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 http://www.fiercehealthcare.com/story/patient-location-gloves-worker-type-predict-hand-hygiene-compliance/2011-10-04?utm_medium=nl&utm_source=internal#ixzz1x6O2AD00
Subscribe: http://www.fiercehealthcare.com/signup?sourceform=Viral-Tynt-FierceHealthcare-FierceHealthcare

Enhanced by Zemanta

January 8, 2012

Most in-hospital adverse events unreported: OIG

Here is an article from ModernHealthcare.com  that addresses the failure to report events causing patient

Logo of the United States Department of Health...

Image via Wikipedia

harm.  The article goes on to point out reasons for such a failure and the reasoning does make sense.  However, I feel quite strongly that if nurses had the time to make reports and if those reports were simple and easy, there would be quite a few made.  As it is, nurses are drowning in patient loads, paperwork, and have little to no time to eat or use the restroom, so forgive me if we sometimes don’t stay after our shift to enter cumbersome reports into the computer about events that really did not cause harm but could have.

Please read this article and I would love to hear your take on this topic.

____________________________________________________________________________

By Maureen McKinney

Posted: January 6, 2012 – 4:00 pm ET
Read more: Most in-hospital adverse events unreported: OIG – Healthcare business news and research | Modern Healthcare http://www.modernhealthcare.com/article/20120106/NEWS/301069970#ixzz1isnhQ09U
?trk=tynt

The vast majority of in-hospital adverse events go unreported by staff, according to a report from HHS’ inspector general’s office (PDF).

Using a month of survey data from a sample of 189 hospitals, the inspector general’s office found that hospitals’ voluntary incident reporting systems captured only about 14% of events that cause patient harm, such as medication errors. Federal investigators attributed low reporting rates, at least in part, to poor knowledge among hospital staff about what patient harm actually means.

“For example, staff reported only one of 17 sample events related to catheter usage (e.g., infection and urinary retention), a common cause of harm to Medicare beneficiaries,” according to the report.Other types of events that went unreported included cases of excessive bleeding related to misuse of blood thinning medications, and hospital-acquired infections.Incident reporting systems are a requirement for participation in Medicare, but a lack of uniform requirements—such as lists staff can use to identify patient harms—can damage the systems’ reliability, according to the report.“Because hospitals rely on incident reporting systems to track and analyze events, improving the usefulness of these systems is critical to hospitals’ efforts to improve patient safety,” the report said.

The report urged the CMS and HHS’ Agency for Healthcare Research and Quality to develop a list of adverse events for hospitals to use. Additionally, the office said, the CMS should reassess its methods for judging hospital compliance with the reporting-system requirement.

Enhanced by Zemanta

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]

Enhanced by Zemanta

September 7, 2011

Disruptive behavior, negligence, endangered patients, and millions of dollars

Centers for Medicare and Medicaid Services (Me...

Image via Wikipedia

Here’s an article from the Patient Safety Monitor that makes my skin crawl.  Patient safety and well-being are tantamount to nurses.  Have we, as nurses, given up the role of patient advocate?  This article cites several recent court decisions against medical facilities for failed patient safety observances.  Where were the nurses in this?

Staffing is always the core problem in these types of problems.  Hospitals expect nurses to do more and more and more without giving the proper staff to accomplish this goal.  As long as hospitals continue to get away with short-staffing, they will because they are a business.  The bottom line is profit, even in non-profit facilities.

Think about it like this:  is it less expensive to pay a fine every so often that does not amount to the cost of maintaining proper staff to patient ratios?  Why pay every day for more staff, at a cost that is very high, when you can pay much less in fines and then only if you get caught.

I know that I do not speak for the majority of the nursing profession.  I can only speak for myself, based on my own experiences in hospitals.  I love nursing.  I love being a nurse.  I don’t love the way hospitals staff.

Please read this article and leave me a comment, won’t you?  When you visit the site, look around because you will find many interesting articles about nursing and hospitals there.  Be sure to leave them a comment on this post while you are there.

__________________________________________________________________________

August had been filled with a number of different patient safety rulings and findings that show poor patient safety can be costly in many different ways.

Let’s start with Boston, where two old cases have been settled.

First, parents of a newborn who died at Beth Israel Deaconess Medical Center in Boston seven years ago were awarded $7 million by the Suffolk County Superior Court after a physician and nurse practitioner were found negligent in their care. The parents claimed they did not react quickly enough to the infant’s deteriorating condition. The premature infant developed necrotizing entercolitis, something caregivers should have been watching for as it is common in infants delivered prematurely.

The parents alleged they came to visit their daughter and found her discolored and unresponsive, and said staff took more than an hour to respond.

In another recent decision, the U.S. Court of Appeals upheld a lower court verdict against Brigham and Women’s Hospital involving alleged disruptive behavior exhibited by Arthur Day, MD, the former head of neurosurgery. Sagun Tuli, MD, claims the hospital retaliated against her for complaining about her work environment.

The court ruled that Tuli was defamed and that her career was affected.

Now, on to Dallas.

It was recently reported that in March, 2010, Parkland Medical Memorial Hospital in Dallas, TX, informed 73 female patients that instruments that were not properly sterilized had been used on them, putting them and any sexual partners at risk of infections.

