Nursing Notes

June 7, 2012

Patient location, gloves, worker type predict hand hygiene compliance

Filed under: Nursing — Shirley @ 5:33 am
Tags: , , , ,

Here’s another article on the ever growing battle about handwashing in the hospital.  It is true that strict adherence to handwashing policy will save lives and money, but for some reason we have trouble following this simple policy.  Why is that?  Maybe there is not enough time in a shift to do all the handwashing called for?   I don’t have any answers, but would love to hear your take on this growing concern.

This article is from FierceHealthcare, which is a source I like very much.  I find many interesting articles about medicine and nursing here and you will, too.


Patients who receive care in a hallway bed are the most likely victims of healthcare workers not washing their hands, according to researchers from Boston’s Brigham and Women’s Hospital in a study to be published in the November Infection Control and Hospital Epidemiology.

In the largest hand hygiene study with more than 5,800 patient encounters in the emergency department (ED), researchers found that bed location, the type of healthcare worker providing the care, and whether the provider used gloves all were predictors of poor hand hygiene in the ED.

“We found that receiving care in a hallway bed was the strongest predictor of your healthcare providers not washing their hands,” said study author Dr. Arjun Venkatesh, an emergency medicine resident at Brigham and Women’s Hospital, in a Society of Healthcare Epidemiology of America press release yesterday.

In addition, researchers found that workers transporting patients were less likely to wash their hands because they likely do not receive as much hand hygiene training as others, according to the press release. They also said that providers using gloves was not a substitute for handwashing in controlling infections.

However, in most cases (90 percent of time), ED workers do wash their hands.

Handwashing could save up to $33 billion, according to a UPI article. In a Health Affairs study, infection control interventions such as handwashing resulted in patients leaving two days earlier and reduced mortality rates by 2 percentage points. Hospital costs also were $12,000 less, according to the article.

For more information:
– read the press release
– here’s the study abstract
– read the UPI article

Related Articles:
Hospital workers comply with hand hygiene signs about patients, not themselves
CDC: Physician offices too lax about infection control
Handwashing more common in public restrooms than in hospitals
Doctors, nurses don’t want patients to bug them about handwashing
Is 100 percent compliance on handwashing possible?

Read more: Patient location, gloves, worker type predict hand hygiene compliance – FierceHealthcare

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April 17, 2012

Mental illness means higher risk of physical problems

Filed under: Nursing — Shirley @ 1:08 pm
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Here’s an article from that talks about a study showing a correlation between mental health and physical health.  As a psychiatric nurse, I have always know that my patients have a higher risk of certain physical diseases.  It’s amazing to me that it has taken so long for others to notice and try to figure it out.

Asthama, diabetes, hypertension, and even strokes are common Axis III diagnoses for inpatient mental health patients of all ages.  There has to be a reason for this correlation.  Maybe now there will be more studies to try to figure out the connections.  I can only hope so.

Please read this excerpt of the article and click over to to read the rest.  It’s worth your time and effort to do so.  While there, check out some of the other articles they have about current nursing issues.


Adults who had a mental illness in the past year have higher rates of certain physical illnesses than those not
experiencing mental illness, according to a report by the Substance Abuse and Mental Health Services
For example, 21.9% of adults in a SAMHSA national survey who experienced any mental illness (based on
diagnostic criteria specified in DSM-iv) in the past year had hypertension. Meanwhile, 18.3% of those without any
mental illness had hypertension.
And 15.7% of adults who had any mental illness in the past year also had asthma, while 10.6% of those without
mental illness had the condition.
Adults who had a serious mental illness (a mental illness causing serious functional impairment that
substantially interferes with one or more major life activities) in the past year also showed higher rates of
hypertension, asthma, diabetes, heart disease and stroke than did people who did not experience serious mental
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more including
significant problems with every-day aspects of life such as sleep, eating, feelings of self-worth, etc.) had higher
rates of the following physical illnesses than those without major depressive episodes in the past year:
hypertension (24.1% vs. 19.8%), asthma (17% vs. 11.4%), diabetes (8.9% vs. 7.1%), heart disease (6.5% vs.
4.6%) and stroke (2.5% vs. 1.1%).
The report also shows significant differences in ED use and hospitalization rates in the past year between adults
with mental illness in the past year and those without. For example, 47.6% of adults with serious mental illness
in the past year used EDs, as opposed to 30.5% of those without past-year serious mental illness. Adults with
past-year serious mental illness were more likely to have been hospitalized than those without (20.4% versus
11.6% respectively).
“Behavioral health is essential to health. This is a key SAMHSA message…[read more]

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December 30, 2011

Goodby, Don Berwick

Here’s an article from the Austin American Statesman written by my fellow nurse, Toni Ingles at Seton English: This is an image of Donald Berwick, w...Healthcare.  I’ve posted her articles before about the Texas whistleblower nurses and the trial.  This article is about the loss of Don Berwick.  Whether you liked him or not, this is a very good article and deserves to be read.  Enjoy the article.

