Nursing Notes

November 25, 2010

Despite Efforts, Study Finds No Decline in Medical Errors

When I first saw this article, I thought, “Yea! Someone is paying attention to what nurses are saying, finally!”  However, after reading the entire article, I was appalled to see that nursing was not mentioned one time.  The only medical personnel talked about were physicians and how overworked they are.

So, let’s look at this problem from another standpoint, please.  If you are sick enough to be hospitalized (and that means really, really sick), you will find yourself on a unit that is understaffed and overworked–no doubt about that.  You will share your RN with 6-7-8 other patients who are as sick or sicker than you.  You will be lucky to see your nurse for 15 minutes in the 8 hour shift when the RN does your assessment for the shift.  You will see the RN next whenever it is time for medications, but there will be little time for interaction other than about medications.  You will spend most of the day alone in your room watching television or sleeping because there is no one available to spend time helping you deal with your illness.  Your nurse will be available by call button, maybe.  Usually the call light will get you the aide.

If a nurse is caring for too many sick patients, there is no time to get to know the patient at all.  First, the lengths of stay have become so short that you hardly have time to learn everyone’s name.  Then, there is so much to do to take care of such a load of patients that you simply don’t have time to spend at the bedside.  Then, of course, there is the never ending charting to be done–everything you have done during your shift must be charted.  Your assessments must be charted; calls to physicians must be charted.  All orders need to be checked for correctness and carried out, then noted.  Don’t forget that while you are doing all of this, you will be discharging some patients and admitting others.  The beds MUST stay full!

I can certainly see why mistakes happen–honest mistakes that are made because you simply don’t have a minute to stop and think about what you are doing; because you have a list of 20 other things that are timed to be done at the same time and if not done then will be an error against you.

This is not whinning.  This is what happens for just about any nurse who works the floor today.  We are all clamouring for patient-to-nurse ratios so we can give safe patient care, not so we can have it easy.  We don’t do easy.

Please read this article and see if you feel as upset about it as I do.  This is from BusinessWeek.com, and only part of it is below, so you will have to click over to read the rest.  I recommend that you do.  Maybe you could leave them a comment, too, while you are there.

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But experts say some safety initiatives may take time to bring results

By Maureen Salamon
HealthDay Reporter

HealthDay/ScoutNews LLC

WEDNESDAY, Nov. 24 (HealthDay News) — Despite intensive efforts to improve patient safety, a six-year study at 10 North Carolina hospitals showed no decline in so-called patient “harms,” which included medical errors and unavoidable mistakes.

Sorting through patients’ medical records from more than 2,300 randomly selected hospital admissions, teams of reviewers found 588 instances of patient harm, which included events such as hospital-acquired infections, surgical errors and medication dosage mistakes.

While most harms were minor and temporary, 50 were life-threatening, 17 resulted in permanent problems and 14 people died, said the researchers, who selected North Carolina hospitals because the state has shown a strong commitment to patient safety. The admissions records spanned the period from January 2002 to December 2007.

Study author Dr. Christopher Landrigan said the results likely reflect what’s happening nationwide. A 1999 Institute of Medicine report publicizing high medical error rates spurred many U.S. hospitals to implement safety-promoting changes, but no uniform set of guidelines exists to direct facilities which changes to tackle, he said.

“What has been done right is that regulatory agencies have begun prioritizing patient safety,” said Landrigan, an assistant professor of pediatrics and medicine at Harvard Medical School. “But these efforts have largely been a patchwork of unconnected efforts and so far have not been as strong as they can be.”

Slightly more than half of the errors were avoidable, Landrigan said. They were detected by investigators who scanned patients’ charts for “trigger” events that suggested mistakes had occurred, such as a prescription for an anti-opioid drug that could remedy a morphine overdose.

The study, published in the Nov. 25 issue of the New England Journal of Medicine, is important because health-care professionals “really haven’t had a good sense of what’s going on with safety over time,” said Dr. David Bates, a professor of health policy and management at the Harvard School of Public Health, where he co-directs the program in clinical effectiveness.