Following that incident, the Centers for Medicare & Medicaid Services (CMS) investigated the hospital in July, 2011. The investigation led to the finding that the hospital created an “immediate and serious threat to patient health and safety.” The report found that ED patients in severe pain were given maps of the hospital to find the appropriate place for treatment and children sent home without screenings.

Meanwhile, in a separate investigation, Parkland Memorial Hospital, along with the University of Texas Southwestern Medical Center, agreed to pay $1.4 million after a four-year Medicare billing fraud investigation revealed that resident surgeons were not properly supervised and also failed to comply with informed consent requirements.

Another Dallas hospital, Methodist Dallas Medical Center, was also recently cited for 10 violations by CMS, some which include failing to screen and stabilize emergency department (ED) patients and understaffing the ED.

Do these more recent findings indicate that CMS is getting tougher? Would similar findings be found elsewhere, if investigated? Is this the sign of the times of healthcare reform? What do you think? Share thoughts below.

Enhanced by Zemanta

September 1, 2011

Nurse Staffing Costs Must Be Weighed Against Cost of Errors

Hospital

Here is an article that talks about staffing…again.  This article, however, is written from the administrator’s vantage point and is remarkable in what it states.  Nurses are necessary!  Nurses can affect the hospital’s bottom-line in either a good way or a bad way.  She also goes on to state that “a-nurse-is-not-a-nurse” which seems to be how most people think of nurses.  We are not all alike and my experience is of no use to me if I am sent to work in ER.  Hospitals should value nurses and plan to utilize nursing staff appropriately if they want to see improved patient satisfaction, decreased errors, and less turnover.  Overall, a very good article.  Please do visit the original site where you can find many other fine articles that apply to nursing today.

____________________________________________________________________________

Rebecca Hendren, for HealthLeaders Media , August 30, 2011

When revenues fall, hospitals stop investing in the biggest budget expense: nurses. That’s a bad short-term solution to a long-term problem. It’s time we change the way we think about hospital staffing.

“When we look at all the problems we have [in healthcare right now], what is the first thing we do? Start slashing nurses,” says Kathy Douglas, MHA, RN, president of the Institute for Staffing Excellence and Innovation, CNO of API Healthcare, and a board member of the journal Nursing Economic$, which has devoted a whole issue to examining the evidence around nurse staffing.

“Healthcare executives and nurse leaders need to be more aware of thinking about staffing and scheduling from a bigger perspective so we understand all of the financial implications,” she says. “How do we manage our way effectively through the maze and chaos we are in right now?”

To deal with ongoing challenges presented by value-based purchasing and healthcare reform, executives must acquaint themselves with studies demonstrating how nurse staffing affects a hospital’s overall performance and base staffing decisions on evidence.

“What we know from research and experience is that there are very direct links between staffing and length of stay, patient mortality, readmissions, adverse events, fatigue-related errors, patient satisfaction, employee satisfaction, and turnover,” says Douglas. “All of these things have studies that directly relate them to staffing. And all have the potential for significant costs. When we don’t look at the relationship between our LOS and our unreimbursed never events and our staffing, we’re not looking at the whole picture.”

Too few hospitals track staffing data in comparison to these big issues.

“Some of these things people might call ‘soft costs,’ like nurse turnover,” says Douglas. “But to me, money is money.”

Soft costs have hard financial implications. Value-based purchasing has already put real money behind patient satisfaction. To make the link to staffing research and why it matters, we have to stop looking at staffing numbers in isolation. Until we look at the whole picture, which includes everything associated with staffing, we’re not going to understand financial performance.

“Staffing costs sit in one part of the budget, so we think of the results there,” says Douglas. “Then the cost of errors sits in another part of the budget. If I could say one thing to healthcare executives it is to make staffing a top strategic priority in your organization. If you look at top priorities—LOS, safety, quality—all of these things have direct links to staffing.”

An organization that has cut back on staffing may not notice that it is overusing overtime and not notice that there’s a relationship between the overtime and the number of infections on a unit.

Peter I. Buerhaus, PhD, RN, FAAN, chair of the National Health Care Workforce Commission, a 15-member panel composed of distinguished leaders from academia and the healthcare industry created under The Patient Protection and Affordable Care Act, published research in 2008 looking at unreimbursed errors in healthcare, such as catheter-associated urinary tract infections and central line infections.

“I decided to get out my calculator and add them up. When I looked at it in one year the total came to $21 billion in unreimbursable events,” says Douglas.

“When hospital executives tell me there’s not enough money to staff well, my first thought is ‘what about the $21 billion we spend each year on unreimbursed never events?'”

Douglas believes the answers lie in using data and evidence to make effective decisions and utilizing technology in decision making. She is not a fan of blanket ratios.

“It’s not that ratios are bad in and of themselves. Ratios happened, in my opinion, because hospital leadership and nursing weren’t communicating well,” she says. “My issue with ratios is that it assumes [staffing] is about a number. I disagree with that. It’s not about a number. It’s about the right number with the right qualifications with the right competencies with the right experiences.”

