Complexity Compression

Have you ever heard the term complexity compression? I first learned of this term when reading Preserving a positive image of nursing in a complicated healthcare environment. This article caught my eye because although I had never heard the term, I certainly was familiar with the experience. By definition, complexity compression is "what nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame." Sound familiar? We’ve all been there - having to perform tasks that take us away from direct patient care and having to do more in less time.

It didn’t take long to find the source of this terminology. In 2007, nurse representatives from the Minnesota Nurses Association and faculty from the University Of Minnesota School Of Nursing sought to validate what nurses were experiencing every day - complex patients and complex systems, both with increasing demands. Through the use of focus groups, the researchers identified six major themes that contribute to complexity compression: personal factors, environmental factors, practice factors, systems and technology factors, administration and management factors, and autonomy/control factors.  You can read the published study in its entirety here: Complexity Compression: Nurses Under Fire. 

What's the biggest factor that contributes to complexity compression during your workday?

Reference: Krichbaum, K., Diemert, C., Jacox, L., Jones, A., Koenig, P., Mueller, C., & Disch, J. (2007). Complexity compression: Nurses under fire. Nursing Forum.

Posted: 11/29/2010 8:37:03 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Come Monday, it'll be all right?

During the month of November, two studies came across our newsfeed with regard to hospital admission on weekends. Researchers in the first study, Association between weekend hospital presentation and stroke fatality, published in Neurology on November 2nd, included consecutive patients with acute stroke or transient ischemic attack seen in the emergency department or admitted to the hospital. Of these 20,657 patients, stroke fatality was higher (8.1% vs. 7.0%) with weekend compared to weekday admission.

The second study, Weekend Admissions Predict Higher Mortality in Patients with End Stage Renal Disease, was presented at the American Society of Nephrology's Renal Week 2010. In this retrospective study, 19.7% of the 836,550 estimated admissions with end-stage renal disease were admitted on the weekend. Researchers found that those admitted on the weekend had significantly higher mortality (7.6% vs. 6.6%) than those admitted on a weekday.

A literature search on “weekend hospital admissions” revealed a few more similar studies published over the past 2 years. These included research on patients with acute kidney injury, gastrointestinal hemorrhage, and heart failure. All the studies concluded with similar results; that is, weekend admission is associated with a higher risk for death compared with admission on a weekday. What are the reasons behind this “weekend phenomena?”

Posted: 11/22/2010 8:52:07 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Drug shortages...putting people at risk

I was made aware of a serious problem with drug availability to consumers and health care institutions recently. My youngest daughter is allergic to milk and cheese which requires her to have an epipen available at all times and have an epipen available at school.  When I recently went to refill her perscription from the pharmacy, I was only permitted to get 1 pack of epipens. Each pack has 2 pens in it so we need two, one to carry and one to leave at school.  I was told by the pharmacist that there was a shortage of epinephrine emergency syringes so we were only able to get one at a time.

Today I was reading the health section of www.msnbc.com and found an article that really peaked my interest, "When vital drugs run out, patients pay the price". The article discussed the drug shortages that exist today and how these shortages are putting the health and welfare of the U.S. population at risk. According to the Food and Drug Administration, the majority of drug shortages are caused by manufacturing issues, safety concerns, and production delays. The article stated that there are 150 drugs currently on the shortage list by the American Society of Health-System Pharmacists. I went to their site, www.ashp.org, and found that in fact there are 150 drugs on the list, and the issue is so prevalent that there is an article titled, "ASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems," posted on their site. 

Over the last year, I've noticed a shortages of drugs that are essential to my practice and now the shortage has affected me at home.  Unfortunately, the FDA does not have the authority to ensure that pharmaceutical companies produce adequate supplies of drugs. There has to be a change in the pharmaceutical drug supply chain to fix the drug shortage issue.    

Posted: 10/27/2010 8:38:33 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


The art of giving report

Have you ever left after a shift and realized you forgot to relay some important piece of information to the next nurse? It can be tough to organize and prioritize your communication in a timely manner. A structured format or even the use of a template can be helpful; however experience definitely plays a role here too. Like anything else, giving report to an oncoming shift or during any patient hand-off takes practice. A common acronym used to ensure an organized and thorough report is SBAR: Situation, Background, Assessment, and Recommendation.

When I first heard of this method, it seemed too short for me. How could 4 letters/headings be used to convey all the information about my patients after a 12-hour shift? As I learned a little more about SBAR, I realized it was not much different from the method of report I had been using for years.

S= Situation. Include admitting diagnosis, history of present illness, events of hospitalization (Tip: for patients with long hospitalizations, a timeline of events is helpful.) Also, what is the patient’s current situation? Include review of vital signs and events from the past 24 hours.

B= Background. Past medical history, past surgical history, family history, psychosocial history.