“It’s very useful to have robust estimates of the frequency of harm over time in a relatively large sample,” said Bates, who also serves as medical director of clinical and quality analysis for Partners Healthcare System in Massachusetts and is associate editor of the Journal of Patient Safety….[read more]

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November 20, 2010

Texting improves medication adherence, patient health

Texting on a keyboard phone
Image via Wikipedia

Here is an article that shows the way new technology can be integrated into plans of care to obtain positive outcomes.  With smart phones taking front stage, it was only a matter of time before the medical field discovered that these devices could be used to improve adherence and patient health outcomes.  This article is from FierceMobileHealthCare, which is a source I find useful and informative.  Please visit the site to see other really good articles.

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Text messages containing both medication reminders and information about a specific skin condition helped greatly improve adherence to treatment regimens, self-care behaviors and quality of life while also lessening disease severity, according to a newly published scientific article in the journal Dermatology Research and Practice.

“It is not surprising that text messaging helped patients stick with their treatment plan and take their medication as prescribed,” Dr.  Joseph C. Kvedar, director of the Center for Connected Health at Partners HealthCare System in Boston, says in a press release. “However, we went a step further by including educational information which, we believe, can lead to critical improvements in self-care behavior that were observed in this study.”

The Center for Connected Health says this is the first study to combine medication reminders with educational information in text messages.

Researchers at Massachusetts General Hospital examined 25 adolescents and adults with a form of eczema called atopic dermatosis, and then sent the patients daily text messages for six weeks, reminding them to continue their prescribed treatment or offering information about the condition. Though at the outset, 92 percent of participants reported occasionally forgetting to take their medication–with nearly as many saying they would stop treatment when symptoms improved–by the end of the study, 68 percent reported an improvement in the number of self-care measures they performed.

After the six weeks, 76 percent of patients had seen an improvement in their skin condition and 72 percent said their quality of life was better. About 90 percent found the text messages helpful, and 84 percent would want to continue receiving the texts.

“Text messaging is a cost-effective way to deliver short, concise information to patients over a longer period of time, and because it is automated, requires no extra effort from the provider,” Kvedar says. “Our study also indicates that patients are willing and ready to integrate technology, such as text messaging, into their care. It can also help to improve communication between patients and providers.”

Read more: Texting improves medication adherence, patient health – FierceMobileHealthcare http://www.fiercemobilehealthcare.com/story/texting-improves-medication-adherence-patient-health/2010-09-28#ixzz15TeSZJbm

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November 18, 2010

Increasingly, nurses facing violence on the job

Here is another article that lies out the problem with violence that nurses and nursing staff are dealing with.  This is a good, but long, article and I hope you will click over to read the entire thing.  Nurses should not have to wonder if going to work will mean a loss of livelihood or worse, a loss of life.

This article is from The Philadelphia Inquirer.  Please do go to the site and read the next page.

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By Jane M. Von Bergen

Inquirer Staff Writer

 

Amber Knierim, 20, wanted to be a nurse when she grew up, her MySpace profile says.

Instead, she’s in jail for beating one up – a Temple University Hospital emergency-room nurse who was attacked when she tried to keep Knierim from grabbing needles from an empty examination room on June 21.

“She picked the wrong person to mess with,” said Joan Meissler, 53, of Northeast Philadelphia, now working on light duty until she heals from the beating that wrecked her finances and left her in permanent pain, angry, and disheartened.

On Wednesday, 180 nurses and other health-care workers will convene in a ballroom at the Philadelphia Airport Hilton for a booked-to-capacity session on workplace violence for health-care workers, sponsored by the Pennsylvania Association of Staff Nurses and Allied Professionals, a union.

“It’s a national problem,” said union president Patricia Eakin, adding that she did not want to single out Temple. Eakin, a nurse, an emergency room colleague of Meissler’s, was on duty the day Meissler was attacked.

