Emergency preparedness in light of recent events in Boston

Unfortunately, as healthcare providers, we must be prepared to intervene during emergencies that we would never imagine.  The bombings at the Boston Marathon have left me with a heavy heart, yet I am inspired by the stories of heroism that have resulted. My thoughts and prayers go out to all those impacted by this tragedy.

When a traumatic event occurs, I tend to immerse myself in information – not so much the media details surrounding the event, but in the human stories, especially about the “helpers” that I’ve been reading so much about over the last few days. We have several articles related to emergency preparedness that may give you some insight and confidence that you are the nurse that would be using your skills to care for the injured with expertise and compassion.

 Dealing with Disaster
Nursing Management, July 2007

 Disaster preparedness: Are you ready?
Men in Nursing, June 2007

 Emergency Department Response to Terrorism
Topics in Emergency Medicine, March 2005

Sending heartfelt wishes to those affected by the events of this week. Many thanks to the first responders for their swift action and to those who continue to care for the injured. 

Posted: 4/18/2013 8:19:32 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Standardizing nursing handoffs

Handoffs are a known “trouble spot” when it comes to patient safety. As nurses, we participate in handoffs any time we transfer care to another provider, whether at change of shift, transfer to another floor or unit, or transfer to another facility. Errors that occur during these times can result from a variety of barriers, many of which are human factors, ranging from understaffing and interruptions to fatigue and information or sensory overload. 

The Joint Commission requires a standardized approach to patient handoffs; it is one of the National Patient Safety Goals (2006 National Patient Safety Goal 2E). During her presentation “Effective Handoff Communication: A Key to Patient Safety” at Nursing2013 Symposium, JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS, shared several acronyms that can be used to help guide a well-organized transfer of information and minimize errors and omissions during patient handoffs. 

SBAR + 2 (See also The Art of Giving Report and The impact of SBAR.)
  Introduction
  Situation
  Background
  Assessment
  Recommendation
  Question & Answer

5 P’s Model
  Patient
  Plan
  Purpose
  Problems
  Precautions

PACE
  Patient/Problem
  Assessment/Actions
  Continuing/Changes
  Evaluation

I PASS the BATON
  Introduction
  Patient
  Assessment
  Situation
  Safety Concerns
  the
  Background
  Actions
  Timing
  Ownership
  Next

What is the standard for nursing handoffs where you work?

References:

Cairns, L., Dudjak, L., Hoffman, R., & Lorenz, H. (2013). Utilizing Bedside Shift Report to Improve the Effectiveness of Shift Handoff. Journal of Nursing Administration, 43(3). 

Riesenberg, L., Leisch, J., Cunningham, J. (2010). Nursing Handoffs: A Systematic Review of the Literature. American Journal of Nursing, 110(4). 

Schroeder, S. (2006). PATIENT SAFETY: Picking up the PACE: A new template for shift reportNursing2006, 36(10).  

Posted: 3/29/2013 7:18:36 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Pause and listen

How many times has a patient said “I feel funny” or “I don’t feel right” and then proceeded to code shortly thereafter? That happened to me twice.

How many times have you felt pulled in different directions – between call lights, alarms ringing, medications to be administered, dressings to be changed, patient education to be provided, etc.? For me the answer is TMTC (too many to count!)

How many times has a patient deteriorated quickly or coded without any warning signs? I’d say several.

I wonder if during any of those times a patient was trying to reach out to me to say “I feel funny” or “I don’t feel right” and the opportunity to intervene passed without my knowledge because I was busy with other tasks.

Just thinking…

I wish that we had enough time during our day to just pause and listen. Wouldn’t that be nice?

 

Posted: 2/4/2013 7:22:14 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


To Those Affected By Hurricane Sandy...

What to say here? I am still in shock by the devastation caused by this hurricane. 

I grew up on Long Island. My parents, my brother and his family, and many childhood friends still live there. Yes, they experienced loss of ‘things’ and remain without power, but they are all safe. As the stories emerge of lives lost, I know how lucky we are. 

The accounts of hospitals closing and patients being evacuated are amazing. I am in awe of those who’ve worked so hard and continue to work so hard to keep patients safe and provide care to those in the hospital as well as out in the community. The evacuation and transfer of patients, especially of NICU babies from NYU Langone Medical Center, is incredible to me. As a mom of 2 NICU graduates, I remember well the challenges of repositioning a sick premature baby in his isolette; I can’t imagine moving across New York City during a hurricane. What more can I say but THANK YOU to our nurse colleagues and the other healthcare professionals who managed this incredible feat. 

To those dealing with loss, I imagine you will never see this post. If, by chance, you do come across this writing someday, know that at this moment, my thoughts and prayers continue for you. I hope that you have rebuilt your home, whether in the same location or somewhere new, and you’ve been comforted and supported in your grief. 

American Journal of Nursing has created a list of helpful resources (open access) to help us cope now and be ready for future emergencies. 

