Off the Charts

If We Know How to Prevent Falls, Why Are Our Patients Still Falling?

Falls: at least ‘theoretically preventable.’

Sometimes it can feel as though managing fall risk takes up a big part of the day. You do your regular risk assessments, put safety measures into place, and still—patients fall.

Considering the frailty of some patients, the many meds that contribute to falls, and the fact that even mild cognitive impairment can be made worse by a hospitalization, it’s a tribute to good nursing care that there aren’t more falls.

But because falls sometimes cause serious injury and are, at least theoretically, preventable, it always feels like we’ve failed when a patient ends up on the floor.

A checklist for high-risk patients.

Nurses at one hospital decided that they needed a new way to approach fall safety. In “Using a Fall Prevention Checklist to Reduce Hospital Falls,” authors Madeline Johnston and Morris Magnan describe their use of a 14-item change-of-shift checklist based on the hospital’s existing fall prevention protocol. For a patient known to be at high risk for falls, oncoming staff went through the checklist to be sure that all prevention interventions were in place before taking responsibility for the patient. […]

Betsy Todd, MPH, RN2019-03-01T11:40:56-05:00March 1st, 2019|Nursing, patient safety|2 Comments

‘We Request Your Quiescent Contribution’: Predatory Publishers Are Absurd, But Not Funny

Multiple daily solicitations.

The screenshot below shows an excerpt from an email our editor-in-chief recently received. Editors at AJN receive multiple emails daily from mysterious publishers soliciting them for article submissions, important roles on editorial boards, or as conference speakers. If it weren’t alarming, it would be flattering. We’re not scholars and experts in sub-specialties of botany or engineering, in fossil fuel geology, neurosurgery, or, for that matter, microbiology. Our advice on such topics might well be dangerous, or at least irrelevant and wrong.

Some open access journals are highly respected in their fields; the journal that sent this letter also bills itself as open access, but if it contains legitimate articles on microbiology, and I’m not saying it doesn’t, they may find themselves with strange bedfellows.

Despite obvious warning signs, some authors are not deterred.

It’s impossible to keep ahead of the flood of such emails, most of which are characterized by typographical oddities and peculiar juxtapositions of tone. There are many other tell-tale signs of predatory publishers, most of which have little or no oversight from real content experts and no editing or filtering of content (one must simply pay a fee to be published or attend a conference).

But what’s most worrisome about this trend is that their strategy of […]

Jacob Molyneux, senior editor/blog editor2019-02-28T11:46:34-05:00February 28th, 2019|Nursing, nursing research, writing|0 Comments

March Issue: Type 2 Diabetes Drugs Update, Arterial Blood Gas Analysis, Fall Prevention Checklist, More

“It’s a challenge—for both nurses and family caregivers—to prepare caregivers for their new duties, often in a very short time span. I often wonder if it’s really possible to do this—and even if it is, should that be our goal?”—AJN editor-in-chief Shawn Kennedy in her March editorial

The March issue of AJN is now live. Here are some highlights.

CE: Original Research: New Acute Symptoms in Older Adults with Cognitive Impairment: What Should Family Caregivers Do?

The authors assessed the frequency with which family caregivers of older veterans with cognitive impairment sought guidance for new physical or behavioral symptoms and described the characteristics of such events, including the diagnoses and advice given.

CE: Type 2 Diabetes: A Pharmacologic Update

A review of established and newer type 2 diabetes medications, plus nursing implications for patient education and monitoring for adverse effects.

Cultivating Quality: Using a Fall Prevention Checklist to Reduce Hospital Falls: Results of a Quality Improvement Project

Nurses at a Midwestern teaching hospital implemented a fall prevention checklist to improve adherence to an existing protocol and evaluated its impact on fall incidence.

Clarifying the Confusion of Arterial Blood Gas Analysis: Is it Compensation or Combination?

This article reviews basic arterial blood gas interpretation and discusses the combinations of imbalances and compensatory mechanisms that may occur.

Seen and Understood: A Postpartum Scare and a Nurse’s Firm Reassurance

After an anxious pregnancy, short-lived relief.

When I got pregnant several months after an unexpected second trimester miscarriage, I was both elated and terrified. The loss taught me that aside from keeping myself healthy and getting prenatal care, I had no real control. I lived every day as if the pregnancy might not work out.

In the end, I gave birth to a healthy baby girl. It was such a relief to finally hold her, to know that I wouldn’t again be blindsided. But this relief was short-lived. I was nursing my daughter at home a week after the birth when I noticed that my pants felt wet. Looking down, I saw blood soaking through my clothes.

I tried to remain calm as I handed the baby to my husband and called the after-hours service at my OB-GYN. I was told to come to the ED right away. Panic-stricken, I realized that I had to take my 7-day-old baby with me. I was nursing, it was nighttime, and I had no formula in the house.

I called 911 and an ambulance came to take me to the hospital. My husband would meet me there with the baby once my mother arrived to watch our sleeping toddler. As the EMTs prepared to move me, I gave my […]

Amy M. Collins, managing editor2019-02-20T11:06:52-05:00February 20th, 2019|Nursing|1 Comment

‘I Sorted, I Triaged’: Notes of an Emergency Nurse

Trauma and triage in the ED.

Ralph Hogaboom / Flickr

Today, I was assigned to be one of just two triage nurses in the emergency department (ED) waiting room. With a limited staff and nearly full department, our next wave of patients arrived. I collected health information from the patients, screened for domestic violence and suicidality, made a triage decision regarding acuity level, and assigned an ED destination based on bed availability and estimation of resources.

Then, a man was wheeled in, with a woman close behind screaming “a car ran over his legs!” I saw an open bleeding wound on his right lower leg. I brought him to the trauma room.

The woman said to me, “I don’t think I can walk anymore.” I asked her if the car hit her too, and she replied, “yes, the car hit me too.”

As a trauma nurse, I stayed to help the trauma staff with the simultaneous trauma cases. Then I went back to the waiting room.

I prioritized.

More patients arrived, seeking assistance for many different needs. Then my charge nurse came out and informed me that I was needed back in the trauma room to receive an incoming patient who had fallen down a 15-foot ravine. Nursing resources were reallocated as needed to […]

Guest Author2019-02-14T10:53:42-05:00February 14th, 2019|Nursing|2 Comments

Falls: at least ‘theoretically preventable.’

A checklist for high-risk patients.

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Multiple daily solicitations.

Despite obvious warning signs, some authors are not deterred.

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After an anxious pregnancy, short-lived relief.

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Trauma and triage in the ED.

I prioritized.

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