Meissler wants Temple to erect a billboard in the neighborhood with two pictures on it – hers and Knierim’s. “Temple needs to send a message to the community,” said Meissler: ” ‘Lay a hand on one of our staff members and you’ll spend the next five years in jail.’ ”

The U.S. Department of Labor Tuesday released 2009 statistics that ranked paramedics and nursing aides as being the workers most likely to miss work because of injuries. While most of the injuries come from overexertion caused by lifting, there are 38 incidents of violent assaults per 10,000 nurses aides.

The only occupations that face a greater likelihood for assault on the job are police and correctional officers.

Between 8 percent and 13 percent of emergency-room nurses are victims of physical violence every week, according to a survey released in September by the Emergency Nurses Association, a professional group in Illinois.

Why is the work so dangerous? Nurses and experts point to a number of factors.

First is proximity. “We as nurses are hands on – to touch and be touched,” said nurse Christine Pontus, occupational health and safety director for the Massachusetts Nurses Association and one of the national leaders addressing the issue. “The boundaries are not as clear.”

Pressed to reduce expenses, hospitals have been cutting back on nursing and security staff at a time when the number of uninsured using emergency rooms is growing. Those same budget constraints are limiting options for treatment and care of the mentally ill and addicted.

Unemployment and the economy has exacerbated stress among the general population, with that tension manifesting itself in hospitals, where frustrated patients and their families waiting longer for treatment tend to lash out at staff members.

Most of the violence is by patients or their families against nurses and other staff, according to the Emergency Nurses’ survey.

Many hospitals don’t have complete safety plans that include adequate staffing, consistent and frequent use of security wands and metal detectors, training in violence de-escalation, safety committees with worker representation, emergency-drill sessions, and analysis of unsafe conditions.

Meanwhile, there is some sense that nurses and others should accept violence as part of the job, Pontus said. She is the lead speaker at Wednesday’s event. District attorneys from Philadelphia and Delaware County are scheduled to attend.

“A lot of times the victims are traumatized and afraid to speak,” especially if the organizational culture doesn’t support them, Pontus said.

“There is a stigma of victimization, embarrassment, fear of being blamed for provoking the assault, fear of job loss,” she said. “The patients abuse us and we abuse each other. We’re all post-traumatic out there.”

Two weeks ago, a California nurse working in the intake area of the Contra Costa County jail died when a new inmate faked a seizure. When the nurse bent over him to help, he grabbed a lamp and smashed her over the head. She died on Oct. 28, three days later.

A psychiatric technician at Napa State Hospital in California was strangled on Oct. 23 by a patient, one of a majority committed there for crimes related to their mental illnesses. Local news reports described a chaotic facility where security had become lax.

Those are the headline cases, but the reality is more like what emergency room nurse Sean Poole, 33, experienced at Crozer-Chester Medical Center on Friday night.

Poole and a fellow nurse were trying to get blood work from an intoxicated and delusional patient when the patient bit his coworker, drawing blood. “It was pretty bad,” said Poole, who lives in the tiny borough of Parkside in Delaware County.

Poole has been punched and bitten, but has never pressed charges. “It’s hard to get anything to stick,” he said. “If they are intoxicated, it won’t hold up because they were intoxicated. If they are mentally ill, it won’t hold up because they aren’t in their right mind.”

In the spring of 2009, Crozer-Chester nurse Aimuel Elder walked into a patient’s room to find family members fighting and using pepper spray. He got sprayed as well.

“I tried to settle things down,” he said. “The police were called and so were our own security. The police arrived before our security.”  …[Read more]

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November 16, 2010

Slain California hospital nurse was strangled

Why is it not alarming to most people to learn that nurses and healthcare personnel routinely run the risks of being brutalized?  In a profession about helping others, why is it excused that these helpers can be beaten, threatened, or even killed?

This article, from Action News 13 Ktnv, only underscores the need for stronger laws to protect nurses and other healthcare workers from danger.  These people have embarked on a mission to help others and should not receive brutality in return.

Let me know your thoughts on this topic after you read the article, won’t you?

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An autopsy has found that a psychiatric nurse who authorities say was killed by a mentally ill patient at Napa State Hospital was strangled to death.