Douglas says hospitals need to be free to examine all the factor…[read the rest of this article]

Enhanced by Zemanta

July 1, 2011

Patient Classification Systems Address Nurse Staffing Balance

Here is an interesting article from Health Leaders Media that I found.  I have read this article several times, because I am impressed with the information it contains.  It is not often that you come across an article that actually gives nurses and nursing in general any credit for lowering bottom line costs and increasing productivity, while improving customer satisfaction.

As a nurse who has worked in the Sharp system as a travel nurse, I can say that their use of electronic staffing equipment far and away leads the nation.  The nurses working for this system really are satisfied and relatively happy with their current employment.  There is the ordinary stress-related bickering, but if asked, these nurses will mostly tell you that they like where they work.  That is a far cry from the responses I have gotten at other hospitals.

Please read this article and then let me know what you think.  Visit the original site, too, because there are many wonderful nursing articles available there.

______________________________________________________________________________

Susan Stone, PhD, RN, and Ruth Plumb, MSN, RN, for HealthLeaders Media , May 24, 2011
Determined to achieve meaningful use of electronic health records (EHR), hospitals and health systems will increasingly adopt clinical information technology between now and 2015. This is certainly a welcome development for our economy and patient health. However, because providers are putting larger investments into EHR systems, they are overlooking other strategies to quickly enhance clinical and financial performance and support their pending transformation to accountable care.

While EHR technology is key to reducing costs and improving care quality, safety, and outcomes, providers also can achieve these goals by leveraging patient classification software and managing nursing staff more effectively. When used in parallel or integrated with an EHR, these combined resources give organizations extra tools to realize even greater clinical and financial benefits. This is a lesson that San Diego-based Sharp HealthCare has learned and benefited from over the past two decades.

Since 1990, Sharp HealthCare has used a nursing staff management solution to assign nursing staff and resources appropriately, improve care, and manage RN labor costs and department budgets. Every hospital faces these common challenges, but addressing them successfully is especially difficult for California-based providers struggling to survive the Golden State’s unique and pervasive capitated environment.

Though health systems in other states have not been exposed to capitation, this will change soon with the Patient Protection and Affordable Care Act allowing the Centers for Medicare & Medicaid Services (CMS) in early 2012 to use payment models such as partial capitation. Under this particular model, providers and accountable care organizations will bear some but not all of the financial risk.

In addition to helping organizations better manage their bottom line in a risk-based reimbursement environment, a patient classification system makes it easier for hospitals to comply with nurse-to-patient ratio regulations. Fifteen states and the District of Columbia have passed nurse staffing legislation, according to the American Nurses Association. But with hospitals admitting a higher volume of sicker patients and cutting nursing budgets across the country, RNs and others are increasingly urging lawmakers in other states to pass laws to ensure sufficient staffing to meet patients’ needs.

Having the right skill mix and nurses with the necessary skills readily available to take care of the right patient at the right time is essential to quality of care, patient safety and financial health. Still, it is common for nurses, unions, and state regulators to question hospitals’ staffing level decisions. An intensive care unit RN, for instance, may contend that a patient’s acuity demands his or her sole attention or the services of an additional nurse. This questioning or complaint about inadequate staffing, which tends to increase when facilities institute layoffs in poor economic times, is often emotional.

A patient classification system enables hospitals to remove emotion from the equation by demonstrating through hard data that its decisions are valid, not arbitrary. The tool applies an evidence-based approach to assign, match, and schedule nurses where they are needed the most based on patient acuity level.

Institutions that use the technology to assess acuity on every shift across all patient care units are able to provide objective documentation showing they are not understaffed, which of course places patients at risk. This proactive assessment of patient acuity helps ensure business continuity when regular charge nurses are out sick or on vacation. Replacements typically are less familiar with a unit’s policies and procedures, which can result in poor patient outcomes and higher costs.

A patient classification system promotes operational consistency by offering data on fill-ins that can be used to run a department efficiently in the absence of the regular charge nurse. More importantly, the process of assessing acuity on every shift gives health systems the ability to act immediately to prevent understaffing and overstaffing, both of which result in higher costs from potential malpractice lawsuits, disputes with employees, lost productivity and overtime.

Lack of awareness among many nurses about the budget process, healthcare financial management principles and how assignments are determined is a major reason for those costs. When bedside RNs are unaware of the financial role they play in managing and determining the fiscal health of their employer, nurses and administrators are pitted against each other.

To eliminate damaging infighting and wasteful spending, Sharp HealthCare, which serves 1.3 million residents of San Diego County in southwest California, has made it a priority to educate nurses how to use the patient classification system to analyze, track, and monitor staffing, productivity, and nursing budgets. Its leaders discuss the critical role that technology, patient acuity, and appropriate nurse assignments play. Every Sharp HealthCare facility shares annual financial targets and justifies its department budget. Hospital executives and RN leadership emphasize that their budget development is comparable to how RNs manage their household finances. In other words, the health system deploys the funds it has to provide care in the most efficient and cost effective manner possible. Like nurses—or anyone else—Sharp HealthCare cannot spend money it does not have.

Today, RNs understand staffing decisions are based on patients’ best interests as opposed to driven by an effort to save money at the expense of quality care. The results are fewer misunderstandings, misconceptions, and conflicts that distract Sharp HealthCare hospitals and nurses from their core clinical mission.