Wishing everyone safety and good health during recovery efforts. 

Posted: 11/2/2012 8:21:44 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Nurses Increase Vigilance for Fungal Meningitis

Nurses must increase vigilance for identifying patients at risk for fungal meningitis following the September 26, 2012 recall of injectable methylprednisolone acetate that was packaged by New England Compounding Facility in Framingham, MA. According to the Centers for Disease Control and Prevention's website, there have been 185 cases and 14 deaths among 12 states and continues to grow (CDC, 2012). The impact is potentially greater because healthcare facilities in 21 states have received the recalled lots of the affected drug. 

Patients who received contaminated injections presented with symptoms from one week to 4 weeks after the injection. It is important for nurses to report patients who are symptomatic of meningitis through the month of October to a physician or licensed advanced practiced nurse. To further assist in the evaluation or referral for meningitis work-up, all health care professionals including those in primary care offices, emergency departments, or retail clinics should go to the CDC website (http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html) for a current list of health care providers who administered the recalled lots. The CDC website also provides continually updated information on the meningitis outbreak and educational information for providers and patients.

Post by Karen Innocent, MS, RN, CRNP, ANP-BC, CMSRN

Reference

Centers for Disease Control & Prevention. (2012). Multistate Meningitis Outbreat Investigation. Retrieved from http://www.cdc.gov/HAI/outbreaks/meningitis.html. Last accessed 10/12/2012.

Posted: 8/12/2012 8:35:04 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Spreading the word about sun safety

My eyes have really been opened over the past year. Since launching the Skin Care Network in collaboration with the Dermatology Nurses’ Association and becoming a member of the editorial board of the Journal of the Dermatology Nurses’ Association, I have learned A LOT about skin cancer, indoor tanning, and prevention. I’ve written about skin cancer before on this blog, not so much about the cancer itself, but my involvement (or lack of) when caring for my dad when he underwent Moh’s surgery (Is Nursing Really For me?) I digress a little, mainly to share that with a family  history of skin cancer, I should and will be more proactive in prevention methods for myself and my family. 

Recent publications demonstrating the increasing incidence of melanoma and its association with tanning bed use include Increasing Incidence of Melanoma Among Young Adults (Mayo Clinic Proceedings), Use of Tanning Beds and Incidence of Skin Cancer (Journal of Clinical Oncology), and Melanoma surveillance in the United States: Overview of Methods (Journal of the American Academy of Dermatology). Many states have enacted or are considering teen tanning bed restrictions (here’s  a nice list) and a Congressional Report revealed “the false and misleading health information provided to teens by the indoor tanning industry.”

I know those are a lot of links to sort through above, however, the number of reports & articles (and there are more) demonstrate what a big issue this is. What is critical here is that there are ways to prevent or minimize skin cancer occurrence, resources to educate our patients and the public, and important information to know to recognize skin cancer so it can be treated early. The following organizations and events are a good place to start! 

Organizations/Programs

National Council on Skin Cancer Prevention 

Children’s Melanoma Prevention Foundation 

SunAWARE 

Outrun the Sun 

Events

Melanoma Monday ~ the first Monday in May; the purpose is to raise melanoma awareness and encourage early detection.

Don’t Fry Day ~ the Friday before Memorial Day; the purpose is to increase sun safety awareness and remind everyone to protect their skin while spending time outdoors.

Posted: 5/2/2012 8:57:42 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Patient Safety


A pill a day won't keep heart disease away...on its own

"An apple a day keeps the doctor away." "Take an aspirin and call me in the morning." We're all familar with these sayings and it appears there will be another added shortly.  If you had the opportunity to take a medication to help prevent heart disease would you take it?

 Recently the FDA approved  the added indication of heart disease prevention to a popular statin drug. There are 6.5 million people without cholesterol issues or heart problems that will be eligible for this preventative therapy.  Some healthcare providers are questioning whether putting patients on this  type of preventative therapy is worth it.  Will patients be compliant with the laboratory tests that are necessary while they are on the medication?  Will patients stick to a low fat, low cholesterol, heart healthy diet or will they see this as an opportunity to eat anything and everything they want?  Will patients take the initiative to get off the sofa and exercise on a regular basis?  What about the potential drug side effects? And the final question, can the patient afford this medication? 

Regardless of where you stand on this issue one thing is clear, every patient must be evaluated for this type of preventative therapy on an individual basis. As healthcare providers we  must make sure patients understand they need to follow through with other lifestyle changes needed to prevent this disease in addition to taking the medication.  A pill a day won't keep heart disease away...on its own. 

Post by Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Posted: 3/31/2012 8:38:46 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


One of those quirky nursing things

Have you ever cared for one of those patients who is ‘borderline’ unstable? You know --- kind of stable, but not well enough for you to feel too optimistic that they won’t crash? In the Medical Intensive Care Unit where I worked, I can recall many times where we had this one habit to help us get through the shift and keep a patient stable. Sounds silly, almost superstitious, but sometimes it worked…and I’m wondering if any of you have similar quirks or traditions that you use in your own practice. 

