Nursing Notes

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

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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.

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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.

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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.

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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 dvaldez@elpasotimes.com; 546-6140.

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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 HealthLeadersMedia.com so you can read it and decide for yourself how it makes you think and feel.  Let me know, won’t you?

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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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September 7, 2011

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

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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.

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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.

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August 11, 2011

5 Reasons Nurses Want to Leave Your Hospital

Here is a really good article from HealthLeaders Media.  I frequently find great articles on this site, so I do encourage you to visit there and look for yourself.  After reading this article, I felt that my thoughts had been broadcasted out into the internet.  This article discusses the comments and thoughts of all the nurses I have ever worked with as well as my own thoughts.  I would like to add a 6th reason for a nurse to be looking to leave a hospital and that is personal safety.  If the facility does not think enough of its nurses to protect them from random attacks, it is definitely time to leave.

Please read this article and come back here to let me know what you think.  I love a good discussion, don’t you?

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Rebecca Hendren, for HealthLeaders Media, August 9, 2011

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime

Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.

Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.

Take a look at the last couple of years’ news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units

One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won’t solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.

Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.

Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you’ll never be short of volunteers.

3. Non-nursing tasks

Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn’t have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed. It just wouldn’t happen.

Yes, cleaning a room is important, but don’t force nurses’ attention away from their patients. Distractions are dangerous and compromise patient safety…[read the rest]

 

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July 15, 2011

New Study Adds to Evidence—California’s RN-Patient Ratios Law Improves Nursing, Patient Care

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Here is a press release from the nurse’s union, National Nurses United about the effect of California’s nurse-to-patient ratio has had on the number on nurses in California as well as the effect on patient outcomes.  This is an interesting press release, and yes, maybe it is self-serving, but I had just read another article on newswire about this exact same thing which I will post in a few days.

Let me know what your thoughts and feelings are about mandated ratios, won’t you.  I’d love to start a conversation here with all of you about the pros and cons of such a national law.

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Health Affairs study on achievements of California safe staffing law

Another major study has reinforced a growing body of evidence that California’s landmark law requiring minimum, specific nurse-to-patient staffing ratios enhances registered nurse staffing and the quality of patient care.

The latest study, conducted by eminent University of Pennsylvania and Arizona State University researchers, appears in the July 2011 issue of Health Affairs.

Titled, “Contradicting Fears, California’s Nurse-To-Patient Mandate Did Not Reduce The Skill Level Of The Nursing Workforce In Hospitals,” the report <http://content.healthaffairs.org/content/30/7/1299.abstract>  refutes worries promoted by healthcare industry opponents of the 1999 California law that hospitals might respond by disproportionately hiring lower-skill licensed vocational nurses.

In fact, following implementation of the law in 2004, the results have gone in exactly the opposite direction, the study concludes. California hospitals have added registered nurses, dramatically increasing patient access to professional RN care, a factor long associated with positive patient outcomes in a broad range of care barometers.

“This study brings home once again what California nurses could readily tell you. The safe staffing law has improved the quality of care in California hospitals, ensured that RNs have more time to spend with patients, respond to patient care incidents, and reduced the nursing shortage by keeping experienced, professional RNs where they belong, at the bedside,” said Deborah Burger, RN, a co-president of National Nurses United and the California Nurses Association.

CNA, an affiliate of NNU, the largest union and professional association of RNs in the U.S., sponsored the California law and fought off efforts by the hospital industry and former Gov. Arnold Schwarzenegger to roll back the law.

Overall, the authors write, “we found that the staffing mandate resulted in roughly an additional half-hour of nursing per adjusted patient day beyond what would have been expected in the absence of the policy.”

The study directly compared California hospitals to institutions in New York, Texas, Florida, and Pennsylvania – the five states with the most hospitals. While many states nationally saw increases in nurse staffing the past decade, in the period following implementation of the law, California readily surpassed the national average, and California had  five times as many registered nursing care hours as New York hospitals and twice as many as Texas hospitals.

Authors of the new study include Matthew McHugh and Douglas Sloane of the University of Pennsylvania’s Center for Health Outcomes and Policy Research in Philadelphia, UPenn nursing professor and well known RN researcher Linda Aiken, and Lesly Kelly, RN assistant professor at Arizona State University in Phoenix.

Aiken in particular is one of the nation’s foremost RN researchers and just last year led a study comparing California hospitals to facilities in Pennsylvania and New Jersey which documented that New Jersey hospitals would have 14 percent fewer patient deaths and Pennsylvania 11 percent fewer deaths if they matched California’s 1:5 ratios in surgical units.

In the new study, McHugh, Aiken, and the others note that the intent of the California Legislature in passing the CNA/NNU-backed law was to “improve quality of care and patient safety, and to retain nurses in employment in hospitals. Another primary goal of the law was to avoid high patient-to-nurse ratios, especially for registered nurses.”

