Smoking kills...there's no doubt about it

The Journal of the American College of Cardiology just published an article that showed once again that secondhand smoke is detrimental to your health. The University College London looked at 13,000 people in England and Scotland and discovered that those exposed to secondhand smoke had a 2-fold increase risk of dying of heart disease. Research has shown us that exposure to secondhand smoke increases the risk of developing cancer, worsens bronchitis and asthma, and has been associated with sudden infant death syndrome. 

Smoking and secondhand smoke kills people, there's no doubt about it. Yet, you can still go into the store and buy a pack of cigarettes; where's the logic in that?   The times are changing though. Our local hospital is going smoke-free. They've done a great job reaching out to employees and their families to offer them smoking cessation programs. I've noticed more office buildings and restaurants going smoke-free or limiting smoking to a safe distance away from other people. Even airports have gone smoke-free; no more holding your breath walking through the terminal.  Casino's haven't yet made that full transition to smoke-free but, there's hope for them yet.

I grew up in a home where my mother smoked and she still does. I love her dearly but, I can't stand the way my hair, clothes and skin smells after just a short visit with her. She has tried to quit many times but, still hasn't been able to do it.  At the age of 73, I doubt she ever will.  When I look in her eyes, I see all those people I've cared for dying of COPD, heart disease, and cancer due to being exposed to smoke. I can only hope  that she won't become a statistic for a little while longer. 

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

Posted: 6/23/2010 7:16:44 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Do I really need to take that NSAID?

How many of us take an ibuprofen or a naproxen when we have aches or pains or even a headache without thinking twice about it. If you're like most people, I'm sure that's exactly what you do.  Research published in the journal Circulation: Cardiovascular Quality and Outcomes recently may have many of us thinking differently.  The article, "Cause-specific cardiovascular risk associated with nonsteroidal anti-inflammatory drugs (NSAIDs) among healthy individuals", looked at a sample size of 1,028,437 Danish individuals over the age of 10. Use of the nonselective NSAIDs, diclofenac, and the cyclooxygenase-2 inhibitor, rofecoxib, were associated with a dose dependent increased risk of cardiovascular death.  In addition, ibuprofen, was associated with an increased risk of fatal or nonfatal stroke. Naproxen was not associated with an increased cardiovascular risk in this study.

While this is not the first study to highlight the cardiovascular risks associated with NSAIDs, it gives us a chance to consider the thought that all drugs in a certain pharmaceutical class, don't have the same risk profile. NSAIDs are an integral part of the arsenal of medications we use everyday to alleviate our patients' pain as well as our own.  We need to keep in mind  that  one drug maybe more appropriate for a patient than another.

Here's my challenge for you. Before you take your next dose of one of these drugs, ask yourself this question? Do I really need this medication, or is there something else I could do to feel better? 

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

Posted: 6/9/2010 8:44:22 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Memories of a medication error

A recent study published in the Journal of Nursing Care Quality looks at medication errors from the perspective of nurses.  While the researchers sought information about reporting of errors, importance of technology in reducing errors, and current medication administration procedures, they also asked open-ended questions allowing nurses to share their own experiences with medication errors.

"Nurses were asked, "How did you feel when you made a medication error?" This question yielded somewhat surprising results. Many of the medication error incidents had occurred years before completion of the survey yet responses retained the emotions associated with it. Themes that emerged from these comments included concerns about patient harm; violation of trust; culpability, shame, and self-blame; loss of self-esteem and professional self-image; and an awareness that the system had failed them."

When I was a senior nursing student, I neglected to check a patient’s heart rate before giving him a dose of digoxin. I was devastated. As soon as I saw him swallow the pill, it hit me that I hadn’t taken his pulse. I panicked and grabbed his wrist. His pulse was 62; above the “Hold for heart rate less than 60” but not by much. I hadn’t thought about this incident for a long time, but now thinking back, I can remember this clinical day so vividly. My first concern, of course, was for the well-being of the patient and fortunately, his vital signs remained stable. My own feelings of self-doubt and failure, however, stayed with me for quite some time. How could I have forgotten something so important and yet so simple? 

