Don't miss these substantive, peer-reviewed articles in the December issue of Nursing2006. You can use the PowerPoint slides (links below) as ready-made lectures on these topics. The slides are to access at http://www.nursing2006.com/ (click the "Educators" button).

• Understanding the 12-lead ECG, part II
  By Guy Goldich, RN, CCRN, MSN
  Earn 2.5 ANCC/AACN contact hours.
  

  SPECIAL BONUS: Download PowerPoint slides summarizing this clinical article from http://www.Nursing2006.com/ (click the "Educators" button) and use it for your lectures.

• New weapons to snuff out kidney cancer
  By Sandra L. Wetherbee, RN, OCN, MSN
  Earn 3.0 ANCC/AACN contact hours.
  

  SPECIAL BONUS: Download PowerPoint slides summarizing this clinical article from http://www.Nursing2006.com/ (click the "Educators" button) and use it for your lectures.

Interested in the prep course for certification? Try the new CD-ROM from the NNSDO and earn 16 contact hours for completing the self-directed learning program.

SPECIAL: If your staff needs a handy review about hyperthyroidism, print out this Take 5 brochure and distribute it.

(You'll need Adobe Acrobat to see this; if you don't have it, download the free program here.)

• From the Joint Commission International Center for Patient Safety... Techniques for Improving Patient Safety (TIPS)
• WHO's Collaborating Center for Patient Safety seeks comment on proposed International Patient Safety Solutions--Health care professionals and patient advocates from around the world are invited to comment on nine proposed solutions for improving patient safety, including look-alike, sound-alike medications; correct patient identification; hand-over communications; wrong site, wrong patient surgery; use of concentrated electrolyte solutions; medication reconciliation; catheter and tubing misconnections; needle reuse and injection safety; and hand hygiene. The survey will be available online until February 16, 2007, at www.jcipatientsafety.org/survey.
• 10 Patient Safety Tips for Hospitals
  Medical errors can occur at many points in the health care system, particularly in hospitals. These 10 tips for hospitals resulted from findings of studies from the Agency for Healthcare Research and Quality (AHRQ).
  
  Many findings from AHRQ research can immediately be put into practice in hospitals by following 10 simple tips:
  1. Survey staff in individual units and throughout the hospital about the need to assess and improve the culture of patient safety, as noted in the 1999 Institute of Medicine report, To Err Is Human. The AHRQ survey and its accompanying toolkit materials are designed to provide hospital officials with the basic knowledge and tools needed to conduct a safety culture assessment, along with ideas for using the data.
  2. Limit shifts of more than 24 hours for medical residents and make sure they don't drive home after working extended shifts. Medical residents who work longer than 24 hours are more than twice as likely to have a car crash leaving the hospital and five times as likely to have a near-miss incident on the road than medical residents who work shorter shifts.
  3. Eliminate the tradition of shifts of more than 30 consecutive hours by interns working in hospital intensive care units (ICUs). The rate of serious medical errors at two Boston hospital ICUs committed by first-year interns dropped by 36% when 30-hour-in-a-row work shifts were eliminated.
  4. Adopt interventions to reduce the incidence of ventilator-associated pneumonia in critically ill patients. Putting patients in a semi-recumbent position and using sucralfate rather than H₂-antagonists to prevent stress ulcers can prevent ventilator-associated pneumonia in critically ill patients.
  5. Count surgical instruments and sponges before and after procedures, and X-ray patients after surgery to reduce the likelihood of objects being left inside patients. These simple techniques can reduce the incidence of these types of medical errors, which occur in more than 1,500 patients each year.
  6. Use senior nurses and maintain appropriate round-the-clock staffing levels in ICUs to prevent airway tube complications. A study of adverse events occurring in adult and pediatric ICUs found that more than half were considered preventable. Airway events occurred less frequently during daytime hours (7:00 a.m. to 3:00 p.m.), and their negative impact was limited by skilled assistants, backup, and cross-coverage. ICU managers should take steps to ensure that appropriate staffing and training levels are maintained to limit the impact of adverse events.
  7. Ensure that personal digital assistant-based drug information is readily available at the point of care. Epocrates RxPro, Lexi-Drugs, and mobileMicromedex met AHRQ's quality and safety criteria by reducing potential errors associated with insufficient or incomplete drug information.
  8. Download a free software tool to identify ways to improve medication safety in the ambulatory care setting. The tool, called the Medication Safety Best Practices Guide, helps hospitals identify ways to create safe practices for medication use, manage medical errors, and contribute to patient-safety education in the ambulatory care setting.
  9. Use computer-based order entry to reduce catheter-related urinary tract infections. A computer-based order entry system prompting catheter removal after 72 hours decreases the duration of urinary catheterization by about one-third, or 3 days.
  10. Minimize interruptions and other distractions the nursing staff face in their day-to-day routines. Researchers have visually re-created the fast-changing nature of nurses' work, highlighting areas where interruptions can affect patient safety.