Sharp HealthCare sets goals for facilities partly based on the location and the size of an institution’s nursing staff. As a not for profit healthcare system, the organization’s long-term viability is dependent on its financial health and well being.

Increased nurse awareness and the nurse staffing management system have helped Sharp HealthCare not only weather a weak economy for the past three years, but also post impressive financial results during the same period.

The outreach also gives nurses a clearer view of the economic picture at the facility and enterprise levels, and how their institution compares to local and national peers. Whenever a financial variance occurs in their unit, RNs now can easily pinpoint it and determine the reason why. The software enables Sharp Healthcare to:

  • Deliver accurate patient acuity, skill mix, and census data in real time, ensuring charge nurses and nursing managers have the information necessary to optimize clinical and financial outcomes
  •  Analyze retrospectively whether nursing assignments were a factor in near misses that harmed or placed patients at risk
  • Aggregate information to enhance clinical, financial, and operational decision-making
  • Benchmark internal evidence-based data against national standards for acuity
  • Develop and successfully manage nursing budgets

To further increase time savings for nurses and validity and reliability of data, Sharp HealthCare now is working to integrate the software with its EHR.

With health reform altering reimbursement models and the first of 78 million baby boomers beginning to turn 65 years of age in 2011, staffing, clinical, and financial pressures on providers will only intensify. Since RN labor costs represent providers’ single largest controllable expense and a significant percentage of their operating budget, it is critical to use nursing resources more efficiently and enlist RNs as strategic assets and financially oriented managers. Providers following this path will find it easier to navigate the rapidly changing healthcare ecosystem and meet their goals.


Susan Stone, PhD, RN, is chief nursing officer and Ruth Plumb, MSN, RN, is an acuity nurse specialist at Sharp HealthCare, which comprises four acute care and three specialty hospitals in southwest California.

Enhanced by Zemanta

June 1, 2011

How protocols are taking the decisions away from nurses

Illustration of Florence Nightingale

Image via Wikipedia

Here’s a wonderful article I found on Kevin MD‘s blog that is written by SaraBethRN.  As I read this article, I found myself shaking my head in agreement.  I felt like my own thoughts were printed right there in the article.  I immediately emailed her for permission to reprint here.  I hope you enjoy this article as much as I did.

________________________________________________________________________________

by Sarah Beth Cowherd, RN

If you have been at your nursing job for a while, you’ve probably almost forgotten.

Forgotten what it was like to come in to the healthcare system you now work for and realize there are hundreds of new protocols for you to learn and adhere by as a nurse. After years of routine, you now go about your day as if you actually have some choice in the way you give care.

At one point you probably did. I was not around during this age of nursing. The age when we had autonomy. Freedom to practice. Freedom to be innovative.

Today, I am somewhat saddened by the current state of the nursing profession. Don’t get me wrong: I love what I do. I am so thankful for the opportunities set before me.

But whatever happened to “nursing judgment.” Or “nursing decision.”

I can’t tell you how much recently I’ve heard the phrase, “It is hospital policy that…” “You can’t do that, it is protocol that…”

I understand the need for protocols. They help us in the case that something goes wrong and the hospital gets sued. Did the nurse adhere to the protocol? If not, they will be subject to disciplinary action and take the fall. If something goes wrong and there is no protocol, the hospital can say in its defense: “There is now a protocol in place.”

Maybe a less cynical need for protocols: promote and regulate evidenced-based practice among nurses. Evidenced-based practice was developed for a reason: it brings good outcomes and protects the patients.

Even so, to me it seems we are being protocoled to extinction.

When nursing sprang up, before it was considered a profession, nurses had to make due with what they had. They were forced to be innovative. I heard this once in a seminar on preventing pressure ulcers: the reason we turn patients “every two hours” is not from a scientific experiment that proved people won’t get bed sores if they are turned this often. It was from the very roots of nursing itself. When nurses were (how do I put this nicely?) prostitutes and drunks. They would walk down the room and turn all the patients to one side. Then they would sit and have a drink. When they were done with this, about 2 hours later, they would get up and turn everyone the other way. And repeat.

Even today you will read some “protocols” that require nurses to document turning patients every 2 hours. Some recent studies have shown that slightly repositioning (and not completely turning) patients every hour or even every 30 minutes has had better outcomes.

Now if I used this method of preventing pressure ulcers and did not “turn” my patients every two hours, I would be breaking protocol. I would also be forced to “lie” in my repositioning documentation.

This is just one example. I surely don’t mean to argue we should have no protocols in place.

My point is that at times, the red-tape forces nurses into a corner. We may not be creative for fear of disciplinary action.

One more story: While working night shift with a coworker and friend of mine, we had a patient with dementia that kept complaining that air was drifting on her. She was hallucinating. My friend decided to make a tent. A tent of blankets around her bed. The nurse used the IV pump, the bedside light (turned off, of corse), and the sides of the bed. (Keep in mind, this patient was not ambulatory, nor did she have the strength to sit up or attempt to leave the bed.) This was so she felt safe. She felt as though there was no air blowing at her anymore. She finally got some rest for the first time in her hospital stay.

At 6am, my coworker made a point of going into the room to take down the “tent.” Management was coming in. “I’m not trying to get fired.”