What is it? Here are some examples:

A patient is admitted and we settle him in his room – ECG monitor on, vital signs taken, alarms set, I.V. access established, history taken, and physical assessment completed. He seems fairly stable but when you walk out of the room, his alarm sounds for a systolic blood pressure of 90 mm Hg. His initial blood pressure had been 116/78. Your colleague asks, “Do you want some I.V. fluids?” to which you reply “Yes, let me just keep it in the room.” 

Another patient, who had been on the unit for a few weeks and had resolving ARDS (acute respiratory distress syndrome) was extubated 2 days ago and had been doing well breathing on her own. Throughout the shift, however, her oxygen requirements are increasing and her breathing is becoming more labored. The respiratory therapist asks “Do you think she’ll be reintubated?” and you reply “Please bring a ventilator to her room, just in case.” 

I can think of many patient scenarios similar to these, where we’d bring I.V. catheters, vasopressors or other medications, even urinary catheters, into the room but then didn’t need to use them. I know part of this is being prepared and having a treatment or intervention ‘ready to go’ is something that, as nurses, we do all the time. However, sometimes it seemed that the act of bringing something into the patient’s room was enough to keep him or her stable. Just coincidence? Probably. But if it works…

Posted: 3/23/2012 8:29:26 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


One of those quirky nursing things

Have you ever cared for one of those patients who is ‘borderline’ unstable? You know --- kind of stable, but not well enough for you to feel too optimistic that they won’t crash? In the Medical Intensive Care Unit where I worked, I can recall many times where we had this one habit to help us get through the shift and keep a patient stable. Sounds silly, almost superstitious, but sometimes it worked…and I’m wondering if any of you have similar quirks or traditions that you use in your own practice. 

What is it? Here are some examples:

A patient is admitted and we settle him in his room – ECG monitor on, vital signs taken, alarms set, I.V. access established, history taken, and physical assessment completed. He seems fairly stable but when you walk out of the room, his alarm sounds for a systolic blood pressure of 90 mm Hg. His initial blood pressure had been 116/78. Your colleague asks, “Do you want some I.V. fluids?” to which you reply “Yes, let me just keep it in the room.” 

Another patient, who had been on the unit for a few weeks and had resolving ARDS (acute respiratory distress syndrome) was extubated 2 days ago and had been doing well breathing on her own. Throughout the shift, however, her oxygen requirements are increasing and her breathing is becoming more labored. The respiratory therapist asks “Do you think she’ll be reintubated?” and you reply “Please bring a ventilator to her room, just in case.” 

I can think of many patient scenarios similar to these, where we’d bring I.V. catheters, vasopressors or other medications, even urinary catheters, into the room but then didn’t need to use them. I know part of this is being prepared and having a treatment or intervention ‘ready to go’ is something that, as nurses, we do all the time. However, sometimes it seemed that the act of bringing something into the patient’s room was enough to keep him or her stable. Just coincidence? Probably. But if it works…

Posted: 2/23/2012 8:23:30 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


The impact of SBAR

A while back, I wrote a blog post about using SBAR (Situation-Background-Assessment-Recommendation) as a method to help organize change-of-shift report. First implemented by the U.S. Navy to reduce miscommunications, use of this tool is becoming more widespread in healthcare settings. It has been theorized that the use of a standardized approach such as SBAR creates a “common language” among healthcare professionals and thereby decreases communication errors and may even impact our behavior. A recent study published in Health Care Management Review explored this potential impact of SBAR on the daily activities of nurses.

The researchers interviewed nurses, nurse managers, and doctors in two hospitals where implementation of the SBAR protocol was in its early stages. Analysis of the data revealed two findings: first, that most thought of SBAR as strictly a means of standardizing communication, and second, that SBAR actually had a “more far-reaching effect than just being a communication tool.” 

So what are these “far-reaching effects?”

1. Schema development – SBAR facilitated the development of schemas which help nurses make intuitive decisions.

2. Contribution to the accumulation of social capital – The common language of SBAR serves as a means to integrate nurses into the organization.

3. Providing legitimacy – The common practice also helps individuals gain credibility.

4. Shift in logic – SBAR supports a shift from individual autonomy to standardization and formalization of the nursing profession.

Interesting findings! This fairly simple tool does have far-reaching implications – for our individual practice and our profession. If we communicate more effectively, make decisions more easily, and are integrated into the organization as a credible member of the healthcare team as a nursing professional, won't that ultimately lead to better patient care and outcomes?

Reference: Vardaman, J.M., Cornell, P., Gondo, M.B., Amis, J.M., Towensend-Gervis, M., Thetford, C. (2012). Beyond communication: The role of standardized protocols in a changing health care environment. Health Care Management Review 37(1), 88-97.

Posted: 1/30/2012 7:23:58 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


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