Read the full text of When the 5 Rights Go Wrong: Medication Errors from the Nursing Perspective while it’s on our Recommended Reading list. Please share your own experiences and feelings by leaving a comment!

Posted: 6/7/2010 9:00:43 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Where do you get your drug information?

As I mentioned in a previous post , one of the most stressful things I experienced in nursing school was memorizing all of the drug information. I can remember preparing for clinical the night before with medication lists for my two patients, a drug reference book by my side, a stack of index cards, pencils, and various color highlighters. The lists would be long as if my instructor picked out my patient assignment solely based on the number of meds I would be administering and it never failed that my patients’ medication lists had no overlap. For example, it seemed that even if both were cardiac patients with a history of hypertension, one was on a diuretic and the other on an ACE inhibitor! The joke was usually on me though, for no matter how well I memorized the drug names, indications, dosages, side effects, and interactions, there were always one or two drug orders that were changed by the time I arrived for clinical. Of course, those newly ordered medications would be the ones my instructor asked me about!  Ahhh…the joys of nursing school!

I had heard a lot about the “reality shock” of starting out as a new RN. I knew I would not be able to research my patients the night before and learn all about their medications ahead of time. How would I manage medication administration? Would I deliver them safely and be alert for every potential side effect? Would I make an error?

One of my most important nursing tools when I was a new graduate was a drug handbook that my preceptor gave me. She advised me to highlight in it, mark pages, take notes, and do anything else to it that made it easier for me to safely administer medications. Through the years I bought new editions but I continued to use it in the same manner as that first book.

It is now easier than ever to access drug information. The internet allows us to get any information within seconds. However, it is so important to make sure the information you are accessing is accurate and up-to-date.

Oftentimes, prescribing information can be found on the pharmaceutical company websites or by searching FDA approved drug products. For safety information, the FDA’s Drug Safety Labeling Changes and the Institute for Safe Medication Practices are good sites to add to your favorites. Also, be sure to check out drug updates here on NursingCenter. We’ll keep you informed about drug news, medication errors, and the latest drug-related articles and CEs that publish in our journals. What resources do you use?

Posted: 4/5/2010 9:05:11 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Patient safety, handwashing, and hierarchy

During Patient Safety Awareness Week last week, the following interview from the New York Times caught my attention. In Doctor Leads Quest for Safer Ways to Care for Patients, Dr. Peter J. Pronovost, medical director of the Quality and Safety Research Group at Johns Hopkins Hospital in Baltimore, describes his quest for patient safety after the misdiagnosis of his father and the death of a child from a catheter-associated infection.

At one point in the interview, Dr. Pronovost talks about improving physician handwashing practices. Part of the solution was for the nursing staff to make sure the doctors wash their hands and if the doctors didn’t wash, the nurse could stop the procedure. The following excerpt from the interview demonstrates how both the nurses and doctors responded:

A. You would have thought I started World War III! The nurses said it wasn’t their  job to monitor doctors; the doctors said no nurse was going to stop takeoff. I said: “Doctors, we know we’re not perfect, and we can forget important safety measures.  And nurses, how could you permit a doctor to start if they haven’t washed their hands?” I told the nurses they could page me day or night, and I’d support them.  Well, in four years’ time, we’ve gotten infection rates down to almost zero in the  I.C.U.

Wonderful outcome, right? Yes, but the strategy was not well-accepted initially. Later in the interview, Dr. Pronovost discusses the benefits of empowering nurses and avoiding the hierarchical structure seen in so many settings. As nurses, we spend the most time with patients, we are aware of subtle changes in their condition, and we have a duty to speak up when patient safety is at risk. Along the same lines, we also have the right to be heard. In short, to have a successful team, mutual respect and effective communication are critical.

How comfortable are you with your team? What approach would you take in reminding a colleague (nurse, physician, or anyone else) to wash his or her hands?

Posted: 3/15/2010 7:33:33 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Patient Safety

To report or not to report?