• A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States, from the Advisory Committee on Immunization Practices (ACIP). (Published in MMWR, 55(RR16):1-25, December 8, 2006.)
• Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update, from the American Academy of Pediatrics and the American Academy of Pediatric Dentistry. (Published in Pediatrics, 118(6):2587-2602, December 2006.)
• Injuries Cost Hospitals $20 Billion--U.S. hospitals spend roughly $20 billion annually to treat the nearly 2 million Americans injured seriously enough to require inpatient care, according to a new report by the AHRQ.
• Providing Mass Medical Care with Scarce Resources: A Community Planning Guide provides community planners—as well as planners at the institutional, state, and federal levels—with information on planning for and responding to a mass casualty event (MCE).
• Avoiding Allergic Reactions: Caring for patients with drug, food, and latex allergies, from the Joint Commission Resources (published in Joint Commission Perspectives on Patient Safety, 6(12):1-8, December 2006; fee required)
• National Quality Forum (NQF) endorsed consensus standards for nursing-sensitive care--If you or your organization has implemented--or has considered implementing--nursing quality measures, NQF invites you to complete a brief online survey about your perspectives and insights.
• International Centre for Human Resources in Nursing (ICHRN) has been established by the International Council of Nurses and the Florence Nightingale International Foundation. The Centre is dedicated "to strengthening the nursing workforce globally through the development, ongoing monitoring and dissemination of comprehensive information, standards, and tools on nursing human resources policy, management, research and practice."

See how your staff or students analyze this error--and how they'd avoid it

Situation: Glen Rilley returns to your busy surgical unit with the following antibiotic order: Cefuroxime 1 g q12h. The antibiotic comes from the pharmacy labeled "ceftizoxime 1 g q12h (0900 & 2100). Infuse 50 mL over 30 minutes." You hook up the antibiotic and set the hour rate for 100 mL/hour.

What happened: You've just administered the wrong medication to this patient. Although the names are similar (many cephalosporin names sound and look alike), these are two different drugs. Cefuroxime is a second-generation cephalosporin and ceftizoxime is a third-generation cephalosporin, meaning their bacterial coverage and pharmacokinetics are different.

What should have been done: Pay close attention to drug names, and when the dispensed medication isn't identical to the prescribed medication, check with the pharmacist to see if the substitution is appropriate or if it's a mistake.

Source: Clinical Drug Therapy: Rationales for Nursing Practice, 8th ed., AC Abrams, Lippincott Williams & Wilkins, 2006.

Test your staff's or students' knowledge about influenza in this Quick Quiz. Print it out, then copy and distribute it to them. Below is your answer key.

Answers to Quick Quiz: ANSWERS: 1-b, 2-a, 3-a, 4-b, 5-b, 6-c

COMPLICATIONS AND CAUSES	NURSING INTERVENTIONS
Paralytic ileus	Initiate or continue nasogastric intubation as prescribed. Prepare patient for X-ray study. Ensure adequate fluid and electrolyte replacement. Administer prescribed antibiotics if patient has symptoms of peritonitis.
Mechanical obstruction	Assess patient for intermittent colicky pain, nausea, and vomiting.
Intra-abdominal septic conditions
Peritonitis	Evaluate patient for nausea, hiccups, chills, spiking fever, tachycardia. Administer antibiotics as prescribed. Prepare patient for drainage procedure. Administer parenteral fluid and electrolyte therapy as prescribed. Prepare patient for surgery if condition deteriorates.
Abscess formation	Administer antibiotics as prescribed. Apply warm compresses as prescribed. Prepare for surgical drainage.
Surgical wound complications
Infection	Monitor temperature; report temperature elevation. Observe for redness, tenderness, and pain around wound. Assist in establishing local drainage. Obtain specimen of drainage material for culture and sensitivity studies.
Wound disruption	Observe for sudden appearance of profuse serous drainage from wound. Cover wound area with sterile towels held in place with binder. Prepare patient immediately for surgery.
Intraperitoneal infection and abdominal wound infection	Monitor for evidence of constant or generalized abdominal pain, rapid pulse, and elevated temperature. Prepare for tube decompression of bowel. Administer fluids and electrolytes by I.V. route as prescribed. Administer antibiotics as prescribed.
Anastomotic complications
Dehiscence of anastomosis	Prepare patient for surgery.
Fistulas	Assist in bowel decompression. Administer parenteral fluids as prescribed to correct fluid and electrolyte deficits.