Congress chewed him up and spit him out. Marilyn Tavenner will be a
good replacement for him. She is a nurse, has terrific experience and
is greatly admired by Don Berwick (and by me). Berwick’s immense
respect and confidence in her are demonstrated by his having tapped
her as his top deputy.


For the past 17 months I’ve watched through my fingers as Congress has
slowly eviscerated a gentle, brilliant, apolitical pediatrician and
Harvard professor — Don Berwick. It’s been painful, gut-wrenching and
depressing. Congress will finish him off today, when his resignation
as administrator of the Centers for Medicare & Medicaid Services takes

The words “missed opportunity” understate.

The visionary Berwick, champion for patients, was picked for the job
because his “triple aim” (his words) at health care was the same as
President Barack Obama’s reform goals: improving the patient
experience, improving population health and reducing costs — and
because Berwick had decades of experience successfully achieving those
goals in this country and worldwide.

Through the organization he founded in the early 1990s, the Institute
for Healthcare Improvement, care has been redesigned and hospitals
trained to prevent thousands of injuries and deaths.

How has Berwick achieved these changes? Intractable problems in health
care are identified, and IHI, often in partnership with the Robert
Wood Johnson Foundation, take aim at them.

In the hospital system where I work, we know about Berwick, and we’ve
worked with people from the IHI and the RWJ foundation. In 2003, we
were chosen as one of 13 pilot sites to transform care at the bedside
in medical-surgical units.

Direct-care, front-line nurses were challenged and given full license
and encouragement to develop and test methods to improve care. And
that we did. Many of the innovations Seton nurses designed are
practiced in thousands of hospitals worldwide.

In the eight years since the project began, physicians, patients and
families have become engaged in care; bedsores, patient falls,
infection and birth trauma have been drastically reduced;
communication during shift report has improved; multidisciplinary
rounds are made to enhance discharge planning, teamwork and safety;
patients are checked on hourly; response teams rush to a patient in
crisis before it’s too late; and patient and nurse/doctor satisfaction
and retention have dramatically improved. Hospital readmissions have

Through the transforming care project, in the perinatal area, birth
trauma has effectively been eliminated. Clinicians developed a bundle
of best practices for obstetricians.

This safety initiative has saved the government a bundle of money. In
2003, Seton billed Medicaid $500,000 for birth trauma; in 2009, zero.

Berwick has promoted understanding of this concept as a way to curb
government spending on health care. As part of the Affordable Care
Act, Berwick implemented financial incentives for doctors and
hospitals to coordinate care and improve patient outcomes.

Stunningly, Congress refused to confirm the nomination of this proven,
accomplished and promising leader. Eager to demonstrate contempt for
the Affordable Care Act, Republican demagogues seized on Berwick as an
irresistible target.

They dubbed him Dr. Death Panel. Why? Because he — and the Affordable
Care Act — encourage end-of-life discussions between doctor and
patient/family when medicine can do no more.

In addition, they exploited his remarks as an academic praising
Britain’s health care system for covering all its people and reining
in costs while improving outcomes.

Taking his remarks out of context, Republicans portrayed him as an
advocate of rationed care and socialized medicine. This, despite
Berwick’s insistence all along that the British system cannot be
copied here and that America’s system, having evolved around
insurance, needs its own solution.

If you repeat “Dr. Death Panel” and “rationing care” enough times, you
begin to brand and unfairly define Berwick and the health care reform

Marilyn Tavenner, a nurse and his top deputy, will succeed him. Let’s
hope that she will be able to execute his goals. Congress will be more
comfortable with her, as she is more manager than visionary.

Back to his triple aim. Has his work improved the patient experience?
Yes. Has it improved population health? Yes. Has it reduced costs?

Have we missed an opportunity? Oh, and how.

