Update on Preeclampsia: What Nurses Need to Know

Illustration by Sara Jarret.

Preeclampsia is the most common hypertensive disorder of pregnancy, yet there is still much we don’t know about why it develops and how to prevent it. It can present in different ways, from hard-to-ignore symptoms such as constant headache or severe right upper quadrant pain, to no symptoms at all before elevated blood pressure or urine protein is detected at a routine prenatal visit.

Did you know that:

  • despite a long list of known risk factors, most cases of preeclampsia are diagnosed in healthy nulliparous women?
  • both moms diagnosed with preeclampsia and infants exposed to it in utero are at greater risk for cardiovascular disease?

Update your knowledge by reading “Preeclampsia:  Current Approaches to Nursing Management” in the November issue of AJN. This CE article provides a helpful clinical update, including the pathogenesis of preeclampsia, diagnostic criteria, screening tests on the horizon, 2017 recommendations for pharmacologic management, optimal timing of delivery, and nursing management.

2017-11-06T09:49:41+00:00 November 6th, 2017|Nursing, patient safety|0 Comments

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 of these seemed […]

Connecting Emotional Intelligence, Team Communication, and Patient Safety

An Early-Career Nursing Memory

Photo by Barry Diomede/Albany Stock Photo.

Many years ago, fresh out of nursing school, I was in charge one night, with no other RNs on the unit. We had an “active GI bleeder” who needed hourly boluses of either ice water or iced milk through an NG tube. (Yes, the standard treatment at that time was gruesomely uncomfortable for the patient, and in later years determined to be counterproductive.) I had more than a dozen other patients to care for, but everyone got their meds and, miraculously, the bleeding man made it through the night.

When my supervisor made rounds at the end of the shift, I reported that all was well and that my critical patient had survived. Her only response: “Mrs. Todd! There is blood on your shoes!”

This senior nurse, standing there in her starched whites and impeccable shoes, didn’t recognize that I had feared I would be inadequate to the task, or even acknowledge my pride as a brand-new nurse in actually saving someone’s life. In retrospect, I can’t help wondering if her choice to focus on a superficial fact, irrelevant to the crisis, could be interpreted as an indication that she lacked a certain acuteness of emotional […]

2017-07-17T16:49:20+00:00 July 17th, 2017|Nursing, patient safety|1 Comment

Viewpoint: A Limitation of Preprocedure Checklists

I once worked at a hospital where some of the surgeons regarded safety checklists as an inconvenience. They saw them as bothersome intrusions by the nursing staff into the surgical suite. One OR nurse was even “counselled” by her supervisor (in the presence of the complaining surgeon) to avoid upsetting the doctors by using the preprocedure time-out.

How important are these tools? Are we using them well, or do we speed through them as rote exercises? Might we even expect too much of them? In AJN’s July Viewpoint, nurse Elizabeth Anne Crooks relates a frightening episode (she was the patient) that led her to think about time-outs in a different way.

Crooks was about to undergo a colonoscopy. The clinical team seemed relatively unconcerned about her bradycardia, which was a significant change from her normal heart rate. After completing the usual time-out protocol, sedation was initiated and the physician began the procedure. Suddenly, Crooks’ heart rate and blood pressure dropped precipitously.

I remember waking in distress and hearing the monitor alarming. The team was working rapidly to stabilize me with fluids and medications.

A routine procedure had suddenly become an emergency.

In reflecting upon her experience, Crooks wonders whether the preprocedure time-out may have given her clinical team a false sense of security—one that led them to downplay a clinically significant change. And yet, as we know, these time-outs focus on ensuring that the correct patient is receiving the correct procedure, and not on other safety […]

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 […]