Get fired? For making use of what she had? For helping the patient sleep without sedatives? For being innovative and realistic?

We may not be extinct, but we sure are endangered species.

Sarah Beth Cowherd is a nurse who blogs at SaraBethRN.com.

Enhanced by Zemanta

April 25, 2011

Nurses fear even more ER assaults as programs cut

Here is an article that is a bit old, but still imparts useful information. The violence against nurses is escalating.   When you go to your work prepared to do whatever it takes to help people survive and improve, the last thing you expect is to be attacked or killed.  It seems that violence against nurses is becoming  the norm not the exception.  What really bothers me is that we seem to have become used to hearing about this violence and no longer react with appropriate dismay.

One of the factors that contribute to this violence may be the actual staffing ratios that hospitals use to staff.  When a very few staff are expected to do all, you set the stage for frustration and violence.  We see evidence of this everywhere today.  Simple frustration regularly erupts into full blown violence.

Please read this article and tell me your thoughts on the topic, won’t you?  This article is from the San Diego Union-Tribune.   You can visit the site to read comments and leave your own.

____________________________________

By JULIE CARR SMYTH, Associated Press Writer

Tuesday, August 10, 2010 at 11 a.m.

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

// / AP//

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio. A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press. Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

U.S. map and chart show expected state mental health budget cuts;

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

– AP

In this July 29, 2010 photo, emergency room nurse Jeaux Rinehart sits in a treatment room at Virginia Mason Hospital in Seattle. Rinehart was accustomed to fielding kicks, spits, scratches and flying punches from his patients there, but one day in 2007 he didn’t move quickly enough. An erratic intravenous drug user who had entered the ER in search of a fix, grabbed a club, came up from behind and, as Rinehart turned, smashed it into his face. Bones broken, Rinehart sucked meals from a straw for weeks. (AP Photo/Elaine Thompson)

In this July 28, 2010 photo, nurse Erin Riley poses for a photograph in Lakewood, Ohio.  A victim of on-the-job violence herself, Riley is not alone, according to an examination by The Associated Press.  Violence against nurses and other health professionals is rising as an influx of drug addicts, alcohol abusers and psychiatric patients are forced into hospital emergency departments by cuts to state treatment programs. (AP Photo/Amy Sancetta)

COLUMBUS, Ohio — Emergency room nurse Erin Riley suffered bruises, scratches and a chipped tooth last year from trying to pull the clamped jaws of a psychotic patient off the hand of a doctor at a suburban Cleveland hospital.

A second assault just months later was even more upsetting: She had just finished cutting the shirt off a drunken patient and was helping him into his hospital gown when he groped her.

“The patients always come first – and I don’t think anybody has a question about that – but I don’t think it has to be an either-or situation,” said Riley, a registered nurse for five years.

Violence against nurses and other medical professionals appears to be increasing around the country as the number of drug addicts, alcoholics and psychiatric patients showing up at emergency rooms climbs.

Nurses have responded, in part, by seeking tougher criminal penalties for assaults against health care workers.

“It’s come to the point where nurses are saying, `Enough is enough. The slapping, screaming and groping are not part of the job,'” said Joseph Bellino, president of the International Association for Healthcare Security and Safety, which represents professionals who manage security at hospitals.

Visits to ERs for drug- and alcohol-related incidents climbed from about 1.6 million in 2005 to nearly 2 million in 2008, according to the federal Substance Abuse and Mental Health Services Administration. From 2006 to 2008, the number of those visits resulting in violence jumped from 16,277 to 21,406, the agency said.

Nurses and experts in mental health and addiction say the problem has only been getting worse since then because of the downturn in the economy, as cash-strapped states close state hospitals, cut mental health jobs, eliminate addiction programs and curtail other services.

After her second attack in a year, Riley began pushing her hospital to put uniformed police on duty.

The American College of Emergency Physicians has recommended other safety measures, including 24-hour security guards, coded ID badges, bulletproof glass and “panic buttons” for medical staff to push. Detroit’s Henry Ford Hospital is among hospitals that have had success with metal detectors, confiscating 33 handguns, 1,324 knives, and 97 Mace sprays in the first six months of the program.

But there are practical and philosophical obstacles to locking down an ER. Bellino and others say safety begins with training health care workers to recognize signs of impending violence and defuse volatile situations with their tone of voice, their body language, even the time-outs parents use with children.

He said nurses, doctors, administrators and security guards should have a plan for working together when violence erupts. “In my opinion, every place we’ve put teamwork in, we’ve been able to de-escalate the violence and keep the staff safer,” he said.

Also, he and others said it is important to combat the notion among police, prosecutors, courts – and, at times, nurses themselves, who are often reluctant to press charges – that violence is just part of the job.

“There’s a real acceptance of violence. We’re still dealing with that really intensely,” said Donna Graves, a University of Cincinnati professor who is helping the federal government study solutions.

Robert Glover, executive director of the National Association of State Mental Health Program Directors, said economic hard times are the worst time for cuts to mental health programs because anxieties about job loss and lack of insurance increase drug and alcohol use and family fights.

“Most of them, if it’s a crisis, will end up in emergency rooms,” he said.