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December 26, 2011

Please thank your nurse this Christmas

Filed under: Nursing — Shirley @ 11:41 am
Tags: , , , ,

Here’s an article that I found on CNN that I hope you will enjoy.  Christmas is one time of the year when nurses have to sacrifice time with family to care for patients.  It’s nice to see in print that someone, somewhere notices. 


Anthony Youn, M.D., is a plastic surgeon in Metro Detroit. He is the author of “In Stitches,” a humorous memoir about growing up Asian American and becoming a doctor.

You can guarantee that three places will be open on Christmas day: Chinese restaurants, Denny’s and hospitals.

I spent part of last Christmas in the hospital visiting my mother-in-law who was recovering from open heart surgery.  I felt depressed walking into the building that morning.  My mother-in-law treasures the holidays more than anyone else in my family.  Lying in a hospital bed was the absolute last way she wanted to spend Christmas.

But during the time I spent at her bedside, my depression lifted, replaced by an overwhelming sense of gratitude for her doctors, nurses, and medical technicians.  I never felt for one second that her care suffered because her medical team was working on Christmas.  The nurses and support staff were cheerful, accommodating and responsive. One male nurse even wore a Santa’s cap and greeted my mother-in-law with “Merry Christmas” and “Ho-ho-ho” before he took her blood pressure.

Most physicians who work on Christmas – with some exceptions like ER docs – round on patients in the morning so they can get back home in time for Christmas dinner.  Not so for nurses and other hospital employees.  They put in full or extended shifts on Christmas to make sure that all the patients are cared for.  Thankfully, hospitals never close; medical care never takes days off.

Each Christmas, nurses and hospital support staff juggle their work schedules and sacrifice their time, giving up their own Christmases to accommodate the needs of patients.  As I sat by my mother-in-law’s bedside and looked forward to my own Christmas dinner, I thought about the dedicated caregivers who would spend their day changing catheters and cleaning wounds while the rest of us enjoyed being with our families in the warmth of our homes.

Some nurses go way beyond the call of duty.  A few years ago I went to the hospital on Christmas morning to see a patient who had undergone reconstructive surgery.  Her nurse, Sara, smiled as she worked.  Even so, I thought she looked a little tired.  I asked her how she was doing.  She told me she was working her second twelve-hour shift in two days.  She was covering for a nurse who had called in sick.  You would never know it. Sara was professional, caring and attentive to my patient, as well as to the five other patients assigned to her.  I was in awe of Sara.

Operating on almost no sleep, she was spending Christmas working in the hospital, instead of with her small children, and she was going about her job cheerfully without complaint and with consummate professionalism…[read more]

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December 22, 2011

Group says El Paso’s nurse-patient ratios inadequate

Here’s an article from the El Paso Times that discusses the differing viewpoints of what is adequate and safe staffing.  When you have sick patients that are totally at your mercy for safety, how can you skimp on the number of nurses assigned to care for them?  It is a shame that this article will get little to no attention because the topic is being put forward by the nursing union and today everyone hates unions, it seems.

This is a timely and interesting article that I hope you will read to the end and leave your thoughts about.  When nurses strike or threaten to strike it most surely will be because of patient care adequacy or patient safety.  Rarely will you find a nurse who says she/he does not make enough money.


Posted: 12/22/2011 12:00:00 AM MST

El Paso nurses alleged Wednesday that hospitals are jeopardizing patient safety by having inadequate nurse-to-patient ratios.

This is happening with greater frequency, and it has nothing to do with nurse shortages, said members of the National Nurse Organizing Committee (NNOC)-Texas/National Nurses United (NNU).

A group of registered nurses who belong to the organization had a news conference Wednesday across the street from Del Sol Medical Center to bring attention to patient, staffing and pay issues.

The NNOC/NNU said in a statement that nurses have filed 334 formal complaints known as ADOs against Del Sol and Las Palmas Medical Center.

“ADOs (assignments despite objections) are lodged when nurses are given assignments that, in their professional judgment, could affect patient care standards,” the statement said.

El Paso NNOC/NNU members Gloria Givens and Amy Peña said they also are seeking better pay for nurses at Del Sol and Las Palmas, which together employ about 800 registered nurses.

Guidelines for the ideal nurse-patient ratios vary, depending on the level of care required for patients.

The NNOC/NNU members said California is the only state that has codified nurse-patient ratios. Although national guidelines exist, each hospital in the rest of the states sets its own policies and procedures.

