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
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Nursing Insights: The Experience of a Chronic Illness as a Series of Subtractions

Illustration by Janet Hamlin for AJN. All rights reserved. Illustration by Janet Hamlin for AJN. All rights reserved.

Chronic illness is often experienced by patients as a series of subtractions. A progressive illness like Parkinson’s reveals this process vividly as the ability to move, speak, care for oneself, all gradually disappear or diminish.

The grief of lost freedom, lost abilities, lost agency, lost avenues of communication is easy to overlook. But it’s real, and can come out in uncomfortable ways. Here’s an excerpt from the start of this month’s Reflections essay in AJN, “A Room With a View.”

David was in his late 50s and had been diagnosed with Parkinson’s disease several years previously. Following a lengthy hospitalization, David’s wife agreed to a placement on the subacute/rehab unit in the facility where I was the instructor for nursing students during their older adult clinical rotation. . . . Although ravaged by the disease, David seemed to like having students provide his nursing care. . . .

One of his favorite activities was sitting by his room window, which overlooked the facility gardens and a play area for the preschool next door. For several weeks, I discovered a nursing student and David sitting by the window watching the outdoor activities in companionable silence. […]

2016-11-21T13:01:19-05:00April 4th, 2016|Nursing, nursing perspective, nursing stories, patient engagement|0 Comments
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‘Applying QI to Care in Nursing Homes’: A Nurse’s Take on the Tools Needed for Change

nursing homeA colleague once remarked, “Isn’t it strange that the universal response to hearing that someone has gone into a nursing home is ‘Ugh’?”  As nurses, we might hazard a guess as to what kind of care the new resident may receive. But is there a way to reenvision the care that we provide in nursing homes?

In AJN‘s April Viewpoint essay, NP Heather Walker argues that there is, and that quality improvement (QI) can be an effective tool for change. Walker suggests that QI can do for nursing homes what it has done for acute care: focus attention on the systemic issues that stand in the way of good nursing. As she says in the article,

“QI doesn’t negate personal responsibility, but it broadens the focus so that systemic problems are taken into account.”

The QI process fosters reflection, accountability, and teamwork, which in themselves can improve the work environment and residents’ living experience. For more information about this approach, read the short article, here.—Betsy Todd, AJN clinical editor, MPH, RN, CIC

 

2016-11-21T13:01:19-05:00March 31st, 2016|career, Nursing|0 Comments
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‘Cold Calls’: Tips for Nurses When the Patient Just Got the Bad News

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog. Illustration by the author.

Julianna_Illustration_Cold_CallsIt’s difficult to choose which is more difficult: That moment before dialing the number of someone I’ve never met soon after they’ve received a cancer diagnosis, or the moment standing in the doorway before entering the hospital room occupied by someone I’ve also never met soon after their cancer diagnosis.

These scenarios are the health care version of a cold call. I manage them daily.

The term cold call generally refers to marketers calling someone without prior introduction with hopes of convincing them to buy their product. In the arts community, cold calling refers to an artist walking in off the street with a portfolio in the hopes of convincing a gallery owner to exhibit their art. Rarely are either appreciated.

Most nurses involved in patient care make cold calls. Walking into the room of a patient you’ve never met is a cold call. Starting an IV on someone else’s patient or in one you’ve just met is a cold call. A cold call occurs when the unconscious patient brought to the ED opens his eyes and your face is the first thing he sees.

Lots of things about nursing are difficult. For the novice and experienced alike, walking into a patient’s room after they’ve received news they or their loved one will […]

2016-11-21T13:01:20-05:00March 29th, 2016|Nursing, nursing perspective, patient engagement, Patients|0 Comments
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AJN in April: Nurses and Self-Care, Late HL Treatment Effects, POC Blood Glucose Meters in ICUs, More

AJN0416.Cover.Online

On this month’s cover is a 1924 portrait of the Grace Hospital School of Nursing basketball team in Detroit. Most nursing schools had basketball teams in their early days—as far back as the 1920s. This photo of the Grace Hospital team was featured in the September 1924 issue of AJN in an article on basketball in Detroit nursing schools.

Understanding the importance of maintaining physical well-being is a fundamental aspect of nursing. For a variety of reasons, including competing priorities and the demands of caring for others, nurses may not practice sufficient self-care. To read a study that analyzed how today’s RNs fare in terms of health-promoting behaviors like physical activity, stress management, and more, see “Original Research: An Investigation into the Health-Promoting Lifestyle Practices of RNs.” While “physical activity and stress management scores were low for the entire group of RNs,” there were some notable differences between age groups of nurses.

Some other articles of note in the April issue:

CE Feature: “Cardiotoxicity and Breast Cancer as Late Effects of Pediatric and Adolescent Hodgkin Lymphoma Treatment.” This second article in a series on cancer survivorship care from Memorial Sloan Kettering Cancer Center reviews the late adverse effects associated with the management of Hodgkin lymphoma (HL). Nurses’ familiarity with and attention to the late effects of the chemotherapy and radiation therapy used to treat HL, which include breast cancer as well […]

2016-11-21T13:01:20-05:00March 25th, 2016|Nursing, nursing research|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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