Vermont nurse David DeRosia, who has been attacked at work, said patients want McDonald’s-like fast service even when they visit busy emergency rooms. When they don’t get it, some lash out.

“They want to be able to pop in and get what they need immediately, when the emergency department has to see the sickest patients first,” he said. “There are many people who have unrealistic expectations they can get whatever they want immediately, and it isn’t a reality.”

What has heightened fears among nurses and other health professionals is that attacks have become more violent, Graves said. “What’s bringing attention to it now is the type of violence: the increase in guns, in weapons coming in, in drugs, the many psychiatric patients, the alcohol, the people with dementia,” she said.

Twenty-six states apply tougher penalties for assaults against on-the-job health care workers. A renewed push to stiffen punishment began the Emergency Nurses Association reported last year that more than half of 3,465 emergency nurses who participated in an anonymous, online survey had been assaulted at work.

“It came as news to me that they are one of the most assaulted professions out there,” said state Rep. Denise Driehaus, who is pushing tougher nurse-assault penalties in Ohio.

Yet bills making an assault on a nurse a felony instead of a misdemeanor failed in North Carolina and Vermont during sessions that just ended, and Virginia shunted its proposal to a state crime commission.

Rita Anderson, a former emergency nurse who pioneered efforts in New York in 1996 to make it a felony to assault a nurse, said resistance is often strong – among both nurses and law enforcement officials.

In 1999, after her jaw was dislocated by a 250-pound teenager, Anderson pursued charges under the state law she had worked hard to pass. She said police were surprised a nurse would press charges against a patient, and prosecutors were skeptical of the case.

“It doesn’t matter if you’re drunk or you’re on drugs or you’re in pain,” she said. “That doesn’t give you the right to hit another person.”

Seattle ER nurse Jeaux Rinehart had learned to get outside fast to avoid kicks, spit, scratches and punches on the job at Virginia Mason Hospital. Then one day in 2007 Rinehart didn’t move quickly enough and a junkie who had entered the ER in search of a fix smashed him in the face with a billy club. Bones broken, Rinehart sucked meals from a straw for weeks.

“A thing like that sticks in your mind to the point where it’s always there, it’s always present,” Rinehart said. “I’m on heightened alert a hundred percent of the time.”

Rinehart was attacked again in July. An intoxicated patient punched and spit on him, then threatened to come back with a gun and kill him. He is pursuing felony charges.

Please go to the original site to read this and others like it:

Online:

Emergency Nurses Association: http://www.ena.org

Enhanced by Zemanta

April 19, 2011

mHealth

I frequently read articles from H&HN (Hospitals and Health Networks).  Although slanted more for hospital CEO’s and management, I find many really interesting articles that show nursing as an integral part of hospital management, and in a positive light.

This article, though not about nursing, is about how our patients are changing the way they take care of themselves and how the healthcare field can help patients be better informed about their personal health issues.  It is a really good article and one that we should all think about.  Just this morning, I received an email trying to sell me  a program to make “Apps” without knowing any technical information.

The future is here.  We need to keep up.

___________________________________________________________________________
By Howard Larkin

Patients and doctors are jumping on the mobile app bandwagon, changing health care as we know it

Got kidney stones? There’s an app for that—and for just about every other clinical and administrative function. As mobile applications reshape health care, hospitals will be pressed to keep up.

“The No. 1 thing that patients can do to reduce their risk of kidney stones is to drink more fluid. But people don’t drink as much as they think they do, so how do you keep track?” asks William Johnston III, M.D., a urologist practicing at NorthShore University HealthSystem in Chicago’s northern suburbs.

Johnston’s answer is a mobile app he developed for the iPhone. Since going live on the Apple Store in June 2010, the free program has been downloaded more than 2,500 times.

Every time a patient drinks a soda or coffee or a glass of water, he opens the app, taps a picture of the beverage and enters the amount. The application automatically tracks the quantity and displays it as a percentage of the daily target—typically set at 75 ounces. It also charts fluid intake over the last week and month. It even can e-mail the information right to a physician.

“Patients are mobile, so this makes it easier to keep accurate records and get them to the physician,” Johnston says. Currently, clinic staff must transfer data manually from the app to NorthShore’s sophisticated electronic medical record, but Johnston is working on systems that will enable mobile apps to populate patient health records directly .

But does the app really help patients drink more—or reduce kidney stones? “Our observation in clinic is it definitely does,” Johnston says. “When they start using it, most patients find they are not anywhere close to the goal. If you look at it in the afternoon and you are at 25 percent, it makes you want to drink some water. I use it myself.” He is planning a clinical trial to measure the impact of the app on patient behavior and outcomes.

He’s also developing an app to help patients with enlarged prostates monitor urine flow. Other apps will provide prostate surgery patients with day-by-day perioperative and discharge instructions—complete with checklists, warning signs, and automated medication and follow-up appointment reminders.

“If the patient is at the mall and they see blood in their urine after prostate surgery, the information they need is right in their pocket. If they need help, they can call or message right away. It really opens up a new frontier for patient care, patient safety and access to doctors,” Johnston says.