“Patient care is our first and absolute priority every day at both Las Palmas and Del Sol Medical Centers,” said Carla Sierra, spokeswoman for the two hospitals.

The allegations made by the National Nurses Organizing Committee (NNOC) about staffing issues at both hospitals are not true. We have been bargaining with the NNOC in good faith, and we will continue to do so in an attempt to reach agreement on a contract.”

At Las Palmas, nurses have complained about inadequate staffing and the treatment of nurses.

“For example, in the neo-natal intensive care unit — where the most critically ill babies are cared for — staffing standards are not consistent with either the hospital’s policy or national guidelines,” the NNOC/NNU statement said. “In the telemetry unit, where adult patients are monitored and cared for — a similar situation exists, where staffing ratios are below standards.”

At Del Sol, NNOC/NNU members said, nurses also have raised concerns with management, at the bargaining table and in individual units, including medicalÐsurgical, cardiac ICU, and telemetry units, about the hospital’s nurses staffing in these units required by the hospital’s own patient classification system.

“The nurses are in negotiations with their respective hospitals, owned by Nashville-based Hospital Corporation of America,” the NNOC/NNU statement said, and added that Hospital Corporation of America continues to rank at the top of the nation’s most profitable hospitals.

Peña said, “This is the time for hospital management to focus on a host of issues related to RN staffing. We have laid out these with detail and towards the goal of a comprehensive policy to ensure patient care standards.”

NNOC/NNU members said they are encouraged by the fact that registered nurses recently concluded a collective-bargaining agreement with an HCA-affiliated hospital in Las Vegas, which incorporates enhanced professional and economic standards.

“The gains we made makes me excited to continue my career in a facility that will really value skilled, experienced nurses,” said Liz Bickle, a registered nurse in the Las Vegas hospital’s progressive care unit.

The HCA Mountainview-Las Vegas contract creates a staffing committee to examine the hospital’s staffing levels. Registered nurses will also receive pay raises of 9 to 19 percent during the contract’s three-year period.

Diana Washington Valdez may be reached at; 546-6140.

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December 18, 2011

Top 10 Nursing Stories of 2011

Filed under: Nursing — Shirley @ 10:51 am
Tags: ,
An oil lamp, the symbol of nursing in many cou...

Image via Wikipedia

Here’s a round-up of the top 10 nursing stories this year that I found at  I only posted the first page here, so be sure to click over to see the remaining 2 pages.  I reread all the stories and each one is important and timely, so be sure to click on them too.


Rebecca Hendren, for HealthLeaders Media, December 13, 2011

2011 has been a tumultuous year as healthcare organizations come to grips with value-based purchasing, rules for ACOs, meaningful use, and financial upheaval. Nursing has dealt with continued cost cutting while also being expected to lead care delivery transformation, improve patient satisfaction, and reduce healthcare-associated infections.

Here’s a rundown of the most popular nursing stories we covered in 2011 in case you missed them or just want to have another look.

1. Five Reasons Nurses Want to Leave Your Hospital
Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? Mandatory overtime and ignored bad behavior are two issues that have nurses eyeing the exits.

2. Suicide After Medical Error Highlights Importance of Support for Clinicians
A tragic story about the death of a child from a medical error turned even sadder in the spring after the nurse who administered the medication took her own life. The incident served as a grim wake-up call for hospitals and how to deal with clinicians after errors.

3. 5 Ways to Retain New Graduate Nurses
New nurses have a difficult time bridging the gap from nursing school to practice and often don’t stay with their first job for the long term. Hospitals can recognize this transition and help new graduate nurses through the transition with these five strategies that ensure they are engaged, long-term employees.

4. Does Mandating Nurse-Patient Ratios Improve Care?
The debate intensified as more than a dozen states considered laws to establish hospital nurse-to-patient ratios. This article examined whether patients get better care, experience fewer adverse events, and have shorter lengths of stay and lower mortality with ratios…[read more]






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December 10, 2011

A growing number of registered nurses in California, U.S.

Filed under: Nursing — Shirley @ 8:17 pm
Tags: , , , ,

Here’s an article from the Los Angeles Times that I found very interesting.  At first I read this thinking, “Great, a good article about nursing for a change.”  Then I reread the article and had a change of heart.  It seems that California, a state with a legally mandated nurse-to-patient ratio, is seeing more growth in the nursing field than any other state.  Imagine that–hmmm, I wonder why that might be?

