” offers a quick update of the best ways to prevent C. diff infection and transmission in hospitalized patients.

Author and infection prevention nurse Nancy O’Connor explores the finer points of key basics, including the importance of maintaining a high index of suspicion for cases, performing excellent hand hygiene, and cleaning all surfaces in a case patient’s room with a bleach solution. (And did you know that if the patient remains in the same room posttreatment, after symptoms have resolved, the room should be terminally cleaned to avoid reinfection?)

Isolation precautions and C. diff.

So, what about isolation precautions, which need to be started as soon as C. diff is suspected? Most respondents to our Facebook question thought that standard precautions were sufficient until a C. diff diagnosis was confirmed. But if this “rule-out” patient with diarrhea is positive, does s/he begin to shed C. diff only after the infection has […]

2017-09-22T11:21:11-04:00September 22nd, 2017|infectious diseases, Nursing|0 Comments
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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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