Poor ratios, they note, are widely associated with “a number of negative patient outcomes, such as higher surgical mortality and higher complication rates due to errors” as well as to “job dissatisfaction and burnout” that drive nurses away from the patient bedside.

“The California law has clearly met all the goals, a major reason why safe RN ratios is considered the gold standard by direct care RNs across the nation,” says Burger.

Nurses throughout the U.S. continue to campaign for similar state and federal legislation, usually against the opposition of hospital corporate lobbyists.

NNU is sponsoring federal legislation, S 992, the National Nursing Shortage Reform and Patient Advocacy Act, in the Senate, and a companion House bill, HR 2187.

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July 8, 2011

Rep. Schakowsky Introduces Bill to Improve Patient Care & Curtail Nurse Shortage

Filed under: Nursing — Shirley @ 3:39 pm
Tags: , , , , ,

Here is an article from FierceHealthCare that I found about the government’s attempt to get nurses some protection and encourage nurses back into the profession.  On the one hand, I applaud the actual attempt to set some minimal staffing ratios for hospitals and nursing homes.

Nurses across the board are overworked and overwhelmed.  Nurses are leaving this profession in large numbers due to burnout, stress, fear of  being sued, fear of making a critical mistake and causing harm.  Nurses want to be able to help patients heal.  Period.

On the other hand, this article doesn’t really state what the actual bill would identify as a minimal staffing ratio.  Asking the administration of said hospitals to meet with staff nurses to determine minimum staffing is a joke.  That’s like telling the fox to guard the hen house.

Hospitals have to make a profit to stay in business, whether they are for-profit or not.  Nurse staffing is the singe largest expense that any hospital has after equipment.  There is no way that the hospital administrators will staff according to the nurses working for them.

Anyway, read this article and then let me know what you think, won’t you?

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WASHINGTON, DC (June 15, 2011) – Representative Jan Schakowsky (D-IL) today introduced legislation to address increasing hospital mortality rates and preventable medical errors caused by nurse understaffing. The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 would establish a federal minimum standard in all hospitals for direct care registered nurse-to-patient staffing ratios.   The bill would greatly improve patient care while helping to restrict the nursing shortage that has left hospitals across the country dangerously understaffed.

“Nurses are overworked and hospitals are understaffed, leading to disastrous results for patients everywhere,” said Representative Jan Schakowsky.  “By creating a workplace in which nurses are asked to do the impossible, we drive nurses away and jeopardize the quality of patient care. The bill is a common-sense solution to improve the quality of patient care and address the nursing crisis in our hospitals.”

The Nurse Staffing Standards for Patient Safety and Quality Care Act of 2011 would require that hospitals work with their direct care nurses to develop safe staffing plans that meet but can exceed  minimum nurse-to-patient staffing ratios.  The legislation would provide whistleblower protection and give nurses the ability to speak out for enforcement of safe staffing standards.

The bill would also require the Department of Health and Human Services to consider staffing requirements for licensed practical nurses and the Medicare Payment Advisory Commission to recommend any changes in additional reimbursement needed due to the requirements of the bill.

A recent study reported in the New England Journal of Medicine (March 17, 2011), found that  “when the nursing workload is high, nurses’ surveillance of patients is impaired, and the risk of adverse events increases.”  Other studies found that understaffing was a factor in one out of every four unexpected hospital deaths or injuries caused by errors and result in higher incidences of cardiac arrest, pneumonia, urinary tract infections and complications

The legislation is endorsed by the AFL-CIO, the Service Employees International Union, the American Federation of State, Country and Municipal Employees (AFSCME), the National Nurses United, the American Federation of Government Employees, the United Steelworkers, and the American Federation of Teachers.

Read more: Rep. Schakowsky Introduces Bill to Improve Patient Care & Curtail Nurse Shortage – FierceHealthcare http://www.fiercehealthcare.com/press-releases/rep-schakowsky-introduces-bill-improve-patient-care-curtail-nurse-shortage?utm_medium=nl&utm_source=internal#ixzz1RY2BgqNC
Subscribe: http://www.fiercehealthcare.com/signup?sourceform=Viral-Tynt-FierceHealthcare-FierceHealthcare

 

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March 22, 2011

Hospital chief pleads guilty in case over firing of Texas nurses

Map of Texas highlighting Winkler County

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Here is the next chapter in the ongoing saga of the Winkler County nurses, Anne Mitchell and Vickilyn Galle.

If I recall, the doctor involved was fined and reprimanded by the medical board.  The sheriff and county attorney are also up for prosecution.

Please read the following article from Modern Healthcare and feel free to leave them a comment, or come back here and leave me a comment.

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By Paul Barr

Posted: March 21, 2011 – 5:45 pm ET

Stan Wiley, former hospital administrator of Winkler County Memorial Hospital, Kermit Texas, pleaded guilty to abuse of official capacity for his role in the firing of two nurses who had complained about a doctor to the Texas Medical Board, according to the Texas attorney general’s office.