Then the Rand Corporation goes public to announce THE END OF THE NURSING SHORTAGE is at hand!  But not until 2030.  Isn’t next year 2012?  Sounds like a lengthy shortage to me.

Then, this article talks about a Cardiac nurse, a Nurse Practitioner, and a Research nurse who wants to be a Nurse Practitioner.  Where are the lowly bedside nurses?  Why are we never consulted or included in these events?

I think I must be extremely biased, but you read the article and make your own conclusions.  Let me know what you think of this article, won’t you?  Maybe I am way off track, but I don’t think so.

If the trend continues, say researchers at the Rand Corp., there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system.

By Anna Gorman, Los Angeles TimesDecember 6, 2011

Lauren Mills’ counselor in college pushed her to consider nursing. She heeded the advice, graduated from Cal State Long Beach in 2007 and now works with cardiac patients at an Orange County hospital. It’s proved a challenging and gratifying choice, said Mills, now 27.

“You are using your brain and in a way you are using your heart too,” she said. “You feel good when you go home. You feel you made a difference.”

Increasing numbers of women like Mills are helping swell the ranks of registered nurses, easing chronic shortages in both California and the nation, according to a study released Monday by the Rand Corp.

Nationwide, the number of registered nurses ages 23 to 26 grew from 102,000 in 2002 to 165,000 in 2009, according to the study. The current cohort of young nurses is expected to be the largest ever, the study said.

If the trend continues, there may be enough nurses by 2030 to meet the projected needs of aging baby boomers and the expansion of the healthcare system, researchers said.

“Compared to where nursing supply was just a few years ago, the change is incredible,” said David Auerbach, lead author of the study. “If it keeps going, it turns everything on its head and it’s a major revolution.”

California has seen an even more dramatic rise in the number of new nurses, said Joanne Spetz, a professor at the Institute for Health Policy Studies at UC San Francisco. “We are seeing a lot of young people entering the field, which is fabulous. These are the people we need to be moving into the nursing workforce.”

More than 11,500 people graduated from California nursing schools in 2010, up from 5,300 in 2002, according to a report Spetz did for the California Board of Registered Nursing. Much of that is due to a concerted effort by hospitals, foundations and policymakers to expand nursing school slots, she said.

Researchers previously predicted that the U.S. could be short as many as 400,000 registered nurses by 2020. In California, experts believed that the state could see a shortage of about 89,000 by 2030…[read more]

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November 29, 2011

Helping Nurses deal with death and dying

Filed under: Nursing — Shirley @ 7:02 am
Tags: , , , , , ,

I recently was contacted about running a story here on an interesting situation.  This is a topic that all nurses must deal with at one time or another.  We don’t talk much about it, and maybe we feel uncomfortable about dealing with it.  However, death and dying are part of living and we, as nurses, are usually there to help the family deal with this trauma.

It’s seems really nice that a mortuary would be willing to help nurses learn about and learn to deal with this situation.  Because of my past experiences and the experiences of many of my sister nurses, I am posting his article here for your education.  Let me know what you think about this topic and if you want me to continue to offer guest postings here.


When a death occurs at a hospital or in hospice and people have questions about what happens and what they should do, who do they ask? Usually the first person of authority they see: a nurse.

 A difficult yet inevitable conversation, what can nurses do to prepare for these questions? O’Connor Mortuary, serving Southern California’s families since 1898, offers CE credits for a tour entitled “Unmasking the Mysteries.” The tour consists of an informative visit to the mortuary and an in-depth presentation on the processes that go on behind closed doors. Dealing with mortuaries is often intimidating for families and nurses alike, but this tour, along with other workshops offered by the mortuary, opens the line of communication and gives nurses a chance to ask questions and fully understand what goes on to better answer the questions of their patients and patients’ families.

If interested in interviewing Neil or if you’d like information about upcoming “Unmasking the Mysteries” tours, please let me know.


Helping a family that has suffered the loss of loved one can be incredibly complicated. Many family members, in their hour of need, may ask a number of very difficult questions as they attempt to deal with both the emotional and logistical challenges of a death in the family. Neil O’Connor, CEO of O’Connor Mortuary in Laguna Hills, Calif., has worked with many nurses to steer these families in the right direction as they deal with the myriad questions that come following a death in the family. Here are some common questions you may encounter, along with some straightforward answers.

 My loved one has passed away. What do I do now?

