Off the Charts

Black Boxes in the Operating Room: Improving Quality of Care and Patient Safety

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Black boxes record video, audio, and data from multiple sources in the operating room (OR), such as cameras, microphones, patient monitoring equipment, and medical devices.
By offering transparency on the multiple simultaneous processes in the OR, black box data can be used to improve safety and efficiency, train staff, and onboard new nurses.
The data can be used for retrospective analysis of specific events or aggregate analysis to detect patterns and variations in practice over time.
Black box data has been used to improve and standardize OR processes such as handling tissue samples, handoff communication during shift changes, and pre-surgical patient positioning.
The data is de-identified and is normally deleted within 30 days.
Finding what went right and learning from it is the goal, not pointing fingers.

Figures in the OR as recorded and de-identified by an OR Black Box. Image courtesy Surgical Safety Technologies.

Rebecca McKenzie, DNP, MBA, MSN, RN, assistant vice president of perioperative services at Duke University Hospital, recently spoke with AJN about her hospital’s use of black boxes in operating rooms (ORs) to standardize key processes to improve safety and efficiency, […]

Jacob Molyneux, senior editor/blog editor2023-05-26T15:01:50-04:00May 5th, 2023|Nursing, patient safety, Quality improvement, Technology|1 Comment

Honoring Notable Black Nurses of History

USS Red Rover hospital ship. National Library of Medicine.

Nurses Week is scheduled to correspond with the birth of Florence Nightingale (1820-1910). We do this to honor her work in professionalizing and modernizing nursing. Her contribution to our profession is considerable, and it is right that we pay respect to her. But it is equally right that we put Nurse Nightingale in context so that Nurses Week can celebrate all nurses, and not just the often well-off white women on which most nursing history focuses. This four-part blog series during the month of May will honor a handful of women of color who accomplished remarkable things during Florence Nightingale’s lifetime.

Ann Bradford Stokes

Ann Bradford Stokes (1830-1903) was born into slavery on a Tennessee plantation. In 1863, she escaped and was taken aboard a Union hospital ship. She eventually became one of the first women to be listed as active duty personnel, and the one of the first Black women to serve as a nurse in the navy. Along with five other Black women who had escaped slavery (Alice Kennedy, Sarah Kinno, Ellen Campbell, Dennis Downs, and Betsy Young Fowler), she cared for about […]

Guest Author2023-05-05T11:31:21-04:00May 1st, 2023|Black nurses, Nursing, nursing stories|0 Comments

May Issue Highlights: Febrile Neutropenia, Pediatric Oncology Pain Management, Reducing CLABSIs

The May issue of AJN is now live. On this month’s cover is Day Off, digital art by medical student Brian R. Smith, who explains: “This work depicts an overworked, exhausted health care worker. On their day off they find peace and respite through a walk in the forest.” Here are some articles in this issue that we’d like to highlight. Note that some may be free only to subscribers.

CE: Febrile Neutropenia in the Chemotherapy Patient

The authors discuss the identification and management of neutropenic fever, including the rapid initiation of antibiotic treatment and ongoing symptom management.

Nurses’ Experiences with Racial, Ethnic, Cultural, and Religious Discrimination in the Workplace: A Qualitative Study

“Although the encounters themselves were fleeting, their impact was enduring. Early-career encounters were most challenging, and participants grappled internally with lasting effects for years.”

Wanted: More Nurses in Office

“At a time when health challenges loom large in policymaking circles, some nurses think more members of their profession should be playing a direct role.”

Best Practices in Pediatric Oncology Pain Management

“Poorly managed pain […]

Jacob Molyneux, senior editor/blog editor2023-04-24T10:39:13-04:00April 24th, 2023|Nursing|0 Comments

Preventable and Aggressive Care for Cancer Patients: To the Bitter End

There have been a couple of recent studies that confirm what I have observed as a palliative care nurse practitioner (NP) in an academic medical center: that there’s still a tendency to pursue very aggressive care with older people with cancer. While every situation is different, the evidence shows that people with cancer could also benefit from palliative care and advance care planning to make sure they’re getting the best and right care for them.

Palliative care could prevent many ED visits.

The first study to catch my eye as a former ED nurse was Trends and Characteristics of Potentially Preventable Emergency Department (ED) Visits Among Patients With Cancer in the US. This study reviewed data on almost a billion (854,911,106) ED visits, of which 4.2% were made by patients with cancer. The mean age of those patients, not surprisingly, was 66. The study found that more than half of ED visits among patients with cancer, 51.6%, were identified as potentially preventable, with the absolute number of potentially preventable ED visits increasing substantially between 2012 and 2019.

The authors concluded that this highlights “the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.”

This […]

Guest Author2023-04-07T09:34:11-04:00April 7th, 2023|end of life, Nursing, palliative care, patient experience, Patients|2 Comments

Pediatric Mental Health Tops ECRI’s 2023 Top 10 Patient Safety Concerns

Photo by Eric Ward on Unsplash

Each year, the ECRI Institute creates a list of top 10 patient safety concerns along with actionable recommendations for institutions to reduce these risks.

Some years, the list includes repeat offenders such as medication errors and concerns surrounding staffing. In the past few years, the list has reflected the reality of living during a global pandemic, with 2022’s top 10 concerns including clinician’s mental health, supply chain disruptions, and vaccine coverage gaps. This year’s list moves away from the pandemic somewhat, but still includes some fallout from COVID-19, with the number one concern reflecting a crisis among our youth: pediatric mental health.

According to the report:

“Concern for pediatric mental health was already high during the 2010s due to the growing use of social media, limited access to pediatric behavioral health providers, drug and alcohol use, gun violence, and socioeconomic impact, among other stressors. However, pediatric mental health issues have been exacerbated by the COVID-19 pandemic, with a 29% increase in children age 3 to 17 experiencing anxiety and a 27% increase in depression in 2020 compared with 2016.”

The report lists some recommendations to confront this issue, including securing leadership support and resources to evaluate the organization’s pediatric […]

Amy M. Collins, managing editor2023-04-05T12:25:54-04:00April 5th, 2023|patient safety|0 Comments

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Ann Bradford Stokes

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Palliative care could prevent many ED visits.

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