Last week, a nurse in Texas was acquitted after a being on trial for reporting a doctor for practicing bad medicine.  Here are some of the details from the case, which came to be known as the “Winkler County nurses” trial:

  • Two nurses, Anne Mitchell and Vicki Gale, reported a doctor because they were concerned about his practice being below the standard of care and affecting patient safety. Another concern was his use of “nontherapeutic treatments and prescriptions.”
  • The case against Gale was dismissed; however the felony indictment will remain on her record.
  • Mitchell faced a third-degree felony charge and up to 10 years in prison for trying to protect her patients.
  • Both Mitchell and Gale were fired from their jobs.
  • The American Nurses Association (ANA) and Texas Nurses Association (TNA) both demonstrated their supported openly. The TNA created the TNA Legal Defense Fund to “to support the legal rights of these nurses in Winkler County – and the rights of every practicing nurse in Texas to advocate for patients.”
  • On February 11, 2010, Anne Mitchell was found not guilty.

You can read more about the details of the case as chronicled by the TNA here

“I was just doing my job,” relayed a jubilant Anne Mitchell, in a phone conversation with TNA immediately following the not guilty verdict, “but no one should have to go through this,” she said.  “I would say to every nurse, if you witness bad care, you have a duty to your patient to report it, no matter the personal ramifications.  This whole ordeal was really about patient care.”

My heart goes out to both Mitchell and Gale for all that they have endured over the last months. While the verdict is a success for nurses and patient safety, what damage has been done simply by the fact that such a case was brought to trial? What are your thoughts? Have you ever been in a similar position in which you felt patient safety was being compromised by a colleague? How did you handle it?


Posted: 2/15/2010 8:03:39 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Disaster Preparedness: Education and Training

  Hi, I'm Karen Innocent, Director of Continuing Education and Conferences for Lippincott Williams & Wilkins. I'm very delighted to have this privilege and opportunity to share insights on continuing education and other issues related to nursing professional development with you through this blog.
  The topic for today is education and training on disaster preparedness. By now you have encountered more than a week of news reports about the earthquake in Haiti. This strikes close to home for my family. My husband grew up in Haiti, and has friends and family still living there. While most of the family has made contact, the communication problems has left the well-being of others unknown. Like many other compassionate observers, we wait anxiously for good news and are doing what we can to send help.
  As a nurse, the most troubling part about witnessing the aftermath of this disaster is seeing the uncoordinated rescue efforts and difficulties that had occurred with providing medical services and supplies to survivors. It is a shame that many people may die because of lack of access to basics such as antibiotics or clean drinking water. This underscores the importance of government and social agencies having a plan and trained professionals ready to respond to emergencies.
  Not many of us were aware of the possibility of an earthquake in Haiti, particularly because the Caribbean Islands are more concerned with the threat of hurricanes. Just as this unexpected tragedy occurred, there is a possibility that natural disasters or accidents of large proportions could occur anywhere. Nurses may be called upon to assist in these emergencies. While nurses are highly educated and have specialized skills, we all might want to brush up on emergency response because we never know when a disaster might hit our home towns.
   We'd like to know what you are doing in your community to prepare for disasters, and how your employer is training nurses on the leadership, organizational, and clinical skills needed to respond to emergencies.

   If you do not practice in emergency, trauma, or public health, it's likely that you could use a review. So I've collected a group of links to websites with reading materials on emergency preparedness that are designed for nurses, health professionals, and the general public.

Emergency Preparedness for Home Healthcare Nurses, Home Healthcare Nurse, January 2006:

Essential links: Emergency Preparedness, Home Healthcare Nurse, January 2006:

Ready. gov:

National Library of Medicine, Disaster Preparation and Recovery:

How Can I Help?

For those who want to volunteer, you may be interested in contacting the following organizations that are sending healthcare professionals to support the rescue and recovery efforts in Haiti.

Center for International Disaster Information:

United States Government:

The American Red Cross:

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

Posted: 1/22/2010 8:46:32 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

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