Off the Charts

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

Case of Nurse Charged with Homicide for Medication Error Raises Concerns

Every nurse’s nightmare.

On February 1, Radonda Leanne Vaught, a former nurse at Vanderbilt University Medical Center in Nashville, was indicted and arrested for impaired adult abuse and reckless homicide. She is accused of inadvertently administering the wrong medication and causing a patient’s death in an incident in late 2017.

This is every nurse’s nightmare.

According to the CMS report from its investigation, Vaught administered IV vecuronium (a neuromuscular blocking agent that causes paralysis and is often used during surgery) instead of IV Versed (a sedating agent) to an anxious patient undergoing a diagnostic scan. The patient stopped breathing, suffered brain damage, and subsequently died. Vaught was charged with recklessness because she overrode the automated medication dispensing system and didn’t follow standard procedures in properly checking the drug name or in monitoring the patient after administering the medication.

What the CMS report says.

The CMS report, which includes interviews with Vaught as well as witnesses and safety officers at the hospital, notes the following information about Vaught’s actions while she was in the medication system searching for the medication:

“[Vaught]. . . was talking to [an] Orientee while he/she was searching the ADC for the Versed and had typed in the first 2 letters of Versed which are VE and […]

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Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2019-03-01T14:14:51-05:00February 12th, 2019|Nursing, nursing career|10 Comments

Protocol to Reduce Hospital-Acquired Pneumonia Improves Outcomes, Lowers Costs

Costs. Length of stay. Patient mortality. We know that the care we provide is central to good outcomes of every kind. But how often do we get to clearly demonstrate this for hospital administration? In “A Nurse-Driven Oral Care Protocol to Reduce Hospital-Acquired Pneumonia” (free until March 1) in this month’s issue, authors Chastity Warren and colleagues describe a QI project that showcased how a simple nursing intervention decreased morbidity, mortality, and costs at their hospital.

A standardized oral care protocol.

Aware of the connection between poor oral care and hospital-acquired pneumonia, a group of nurses at their large Midwest hospital set out to devise a standardized oral care protocol for all adult patients. Patients were categorized as either ventilated, at-risk (for example, someone with a trach or with swallowing difficulties), or short-term care. The care kit and the frequency of oral care were different for each group.

Once the intervention was in place, the nurses tracked not only the incidence of hospital-acquired pneumonia in both ventilated and non-ventilated patients, but also (by creatively “triangulating” several sources of data) the adherence of staff on each unit to the protocols.

Protocol adherence.

Regarding protocol adherence—always a challenge with new protocols when multiple units and staff are involved—the authors noted that there’s still work to […]

Betsy Todd, MPH, RN2019-02-06T09:10:07-05:00February 6th, 2019|Nursing, nursing research|0 Comments