A= Assessment. Review of systems. My preferred method of organization has always been neurologic, respiratory, cardiovascular, gastrointestinal, genitourinary, hematologic/immunologic, and endocrine systems; skin; laboratory values and diagnostic findings; medications; psychosocial issues.

R= Recommendation.  Include anything that needs ongoing or further attention.

What method of report works best for you?

Posted: 10/11/2010 7:37:03 PM by Lisa Bonsall, MSN, RN, CRNP | with 5 comments

Categories: Patient Safety


Universal principles for culturally sensitive care

In the latest issue of the Journal of Christian Nursing, Anthony Hoffman BSN, RN, describes his experiences as a diabetic educator in Nouakchott, Mauritania (located on the west coast of Africa). In his article, Universal Principles for Culturally Sensitive Diabetic Education, we are reminded of the importance of cultural awareness.  While most of us might not travel abroad to work, we care for and will continue to care for patients from other countries or with different faiths and traditions that impact how they manage illness. Mr. Hoffman shares the following “universal principles” which truly can apply to any patient in any setting:

"1. Patients own their culture. A patient needs to be allowed and encouraged to describe his or her culture. I found travel guides and documentaries useful as a starting point in understanding culture, but quickly learned the danger of stereotyping. Having an inquisitive attitude helps us be students of our patients' cultures and avoid stereotyping.

2. Patients own their bodies. In every culture, patients have the right to make their care decisions. Sometimes cultural mores and values will make adherence to the plan of care more challenging, but the final course of action belongs to the patient. We must continue to respect and offer the best to our patients regardless of their healthcare decisions.

3. Patients own their care plans. We need to help patients design their own care plans. Let them suggest ideas for how to follow the recommended plan of care. Set small and incremental goals with the patient for lifestyle modifications and celebrate the achievement of goals. In this way, nurse and patient become teammates working together.

4. Patients are their own best advocates. Teach patients the hows and whys of diabetic care, not just the "shoulds" and "musts." A patient who understands the basic physiology of diabetes is empowered to make informed decisions regarding his or her care plan and to adhere to that care plan.

5. Honesty is always the best policy. We are sometimes tempted to tell less than the "whole truth" in the name of cultural sensitivity. For example, I didn't like telling patients that dates have a high glycemic index or that fasting and binging during Ramadan can wreak havoc on their blood glucose. Withholding unpleasant information does not honor our patients or empower them to make wise decisions about their health."

You can read Mr. Hoffman’s article in its entirety here. Let us know what you think!

Posted: 9/28/2010 9:02:07 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Warning of vaccine administration errors

   Recent news about pertussis outbreaks that have resulted in infant deaths is causing serious concern in the healthcare community. Back in August 2006 and again in July 2010 the Institute for Safe Medication Practices (ISMP) issued a warning about confusion of Adacel and Daptacel which are vaccines for the prevention of tetanus, pertusis, and diptheria. ISMP explained how administering the incorrect vaccine to infants can result in ineffective immunization leaving babies vulnerable to infection. The IMSP Medication Safety Alert from July 1 2010 reported that "Part of the problem is that the official names of the products are very similar although stated in different order on the labels. One of them, diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP), is sold under the brand names DAPTACEL and TRIPEDIA (Sanofi Pasteur), and INFANRIX (GlaxoSmithKline). This formulation is for active immunization of pediatric patients 6 weeks through 6 years of age. The other vaccine, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap), is sold under the names BOOSTRIX (GlaxoSmithKline) and ADACEL (Sanofi Pasteur), and is meant to be used as booster shots for older children, adolescents, and adults."

   This is back to school season and vaccines are on the minds of parents, schools nurses, pediatric nurses and NPs. This is a perfect time to review our procedures for prescribing and administering childhood vaccines to ensure that the correct vaccine is ordered and administered each time. For more details on the recommended vaccine schedule, go to the Center for Disease Control and Prevention website at http://www.cdc.gov/vaccines/recs/schedules/.

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

Posted: 8/27/2010 8:55:49 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Two Texas Nurses Vindicated...ANA Code for Nurses Prevails

Two nurses, Anne Mitchell and Vickilyn Galle, settled with Winkler County, Texas and will share $750,000 in restitution following being fired and criminally prosecuted for upholding their duty to protect the public by sending an anonymous note detailing incompetent physician practice. The settlement is symbolic of both the personal vindication of these nurses and acknowledgement that the ANA Code for Nurses has prevailed.

This closes the book on this horrific experience that Mitchell and Galle endured. What's more is that there is a clear precedent which may discourage retaliation of this sort from happening to other nurses who attempt to blow the whistle whenever they observe substandard care.

