Falls in Behavioral Health: Different Population, Different Risk Factors

“I need help in 230A! Mr. Johnson is on the floor!”

(click image to enlarge)

Does your heart still sink when you hear a patient has fallen? We’ve gotten better at preventing falls, but we haven’t eliminated them. They remain one of the most common “incident” reports in hospitals. And did you know that adult behavioral health inpatients have more falls and fall-related injuries than patients on medical-surgical units?

In this month’s Cultivating Quality article, “Preventing Falls Among Behavioral Health Patients,” free until July 20, Stephanie Ocker and colleagues discuss their very successful falls-related interventions on an inpatient behavioral health unit. As they proceeded with their root cause analyses of recent falls, an unusual risk factor stood out:

“Patients frequently walked in the unit’s common area with bath blankets hanging around them and often trailing under their feet. When nurses would ask patients not to walk around with blankets to reduce the risk of tripping, patients would say they were cold.”

[…]

2020-07-06T10:53:28-04:00July 6th, 2020|Nursing|1 Comment
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Is Your Facility’s Computer System a Patient Safety Risk?

Discussed in this post: “How Often Do EHRs Result in Patient Harm?” (AJN, News, March).

When we first had computers in the hospital—that is, while we still charted on paper but had quick online access to lab, radiology, and pathology results and could easily look up a patient’s prior admission history—it was wonderful. No more little lab slips floating all over the nurses’ station. No more unit-to-unit searches trying to figure out who last had custody of the patient’s X-ray films. (How could objects so large be so easily lost?)

A rocky transition to EHRs.

electronic health recordsThe transition to almost fully digital charting, on the other hand, has been pretty much a nightmare from the beginning. Nursing was rarely included in initial needs assessments. Many rollouts were chaotic, without additional staffing for the inevitable glitches that are bound to occur. Training of frontline clinical staff has been routinely minimal; we seem to be expected to pick up the many fine points of new software by some kind of digital osmosis.

That elusive clinician friendly EHR.

It’s very clear at this point that electronic health records (EHRs) were designed primarily for data collection and billing purposes. I have yet to see a system that could in any way be called […]

2020-03-12T08:02:22-04:00March 12th, 2020|digital health, Nursing, Technology|2 Comments
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EHRs: Losing the Nuances of Nursing Care, and the Value

Image by mcmurryjulie from Pixabay

Our December issue is out, but before we move on from the November issue I want to highlight the Viewpoint, “Advocating for HIT That Captures Nursing Process.” It’s about something that greatly affects nurses’ work, seems to be the bane of all clinicians, and, I think, often prevents individualized patient-centered care.

I’m referring to the electronic health record (EHR), a system built to capture data important for billing and tracking aggregate patient outcomes—but arguably not designed for what clinicians deem as most important for understanding and documenting patient care.

Dylan Stein and colleagues Jasmine Travers and Jacqueline Merrill write what most nurses know about EHRs:

“The nuances of our care get lost in task-oriented, quantitative drop-down menus and checkboxes, while the qualitative value of our interventions and impressions are not encoded in a useful way.”

Nursing notes devalued.

In the old days BC (before computers), clinicians used some checklists for charting but also relied heavily on narrative notes to describe the patient’s individual story. While there are areas one can add notes in an EHR, nurses tell me that it’s not very easy to do so and that no one really reads them because they’re not […]

2019-12-05T12:03:16-05:00December 5th, 2019|digital health, Technology|2 Comments
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November Issue: Chronic Pain and Opioids, CVDs in Pregnancy, Preventing Patient Self-Harm, More

“[S]eeing this patient, his return, his presence, his enduring love, was a gift. Because some days in health care, you don’t really know what hope you are fighting for or for whom.”—Hui-Wen (Alina) Sato, author of the November Reflections column, “Beholding the Returning Light”

The November issue of AJN is now live. Here’s what’s new:

CE: Implementing Guidelines for Treating Chronic Pain with Prescription Opioids

An overview of five tools outlined in the CDC’s 2016 opioid safety guideline—prescription opioid treatment agreements, urine drug screening, prescription drug monitoring program databases, calculation of morphine milligram equivalents, and naloxone kits—and their relevance to primary care nurses.

CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review

The authors discuss three of the most common pregnancy-specific cardiovascular diseases and their risk factors, prevention, assessment, and management.
[…]

2019-10-28T10:00:42-04:00October 28th, 2019|Nursing|0 Comments
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Thoughts on Preventing Delirium During an ICU Stay

It’s well known that an ICU stay presents several risks to patients, whatever their reason for needing critical care.

  • Various infections are more likely to develop than in other care units.
  • Intense drug therapy can result in adverse drug interactions.
  • The excess stimulation and (often) windowless rooms increase the risk for delirium and its consequences.

Would you do anything to protect your own health if you knew that after surgery you would be spending time in an ICU?

In this month’s Viewpoint column, author Patricia Gavin describes how she coped with her own ICU stay, which she knew in advance would be part of her post-op care:

“…when I realized I would be there for a few days, I decided to create
my own ‘care plan’ to stave off delirium and its adverse outcomes.”

Does it help if the patient knows her own risk factors?

She goes on to explain what she knew about her own risk factors for delirium, and the things she could do to stave off the complication during this stressful time.

And she notes how one nurse made a particular difference in helping her to get through her stay without cognitive complications. Gavin reminds us of the practical strategies that nurses can employ, beginning with, “Extend a […]

2019-09-26T10:31:05-04:00September 26th, 2019|Nursing, patient safety|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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