17,000 Apps—and Counting

As of November, there were more than 17,000 medical applications available for download from major app stores for the Apple iPhone and iPad, and for smart phones and mobile computers using the Android, Microsoft Mobile, Blackberry, Palm and Symbian operating systems, says Ralf-Gordon Jahns, head of research at research2guidance.com, a Munich, Germany-based IT consultancy specializing in mobile technologies.

And that’s just the consumer end of the market, which is dominated by mobile phone operators and specialized health care firms. Countless mobile apps exist or are being developed by traditional health care providers, device manufacturers, pharmaceutical manufacturers and researchers around the world. They range from dedicated devices linked to glucometers and blood pressure cuffs that have been around for more than a decade to new applications that take advantage of the accelerometer and GPS capabilities of the latest smart phones to detect and automatically report patient falls and even elopements of patients with dementia. Bluetooth-enabled scales and other detectors that will automate home monitoring of a wide range of clinical conditions also are hitting the market.

Applications for monitoring patients and accessing electronic records inside the hospital using smart phones and tablets also are proliferating. Indeed, many major electronic medical-record suppliers now are developing interfaces that can run as native applications on mobile devices. “Our Haiku application for physicians and nurses allows users to look up any patient in the system and review the chart, notes, labs, X-ray results, medications. Everything that is in the chart can be viewed on the iPhone,” says Sam Butler, M.D., a pulmonary and critical care specialist who is now a clinical informatics team member for Epic. The iPhone app also supports clinical scheduling and dictation, and e-prescribing is in the works. An iPad version also is being developed. Epic, as well as other EMR suppliers, also makes personal health records available to patients over the Internet.

But more significant than the sheer volume of apps is the growing public acceptance of the technology and the increasing ability to integrate capabilities, which heretofore largely have been siloed in phones or dedicated devices, into the mainstream workflow of providers, Jahns says. He points out that many remote applications have been around for years, but haven’t gotten past the trial stage because of provider concerns about privacy and a lack of a standardized way to engage patients. But with the broad acceptance of smart phone apps, he believes the tipping point is at hand.

“In the next three to five years, we see the likelihood that doctors and patients both will realize they have smart phones, and there will be discussions like ‘I see an app for my condition. Is there a chance to include it in my treatment plan so I don’t have to come in all the time?'” Jahns says. Insurance arrangements that reward use of efficiency-creating technology, either directly or through arrangements such as global payment for episodes of care, will cement the deal. He projects that by 2015, 500 million of an estimated 1.4 billion smart phone users worldwide will use an mHealth app—and millions of U.S. baby boomers will be at the forefront.

Jahns also believes that health care providers, as well as pharmaceutical manufacturers, will supplant mobile phone companies as the primary distributors of mHealth apps, with diabetes management leading the way. Until now, charges per download and data transmission charges have paid for mHealth apps, but increasingly the funding will come from providers who can leverage the technology to improve efficiency, and pharmaceutical companies that can use it as a promotional and advertising vehicle, he believes.

“Patient demand is driving it,” Jahns says.

The iPad Effect

And so will physician demand, says William Phillips, vice president and chief information officer of University Health System in San Antonio, a 500-bed county-owned facility that conducts more than 550,000 outpatient visits annually. The main reason is the iPad. Nineteen million of them were sold in a mere nine months after they were introduced. That caught the e-media punditry off guard, and their popularity among physicians startled hospitals and EMR developers.

“We anticipated that mobile apps were coming, but we weren’t quite prepared for the iPad,” Phillips says. “They [physicians] are buying their own and asking, ‘Can you connect this with the hospital network?’ The portability, intuitive interface and 10-hour-plus battery life made it an instant hit with clinicians. The quality of radiology images is actually better on the iPad than on some of the hardwired clinical workstations.”

Doctors like the device because it allows them to keep tabs on more patients without being physically present—a big plus in these days of shrinking reimbursement. For example, anesthesiologists at Emory University developed an iPad app that allows them to monitor patients before and after surgery, increasing their efficiency as well as improving patient safety.

Responding to physician demand, University Health System developed a Citrix interface, which is a commercial program that not only allows remote access to PCs and other computers, but also allows physicians to use their iPads to use the system’s Allscripts EMR. Traffic over the hospital’s Wi-Fi network has increased by about one-third since the Citrix app went online, Phillips says.

Like many emerging eHealth apps, integration with commercially available mobile devices appeared decisive. Allscripts is developing a native iPad interface, and Phillips expects it to be available by year’s end.

But the advantages to even the Citrix interface, which may be slower than a native application and restrict access to some EMR functions, are so compelling that he already has begun implementing it in some nursing units. “We wanted to wait for the native app, but we couldn’t.”

Phillips notes that the cost of the iPad is about one-third of a similarly capable laptop. Essentially, it is set up as a dumb terminal accessing the main EMR database. All data processing takes place on the secure computer system, which communicates wirelessly with mobile devices using appropriate encryption and other data safety features. The battery life and convenience of recharging the device is a huge advance over the typical computer on wheels, or COW, which requires not only a laptop computer, but also an expensive cart and mobile battery to ensure it can make it through an 8- to 12-hour nursing shift. “The cost of a COW is up to six times [that of] an iPad,” Phillips says

Of course, it’s also a lot easier for nurses to tuck an iPad or similar device under their arm than to push an unwieldy COW from room to room, all the time worrying about when it will need to be recharged—in a location that does not violate Joint Commission standards for keeping hallways clear. That’s no small advantage for nurses who often are being asked to care for more and more patients. Moreoever, iPads eliminate the fight for COWs that can take place at the beginning of shifts.

