Nurses vs. Computers: Predicting Risk of Patient Harm

Not All Signs of Potential Harm Are Quantifiable

From chego101, via Flickr

Hospital nurses have many, many responsibilities and tasks, but one of the most important is to ensure patient safety by assessing patients for changes that can signal worsening of a condition or a new potential harm. Creating special units like ICUs, recovery rooms, and step-down units; flags on charts; various alarmed monitors; and safety huddles are a few of the ways hospitals have tried to identify potential problems. Now we have computerized tools to do this—or do we?

The complaint I have heard most from nurses about the electronic health record (EHR) is its inability to capture all the nuances of patient care or various patient problems, especially those that don’t involve easily quantifiable measures like heart rate or lab values. (For more detail, read our November 2016 report on nurses’ concerns with EHRs.)

One cannot accurately use a check mark to convey certain patient behavioral parameters or the “can’t put my finger on it but something’s going on with this patient” assessment that experienced nurses often make. In the April issue of AJN, we published an important study that investigates just this issue: “Identifying Hospitalized Patients at Risk for Harm: A Comparison of Nurse Perceptions vs. Electronic Risk Assessment Tool Scores

Deciding Whether to Implement an Electronic Risk Tool

Researchers […]

Nurses and Patient Safety: Parallel Histories

Photo from AJN archives.

I’m especially pleased that one of the CE articles in the February issue focuses on nursing’s role in creating a safe environment for patients: “Nursing’s Evolving Role in Patient Safety.” And in full disclosure, I was excited to see that the authors used the AJN archives to chronicle how nursing addressed (or didn’t address) safety issues around patient care.

From the earliest days of nursing through to the current complex systems in which we practice, nurses have been the health professionals responsible for ensuring safe passage of patients through the health care system. From Nightingale’s criteria for creating a healing environment to the “5 rights of medication administration,” patients rely on nurses to act as sentinels.

The authors reviewed 1,086 AJN articles from 1900 to 2015 and conducted a content analysis to identify patient safety themes. Aside from uncovering many fascinating (and sometimes alarming!) details of former health care practices, the authors drew this general conclusion:

“Emphasis on patient safety increased as patient care became more complex. As nurses developed a professional identity, they often put a spotlight on safety concerns and solutions.”

Here’s a quote from a nurse who wrote in 1908 about nurses’ duties: […]

Nurse-Led Evidence-Based Sleep Program Helps Hospitals and New Mothers Keep Babies Safe

Photo © Associated Press. Photo © Associated Press.

I can remember, when I was pregnant, reading everything I could get my hands on about every mother’s fear—sudden infant death syndrome (SIDS). My mother, who followed the norms of her time when I was born, was surprised that my son’s crib was bare—no blankets, pillows, toys, or bumpers. He wore a sleep sack and was placed on his back to sleep until he began to roll over by himself.

To add to what I learned from my preparatory reading, the nurses at the hospital I gave birth in set a standard for how to care for my newborn—explaining the abovementioned safe sleep tips, and much more. After all, nurses are probably a mom’s first stop for this information, helping new mothers navigate the choppy waters of caring for their newborns.

This month’s Cultivating Quality article, “An Evidence-Based Infant Safe Sleep […]

2016-11-21T13:00:48+00:00 November 18th, 2016|Nursing, patient safety, pediatrics|11 Comments

Dosing Cups, Oral Syringes, or Spoons: A Pediatric Medication Safety Recipe for Disaster?

pediatricdosingA recent article I came across in Pediatrics said that researchers found (during laboratory experiments) that four out of five parents made at least one dosing error when using either a dosing cup or an oral syringe to dispense liquid medication meant for children. As a new parent who has grappled with multiple dosing tools, I can’t say I am surprised.

Growing up, I remember syrupy medicines being doled out by my mother on spoons of varying size—a teaspoon or tablespoon—not a very accurate method when you also factor in that most spoons differ in shape and, probably, actual volume.

After my son had his first round of vaccines, the nurse told me that, in case he had a fever that night, the standard dose of Tylenol for his size and age was 80 mg. He didn’t get a fever in the end, and I didn’t think about what she’d told me until he had his first fever from a cold several months later.

When I went to open my box of Tylenol, I saw that the syringe that came with it did not use the dosage the nurse had told me (in milligrams), but rather, milliliters. I looked on the box for instructions but it only listed the dose […]

2016-11-21T13:00:52+00:00 November 1st, 2016|patient safety, pediatrics|0 Comments

Quality: The Anonymous Superhero of Nursing

“Clark Kent has his Superman cape, while I have my spreadsheets of data and the ability to set goals and track them.”

This guest post is by Tasha Poslaniec. A registered nurse for 16 years, Tasha has worked in multiple areas, including obstetrics and cardiology. She currently works as a perinatal quality review nurse. She is one of the most viewed nursing writers on Quora, and has had essays published by the Huffington Post.

sm1018-0021In the world of comics, Superman’s alter ego is the incognito Clark Kent. But in fact, that nerdy, data-oriented, and unassuming reporter, whose mission is to “bring truth to the forefront, and fight for the little guy,” could very easily be a quality review nurse.

The comparison between the two might seem a stretch at first, but there are some parallels that are worth pursuing—especially in the context of understanding who and what your quality nurse is, what quality nurses do, and how Clark Kent’s mission isn’t far from quality nurses’ own motivation for what we do.

An anonymous nursing role.

First, let me put into perspective exactly how anonymous most quality nurses are. Do you know who works in your quality department? Do you know where your quality department is? Did you even know that you have a quality department? If you said no to all three of those questions, then I can relate. […]

2016-11-21T13:00:54+00:00 October 11th, 2016|career, Nursing, nursing roles, patient safety|0 Comments