 If the patient has preplanned their funeral, you should simply instruct the family to call the mortuary to notify them of the passing. Sometimes the family assumes the hospital will notify the mortuary, but for safe measure, you should urge a family member to take that first step.

If the patient has not preplanned their funeral, you should ask them if they’ve selected a mortuary. Most hospitals have a list of local mortuaries they can provide. Families are often overwhelmed and don’t know where to begin, but choosing the right provider is an important step in planning a funeral. Hospitals typically give families 1-2 days to choose a funeral home and transfer the care of their loved one from hospital to mortuary, so encourage them to take their time and ask questions about the care they’ll be receiving.

Once the mortuary is engaged to bring someone into their care, it will transport the person to the facility. A written release from the family granting the mortuary permission to do so may be required depending on the hospital.

How soon should I plan a funeral or memorial service?

It is recommended that the funeral occur within 4-6 days of the death, but at O’Connor, we encourage anywhere from 5-10 days. This event will commemorate the life of the loved one, and we don’t want anyone to rush through the planning of this one-time ceremony. We encourage people to take their time and get the details in order to ensure that service will accurately reflect the loved one’s life and provide the best opportunity for remembrance to family and friends.

What is the best way for me to inform friends and family of my loved one’s passing?

In addition to your many responsibilities as a nurse, you are often looked to for emotional support as well. When we hear this question, we advise families to personally call those closest members of their family circle, and then to create a “phone tree” to inform extended friends and family. Enlisting the help of friends and family will help alleviate some of the stress.

Is embalming required by law?

Embalming is not required by law unless they select arrangements that require the body to be embalmed, such as public or private viewing or shipping to another state or country via a common carrier. There are also some occasions when the Coroner’s or Medical Examiner’s office will embalm a body for investigative reasons.

 What if There is not a chosen a mortuary?

 My best advice is not to select a mortuary from the internet or the yellow pages at 3:00 a.m. It is very difficult to make sense out of anything when you are working through a crisis. Even if you have not selected a mortuary and a death has occurred, you still have time to find the right provider for you and your family. Remember, even if you select a mortuary and your loved one is taken into their care, you can still select another company if you change your mind. You do not have to stay with your first choice if you don’t feel comfortable with them.

 What questions should I ask to ensure the funeral home is looking out for my best interests?

 Here are four key questions to ask over the phone or in person.

1. How will you take care of me?

2. Why should I trust you?

3. What makes you different?

4. Will you guarantee your services & memorial products 100% or money back?

If they cannot answer these questions off the tip of their head, they probably are not living these core values.

Do you have questions you’d like to have answered by Neil O’Connor? Ask in the comments section and we’ll get them answered!


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October 27, 2011

Engage Nurses to Raise Your Patient Safety Scores

Filed under: Nursing — Shirley @ 1:13 pm
Tags: , , , , ,

Here is an article about patient safety and who owns the indices.  This article is good, in that it talks about how top-down changes never stick and that you have to involve and empower the hands-on staff if you want to make lasting changes.  That I like.  What I was not too keen on, and I could be way off target here, is it also felt that nurses not taking ownership because of administrations policy and ways of dealing with the problem, was somehow to blame for there still being a problem.

After reading the article, I felt “there’s just another thing to throw on the nurse’s plate” when nurses everywhere are already struggling to stay current and afloat with all the healthcare changes that are in the works.  Nurses just want to nurse.  Period.  Let them do what they became nurses to do and maybe some of these problelms would disappear.  However, you would have to have enough nurses first so that each nurse could actually do the nursing she/he went to school to do.  What a concept!  I’m being sarcastic, in case that does not translate well in print.

Here’s the article from so you can read it and decide for yourself how it makes you think and feel.  Let me know, won’t you?


Rebecca Hendren, for HealthLeaders Media , October 25, 2011

Who owns the quality measure and patient outcome scores in your hospital? Most hospitals have quality, safety, and infection prevention professionals devoted solely to these statistics and ways to improve them.

All their efforts are meaningless unless nurses and other clinical staff are engaged in the process. Too often, they are not. Most staff nurses don’t know what value-based purchasing is or why they should care about it. All they know is that when Administration or “Quality” has a new scheme it will take nurses more time to do their jobs.

Nurses may fully support the changes because they will benefit patients, but they don’t own them and they don’t own those scores.

As the people who actually touch patients, all members of the nursing staff need to feel directly responsible for patient safety. Quality improvement becomes one more meaningless directive from “above” unless nurses feel engaged in the process, involved in the plans, and accountable for the results.