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

Posted: 8/13/2010 8:05:18 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


No more "P" in CPR

When I was a nursing student, my boyfriend's grandmother suffered a cardiac and respiratory arrest in front of me. After a second or two of shock and saying to myself I can't believe this is happening to me, I told my boyfriend to call 9-1-1 and then I moved her from the bed to the floor and started CPR. After a few series of chest compressions and rescue breathing, she vomited into my mouth. They certainly didn't teach me that could happen in the CPR class I had! Once the paramedics arrived, they defibrillated her, got a rhythm and pulse back and they transferred her to the hospital.  When I told several people what had happened, they told me they could never have done CPR on someone because they could never get the ratio of compressions to ventilations right, and they feared catching something from the victim or having the victim vomit in their mouth.  As we now know, lay people are often hesitant to do CPR for just these reasons.

Today The New England Journal of Medicine published an article that will hopefully change laypersons perceptions of doing CPR. The multicenter, randomized trial looked at 1,941 patients who were randomly assigned to one of two groups, to receive chest compresions alone or to receive  chest compressions plus rescue breathing. According to the study, the results support a strategy for CPR performed by laypersons that emphasizes chest compressions and minimizes the role of rescue breathing.

What does this mean for layperson CPR?  Chest compressions are the priority, press hard, press fast, and don't stop until the person wakes up, the rescuer gets too tired to continue, or help arrives. It will be interesting to see if more bystanders will be willing to jump in and perform chest compressions on people who cardiac arrest outside the healthcare setting.  Giving a victim a little "push" may be just the thing to improve their future.

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

 

Posted: 7/28/2010 8:41:52 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Therapeutic communication ~ Let's talk about it!

Last week, during RNchat, a twitter chat for nurses, the discussion turned to the importance of communication. I was reminded that communication is not just talking, but listening. How often do you find yourself talking with someone and not hearing anything they say because you’re thinking of what you’ll say next? I find myself doing that often and even though I make a conscious effort NOT to do that, it seems to happen anyway!

I thought it might be a good time to review those therapeutic communication techniques we learned way back (for me anyway!) in nursing school. At the time, I thought it was silly to practice restating what my fellow nursing student (playing the role of patient) was saying. Later I realized that these techniques really do help patients focus and share information. Here we go:

  • Silence - Moments of silence encourage the patient to continue talking.
  • Facilitation - Use phrases such as “Please continue,” “uh-huh,” and “go on” to encourage the patient to continue.
  • Confirmation - This ensures that you and the patient are on the same track. Use a phrase such as “If I understand you correctly, you said….”
  • Reflection - Repeating what the patient just said can help you get more specific information. A patient might say “I feel so alone.” You can reply, “You feel so alone?” He might say, “Yes, I feel so alone since my wife died and my children moved away.”
  • Clarification - Give the patient an opportunity to explain his statements by using a phrase such as “What do you mean when you say…?”
  • Summarization - Restating information the patient gave you ensures that the information you’ve collected is accurate and complete.

Oh - and don’t forget about watching for nonverbal cues and using open-ended questions! What other techniques do you use to get patients talking?

Reference: (2008). Assessment made incredibly easy!, (4th ed.) Ambler, PA: Lippincott Williams & Wilkins.

Posted: 7/18/2010 7:55:29 PM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Patient Safety


Therapeutic communication ~ Let's talk about it!

Last week, during RNchat, a twitter chat for nurses, the discussion turned to the importance of communication. I was reminded that communication is not just talking, but listening. How often do you find yourself talking with someone and not hearing anything they say because you’re thinking of what you’ll say next? I find myself doing that often and even though I make a conscious effort NOT to do that, it seems to happen anyway!

I thought it might be a good time to review those therapeutic communication techniques we learned way back (for me anyway!) in nursing school. At the time, I thought it was silly to practice restating what my fellow nursing student (playing the role of patient) was saying. Later I realized that these techniques really do help patients focus and share information. Here we go:

  • Silence - Moments of silence encourage the patient to continue talking.
  • Facilitation - Use phrases such as “Please continue,” “uh-huh,” and “go on” to encourage the patient to continue.
  • Confirmation - This ensures that you and the patient are on the same track. Use a phrase such as “If I understand you correctly, you said….”
  • Reflection - Repeating what the patient just said can help you get more specific information. A patient might say “I feel so alone.” You can reply, “You feel so alone?” He might say, “Yes, I feel so alone since my wife died and my children moved away.”
  • Clarification - Give the patient an opportunity to explain his statements by using a phrase such as “What do you mean when you say…?”
  • Summarization - Restating information the patient gave you ensures that the information you’ve collected is accurate and complete.

Oh - and don’t forget about watching for nonverbal cues and using open-ended questions! What other techniques do you use to get patients talking?

Reference: (2008). Assessment made incredibly easy!, (4th ed.) Ambler, PA: Lippincott Williams & Wilkins.

Posted: 7/18/2010 7:52:34 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Patient Safety


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