In Colorado EDs, ‘Alternative to Opioids’ Pilot Project Exceeds Goals

Ashley Copeland talks to her mother in the Swedish Medical Center ED. Copeland was treated for a severe headache with a nerve-blocking anesthetic, but no opioids. (John Daley/CPR News)

Last year, in an effort to address the state’s acute opioid abuse problem, several Colorado health care organizations—including the Colorado Emergency Nurses Association—worked together on an intervention to target patients admitted to the ED with pain. The plan? Implement a pain management program to promote alternative strategies, with a goal of decreasing opioid usage by 15% in the participating EDs.

As discussed in a June news article, the program, which was piloted in 10 hospitals and involved heavy involvement from nurses, surpassed its goal: opioid usage during the intervention period (as measured in morphine equivalent units) was 36% less than in the previous year.

The […]

2018-06-14T09:29:35-04:00June 14th, 2018|Nursing, patient experience|1 Comment
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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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The Risks and Benefits of Transfusion Therapy

Potential complications of transfusions.

Photo © GARO / PHANIE / agefotostock

If your patient develops mild jaundice or thrombocytopenia two weeks after a blood transfusion, would you consider their transfusion history an important part of your assessment?

When I think of monitoring a patient who is receiving a blood transfusion, I think primarily about watching for a hemolytic transfusion reaction or circulatory overload. To me, that means keeping a close watch during the transfusion and for about 24 hours afterwards. Yet “classic” hemolytic reactions and volume overload are not the only potential complications of blood therapy. Delayed reactions can occur days or even weeks after you’ve run through your saline flush and disposed of the blood bag.

Update of current transfusion practices.

In this month’s AJN, Margaret Carman and colleagues provide readers with an update of current practices in transfusion therapy. In “A Review of Current Practice in Transfusion Therapy,” the authors survey the benefits and risks of fresh whole blood (used today primarily in military or disaster settings) and blood components—red blood cells, plasma, cryoprecipitate, and platelets. […]

2018-05-29T11:19:05-04:00May 29th, 2018|Nursing, patient safety, Patients|0 Comments
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What the Patient Knew: Communication and Patient Safety

Anticipating emergencies.

by rosmary/via Flickr

At the start of every shift after receiving report, I take a moment to consider what emergencies I might anticipate for my particular patient in our PICU. Monitor for excessive bleeding in a liver failure patient. Monitor for an altered neurological status in a patient with a head bleed. I try to envision how I would start CPR in the room if required. I try to be thorough in checking that all my emergency equipment is present and working. I try to keep patient safety at the forefront of my mind and priorities.

I came to work one day and received report about my 9-year-old patient who was post-operative day one from a planned craniofacial surgery. He would remain nasally intubated with eyes sutured shut for a few days until the swelling had reduced, and then would return to the OR to be extubated and to have the eye sutures removed. I’d had patients like him before and felt he would be very easy to keep safe, especially given that per handoff report, he was comfortably sedated and not overly agitated when he did briefly waken with nursing care.

A patient’s question.

As I got to know him through the first couple hours of my shift, I found that he was indeed comfortably sedated though […]

2018-05-24T10:08:09-04:00May 24th, 2018|Nursing, patient safety, Patients|0 Comments
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A Moment of Mindfulness: A Nurse’s Mosaic to Remember Patients

A Moment of Mindfulness © 2018 by Tilda Shalof

Noted author Tilda Shalof spent 28 years as an ICU nurse at Toronto General Hospital in Toronto. Over the years, she collected the discarded plastic medical packaging—including medicine caps, tube connectors, and vial lids, all of it sterile. At the suggestion of friend and artist Vanessa Herman-Landau, they used the plastic pieces to create this 4 ft. by 9 ft. mural, which is featured on AJN‘s May issue Art of Nursing page (click through to the PDF version for the best image).

[…]

2018-05-11T08:40:36-04:00May 11th, 2018|Nursing, Patients|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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