Wiley was sentenced to 30 days in the Winkler County Jail by visiting Judge Robert H. Moore III as part of a plea deal in which he has agreed to cooperate in the prosecution of three other defendants, according to a news release from the attorney general’s office, which is prosecuting the case because the Winkler County District Attorney recused himself from the proceedings.

Also being prosecuted are former Winkler County Memorial Hospital physician Dr. Rolando Arafiles, Winkler County Sheriff Robert Roberts and Winkler County Attorney Scott Tidwell. Arafiles recently was fined $5,000, publicly reprimanded and required to undergo training and oversight by the state medical board .

Wiley, Arafiles, Roberts and Tidwell were indicted in January for allegedly retaliating against two nurses who had reported Arafiles to the state medical board in 2009 for actions they believed were endangering hospital patients.

The two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County for $750,000 in August, according to their attorneys.

Read more at:  Modern Healthcare

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December 2, 2010

Oncology nurse Theresa Brown, on promoting a patient-centered culture

Here is a blog post from SmartBlogs.com by Theresa Brown.  I love to read her thoughts about nursing, so I felt you might enjoy this post, too.  She always has her finger on the center of a significant issue in nursing and she freely discusses cause and solutions.  I find her work to be well balanced and timely.

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Theresa Brown, BSN/RN/OCN, is a  floor nurse in Pittsburgh and author of “Critical Care: A New Nu rse Faces Death, Life and Everything in Between.” SmartBrief editor Kathryn Doherty recently spoke with her about the challenges of communication — with physicians, patients and other hospital departments — facing nurses today and how these challenges affec t patient safety. A condensed version of that conversation follows.

How does the nature of the nurse-physician relationship affect communication between these professionals? Does it affect patient safety?

The hierarchical nature of the nurse-physician relationship often impedes good communication. Nurses are looking out for physicians to be arrogant and dismissive, and physicians can be unfairly impatient with nurses. These kinds of interactions are more likely when people are under stress — and almost everyone working in a hospital is under stress.

The problem begins with our training. In nursing school, I received no training in how to work with physicians, and my sense is that physicians get no training in how to communicate with nurses. Yet, each group completely depends on the other to take care of patients. A half-day or daylong workshop, where nurses and physicians work together to learn how to communicate better, could do wonders.

Safety issues are what make the communication between nurses and physicians so important. A physician who dismisses a nurse’s concern for a patient may be ignoring an important sign that the patient is in crisis. A nurse who fails to bring an important detail to the attention of a physician because talking to MDs makes her uncomfortable is also not giving her patient the best care possible. Simple medication errors could be avoided if the nurse’s question was heard not as a criticism of the doctor’s skill, but as a striving for clarification.

Bedside nurses are considered the closest link to patients. How does this proximity affect nurse-patient communication and overall patient safety in a hospital?

Nurses are the “canaries in the coal mine.” The nurse sees the patient for the entire day or night, and will often be the one who first notices when the patient is having a serious problem. Whatever is affecting the patient that day — physically or emotionally — will be impossible to hide from the nurse.

That proximity can also create friction, if the patient treats the nurse as waitress, maid, counselor or punching bag. Patients who  make unreasonable demands on nurses (and we’ve all had these patients) may not realize that they’re distracting their nurse from paying attention to their health.

What changes in hospital culture could be made to improve patient safety?

A lot of the problems in hospitals would solve themselves if people had time to listen to each other, and then do what needed to be done. My feeling at work is that everyone has a little more to do than can be done in the time available — and sometimes a lot more. If we could slow down, we could keep patients safer.

And one thing that would help nurses slow down would be staffing ratios and well-stocked float pools that could fill gaps when nurses were unable to come to work. “Working short” benefits neither nurses nor doctors, and certainly not patients.

Hospital departments can be very separated, physically and ideologically. How could that situation be improved?

An “Us versus Them” mentality has become endemic in many hospitals, and it makes communication very difficult. Medical people don’t like surgical staff, ICUs don’t like floor nurses, certain nurses don’t like certain physicians, etc.

What I find myself saying over and over again is, “We all have the same goal.” Most people who work in hospitals have a deep commitment to being helpful, or at least started their careers with that feeling. If we could reawaken that feeling in people, make them remember why they got into this crazy work environment in the first place, it might help.

The goal of everyone in the hospital should be to give all patients the best care possible. and institutions need to really commit to that goal, rather than giving it lip service while really focusing on profits.  Staff who don’t appreciate that goal may need retraining or reassignment. The nurses and physicians I like the most and respect the most all share the same professional mantra: “It’s all about the patient.”


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November 25, 2010

Despite Efforts, Study Finds No Decline in Medical Errors

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

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

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

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

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

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

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

By Maureen Salamon
HealthDay Reporter

HealthDay/ScoutNews LLC

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

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

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

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

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

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

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

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

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