Source: Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 11th edition. SC Smeltzer and B Bare (eds). Lippincott Williams & Wilkins, 2006.

You can access all of these articles online and use them to earn ANCC/AACN continuing-education contact hours.

Title: Quest for the Ideal: A Redesign of the Medication Use System
Authors: Beatrice Deborah Dang, PhD, RN; E. Robert Feroli, PharmD, FASHP; Carla Gill, RPh, MBA; Lori Paine, MS, RN; Kenneth Shermock, PharmD; Jeannette Suflita, MA, MS; Jo M. Walrath, PhD, RN
Abstract: Medication use systems in hospitals are complex and prone to error. A redesign of the system using idealized design methodology is a starting point in preventing patient harm from medication errors. An interdisciplinary team identified system properties, proposed and gathered feedback on an ideal design, and established a structure to plan changes in the system and monitor their impact.
Source: Journal of Nursing Care Quality, 22(1):11-18, January/March 2007

Title: A Synergy Model of Nursing Education
Author: Deborah A. Green, MSN, RN,BC
Abstract: This article proposes the use of a synergy model of nursing education that can be used as a blueprint for the nurse educator and learner to facilitate acquisition of knowledge, skills, and values across a nursing career.
Source: Journal for Nurses in Staff Development (JNSD) 22(6):277-284, November/December 2006.

Title: Managing VAP effectively to optimize outcomes and costs
Author: Jan Powers, RN, CCRN, CCNS, CWCN, MSN
Abstract: Learn how to decrease ventilator-associated pneumonia incidence, patient length of stay, and care costs while improving outcomes. (Supported by an educational grant from KCI USA, Inc.)
Source: Nursing Management 37(11):48-55, November 2006.

Title: New Technology Applications: Thrombolysis of Acute Deep Vein Thrombosis
Authors: Gail Marchigiano, MSN, CCRN; Debra Riendeau, MN, APRN, BC; Carol Jo Morse, BSN, CMSRN
Abstract: Recent technology using high-frequency, low-power ultrasound, or mechanical thrombectomy with catheter-directed delivery of a thrombolytic drug directly into the clot is available and showing promise. Nurses are caring for patients who receive endovascular interventions with lytic infusions. The nursing challenge is to provide safe and effective patient care.
Source: Critical Care Nursing Quarterly 29(4):312-324, October/December 2006.

We welcome your comments, questions, and feedback on this e-newsletter. Let us know what you think and whether it's helpful to you. E-mail the editors at [email protected].

Subscribe to Nursing2006. Ensure that your nurses stay current. Nursing2006 offers peer-reviewed articles on topics of interest to every nurse, such as I.V. therapy, infection control, patient safety, wound care, pain management, med error prevention, and managing heart failure. Subscribe for just $27.95 + $1.95 S&H--a 58% savings over the single-issue cover price of $73. Individual subscribers now get free access to the journal online, from the current issue back to 2002.

Subscribe to JNSD. Improve and maintain staff competencies and motivate all nurses at your facility to do their best. Journal for Nurses in Staff Development is peer reviewed to give you authoritative advice on meaningful research that's easy to understand and ready to use.

E-mail this Nursing2006 SDU eNews to colleagues and invite them to become members of NursingCenter by joining now. They, too, can sign up for their own issue of Nursing2006 SDU eNews for great content as well as free articles, tips, and more available only to subscribers.

Want to make sure that you keep receiving Nursing2006 SDU eNews? Be sure to add [email protected] to your address book!

NursingCenter respects your privacy and will not share your information with other companies or organizations without your permission. View our Privacy Policy.

If you no longer wish to receive Nursing2006 SDU eNews, update your profile by following these simple steps:

• Click on "My NursingCenter." Enter your username and password, select "Update My Profile," and "Log In."
• Uncheck the fifth box, "Register me for Nursing2006's Staff Development Update (SDU) eNews."
• Click "Submit."

Forgotten your username or password? Please contact Customer Service.