“Culture eats strategy for lunch,” says Mary J. Voutt-Goos, MSN, RN, CCRN, director, Patient Safety Initiatives and Clinical Care Design at Henry Ford Health System in Detroit. “If frontline staff aren’t in agreement and actively engaged in the process, it won’t happen. Top-down approaches to culture change are typically unsuccessful.”

This is one reason why scores can start creeping downward after a successful quality improvement effort has come and gone. If nurses aren’t engaged in the process, they have less inclination to remain on a directed path.

“All frontline staff, not just nurses, should be engaged, as well as empowered to act, if we really want to see a change in our culture of safety,” says Voutt-Goos.

One way to build a feeling of accountability in nurses is to empower them to solve the problems themselves—in conjunction with quality and patient safety professionals, of course. New procedures or processes are more likely to be met with acceptance and to become part of everyday practice when the caregivers themselves are involved in the design.

At Henry Ford Health System, the organization studied aviation industry principles of safety cultures and safety climate literature and identified global indicators of safety culture.

“We use these global indicators as a guiding framework for our culture of safety efforts,” said  Voutt-Goos. “One of the global indicators is employee empowerment.”

Empowering employees involves giving them a level of responsibility and knowledge, which sometimes they may not want, but is vital to achieving an end result of quality patient care in a financially healthy organization.

One common practice to reduce outcomes-related to issues such as patient falls or CAUTIs is to pit units against each other in competition and reward the winner with a pizza or ice cream. While it’s appropriate to celebrate success and recognize hard work, I think it’s a mistake to rely too heavily on competition.

Rewarding the unit that most improves its customer satisfaction scores or reduces patient falls by the greatest percentage is great at building enthusiasm and recognizing hard work, but it’s not an effective long-term strategy. Nurses should be treated like adults and involved in the imperatives behind process improvement, both those related to patient care and those related to the organization’s bottom line.

Just as the hospital should treat nurses as adults, nursing staff should be more interested in quality outcomes. They must seek out and embrace their level of ownership in these metrics. In today’s financial reality, it is no longer acceptable to not take an active role in quality improvement efforts. Organizations should engage nurses in frank and honest communication.

The financial imperative is such that hospitals can’t afford…[read more]

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October 17, 2011

EDs seeing more children for psychiatric care

Here is an article from that presents the findings of a study showing that mentally ill patients, and in particular, mentally ill children are being forced by cutbacks in mental healthcare to utilize the emergency rooms more and more in order to get the help they need.

Emergency rooms are already overcrowded and when you add in mentally ill patients that come to the ER because they cannot get seen in any outpatient clinic, you have a disaster.  People believe that the ER is the magic answer to their health problems when in reality this system is stretched so far that real emergencies have trouble getting care sometimes.

We all know that going to the emergency room with a non-life-threatening problem means a very, very long wait.  Triage will put you to the end of the line and let the life-threatening problems have first opening.  That is really the way it is supposed to work.  However, it seems that with a population woefully under or non-insured, the ER becomes the place of last resort.  There has to be a solution to this problem.  There just has to be.  ER nurses are burning out at record numbers.

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Pediatric patients, primarily those who are underinsured, are increasingly receiving psychiatric care in EDs, according to an abstract presented Oct. 14 at the American Academy of Pediatrics National Conference and Exhibition in Boston.

Researchers reviewed ED data, including patient age, sex, race, ethnicity, insurance status and type of care received, from the National Hospital Ambulatory Medical Care Survey between 1999 and 2007. They found during eight years, 279 million pediatric patients were seen in U.S. EDs, of which 2.8% were for psychiatric visits. The prevalence of psychiatric visits among pediatric patients increased from 2.4% in 1999 to 3% in 2007. The underinsured group — patients without insurance or who are on Medicaid — initially accounted for 46% of pediatric ED visits in 1999 and grew to 54% in 2007.

The data show, as anticipated, psychiatric visits by children to EDs continue to increase in number and as a percentage of all patients being seen in EDs, said lead study author Zachary Pittsenbarger, MD, of Children’s Hospital Boston.

“A second, and more novel finding, is that one group in particular is increasing beyond any other sociodemographic group, and that is the publicly insured,” he said. “It has been found previously that the publicly insured have fewer treatment options and longer wait times for psychiatric disorders when not hospitalized. This new finding argues that limited outpatient mental health resources force those patients to seek the care they need in the emergency department.”

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