While the durability of iPad battery life is an open question, so far it is even longer than the 10 hours advertised, Phillips says. In its new inpatient facility, University HealthSystem is incorporating not only iPad docking stations in patient rooms, but also a much more robust mobile wireless network, including antennae in stairwells and lobbies, to support an anticipated geometric increase in clinical mobile use within the hospital.

Moving Target

But while the expansion of mobile health apps seems inevitable, the precise technology that will be needed is an open question. For example, the latest Wi-Fi protocol—802.11n—allows communication over 5 GHz transmitters as well as the earlier 2.4 GHz bands, and may interfere with 2.4 GHz 802.11a-g transmissions from existing devices. The upcoming 802.11ac standard may jam existing 2.4 GHz signals altogether. This could require hospitals to install new antennae to keep up with changing standards, as well as higher-capacity wireless routers to keep up with growing bandwidth demands.

“Ten years ago, who knew that 802.11n at 5.2 GHz would be in place today?” says Scott W. Johnson, vice president of communications planning for engineering firm SSR Inc. in Nashville. “If you installed 2.4 GHz antennae, you may be ripping it out today. The industry has not been very good at future-proofing technology.”…..[read the rest of this article]

Enhanced by Zemanta

April 9, 2011

Prevent Readmissions With Discharge Planning

With The Joint Commission looking at “revolving door” admissions, it is time for everyone to get on board and start working to prevent readmissions.  Being readmitted benefits no one.  The patient feels like their health has become unmanageable and they are frightened.  The family becomes convinced that they cannot handle the needs of the patient safely.  The hospital, once a safe haven, becomes a scary place.

We have to work “better” not harder at discharge planning.  We need to be looking at the patients’ needs and desires as much as possible.  Just getting patients out of the hospital is no longer acceptable.

The article below is long, but well worth your time.  Only part of it is below, so please do click over to finish reading.  This is from one of my favorite sites, Health Leaders Media, where you will find many other great articles dealing with various issues in today’s nursing.

___________________________________________________________________________

Rebecca Hendren, for HealthLeaders Media , April 5, 2011

 

Discharge planning is a process that should begin as soon as patients are admitted to the hospital. In a perfect world, healthcare team members, patients, and families communicate and work together to move patients quickly and safely to home or the next level of care.

In reality, discharge planning can be fractious. Older adult patients and their families face many choices about where to go and often disagree on the best course of care. Communication among caregivers can be far from ideal and communication between patients and families can be fraught with disagreements.

As hospitals battle readmission rates, more attention is being paid to discharge planning. Lori Popejoy, Phd, APRN, GCNS-BC, assistant professor in the Sinclair School of Nursing at the University of Missouri, has been studying the discharge planning process around older adults and recommends hospitals pay more attention to the decision-making process with these patients.

Popejoy, who has years of experience with care of the older adult before entering academia, recently published a study, “Complexity of Family Caregiving and Discharge Planning,” in the Journal of Family Nursing. I spoke to her about the problems nurses face as they work with older adults and their families, the challenges faced by healthcare providers as they discharge older adults from the hospital, and the healthcare transitions faced by elderly people and their families following hospitalizations.

Popejoy says that our understanding of discharge planning and how patients make decisions is quite simplistic. We usually think about conversations between physicians and their patients or between physicians and families. In reality, dozens of people are involved in any decision. So she examined interactions between healthcare team members, including nurses and social workers, and older adult patients and their families. She wanted to understand how these diverse stakeholders come together to make a single decision about leaving the hospital and where they are going to go. She wanted to understand how much participation in decisions patients and families want the healthcare team to have and what actually happens as decisions unfold.

 

“Every participant comes to the situation with their own values, their own beliefs, and what they want to get out of it,” says Popejoy. “What stands out for nurses or social workers is their overall concern for patient safety. Their input into the decision making process is to find the most reasonable choice and the safest choice.”

For older patients, most just want to go home. Some recognized they were too weak and were willing to go somewhere else, but for them, it was to be a short-term stay where they could get stronger and then ultimately go home.

For families, safety is important, but also the issue of ‘I want my parent to be able to live the life they want to live,’ says Popejoy. “For a spouse, it’s a whole different ball game—they just want their spouse to go home with them.”

Within child-parent relationships, some want their parents to live with them; others recognize that their lives are too complicated to handle a parent at home who is functionally unable to care for themselves. Some can handle a short-term stay, but not one for the long term.

Popejoy says that hospitals need to figure out who the key players are who can influence decisions. “Listen to older adults and find out what they want, but also listen to the family and what they can do,” she says.

She cautions decision makers are often not available during Monday to Friday business hours. Although most organizations know this, it can be difficult to get good information across the week, not just during traditional work days. Discharge planning and communication may have to be done via conference calls or during off hours.

Another important thing that leaves healthcare teams in difficult positions is the idea of autonomy.

 

“In the United States, we value autonomy and your independence above all…[read more]

Enhanced by Zemanta
Next Page »