The Napa County coroner says Tuesday that 54-year-old Donna Gross died of asphyxiation on Saturday in a hospital courtyard. The sheriff’s department says Gross was killed by 37-year-old Jess Willard Massey, who was arrested Sunday on suspicion of murder and robbery.

Sheriff’s Capt. Tracey Stuart says investigators found Gross’ jewelry and a pack of gum she had bought on her dinner break in Massey’s room. Also missing was less than $2 in cash that Gross was carrying.

Massey is scheduled to make his first appearance in court Tuesday.

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November 3, 2010

Stop Losing Experienced Nurses

THORNTON - FEBRUARY 24:  Registered nurse Susa...
Image by Getty Images via @daylife

Here is a great article about the need to retain experienced nurses on the floors.  With aging and health issues arising, we are losing our experience from our nursing ranks.  The high stress levels, the increased patient to nurse ratios, the addition of technology, and the many new hats placed on a nurse’s head due to cutbacks–all increase the loss of our older and more experienced nurses.  It’s a shame, too.  These are the nurses who work tirelessly for the patient; who worry about subtle signs and speak to physicians as equals.  We need them as much as they need us.

Please read this article entirely, as I have only posted a part here.  So, please click over to finish reading.  This article is from Health Leaders Media and I find many really relevant and interesting articles at that site.  Let me know what you think about this article, won’t you please?

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Rebecca Hendren, for HealthLeaders Media , October 26, 2010

There’s no substitute for experience, especially in nursing. Experienced nurses accomplish all their tasks in a shift and somehow their patients never know how busy they are. They still find time to check in, offer support, and even a shoulder to cry on.

 

Nurses who know the ropes understand  how the system works. They can communicate ably with physicians, pharmacists, nursing assistants, patients, and families and are the glue that holds “multidisciplinary care” together. They can take one look at a patient and know “something’s just not right,” fixing a problem  before it degenerates.

Finally, nurses with experience are role models and mentors for new nurses, helping the next generation become experts and passing along their wisdom. So it behooves healthcare facilities to retain these nurses as long as possible.

But experienced nurses are aging and exiting the workforce. According to data recently released from the latest National Sample Survey of Registered Nurses—which has been conducted by U.S. Department of Health & Human Services Health Resources and Services Administration every four years since 1977—the average age of licensed RNs is 47. Nearly 45% of RNs were 50 years of age or older in 2008, a dramatic increase from 33% in 2000 and 25% in 1980.

Because of this looming crisis as experienced nurses retire, the Robert Wood Johnson Foundation launched a national program in 2006 called Wisdom at Work: Retaining Experienced Nurses. The idea was to find out what will keep experienced nurses in hospital settings and find out what effect existing interventions have on the work environment for older nurses.

Through this program, 13 initiatives were evaluated that were intended to retain experienced nurses, which fall into three categories:

 

  • Ergonomic projects, such as lift teams and anything that reduces the physical burden of nursing
  • Human resource strategies to improve organizational culture
  • Strategies that involved employee wellness, clinical technology, or leadership development

While no single initiative or strategy has been identified as a silver bullet, the program has found several strategies that when combined with an organizational culture that values experienced workers and leadership support create an environment that encourages experienced workers to stay.

Successful strategies include:

  • Closed staffing: A model that keeps nurses on their home units rather than assigning them to other units as needed.
  • Giving experienced nurses more control over patient flow, discharge and admission..
  • Staffing for frequent peak occupancy rather than average occupancy.
  • Wellness at work programs that promote wellness through incentives, fitness center memberships, and other components.
  • Virtual ICUs that allow experienced nurses to use computers to monitor ICU patients at multiple sites .
  • Renewing and reframing older nurses’ practices, such as the three-day, off-site educational experience that rewards experienced nurses with an opportunity to renew their nursing practice.
  • Patient lifting devices and other labor-saving technologies
  • Centralized workstations and decreased need to walk long hallways
  • Increased scheduling flexibility
  • Developing new career paths

The hospitals that retain experienced nurses are the ones that include ….[read more]

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