You guessed it, another health care emergency...

It always happens whenever I travel on business, there is almost always a health care emergency. I seem to be a magnet for them.

I recently returned from a business trip to China and had the opportunity to see the Chinese Health Care System up close and personal. One of my colleagues had an injury and needed to be taken to the hospital. As the "nurse" in the group, I went with her along with an interpreter. What I saw really opened my eyes to how luckly I am to practice in the United States.

When we arrived in the Emergency Department, there were no wheel chairs to be found, patients were sitting or lying on the waiting area floor. Once back in the treatment area, there were patients on stretchers, in chairs obviously brought from home, and lined up against the walls. The physicians, nurses and many patients were all wearing masks and there weren't any boxes of gloves or containers of anti-bacterial hand wash to be found.

After sometime, we discovered there was a special area for "foreigners" in another section of the hospital. So off we went through dimly lit corridors to our special area. Without an interpreter we would never have been able to register or speak to the nurses and physicians. "Pay for Service" takes on a whole new meaning in this setting. Before every examination and procedure, you had to get an estimate of the cost and then go pay for it with your credit card before the service was rendered. It was the nurses who gave the cost estimates for care. Can you imagine doing that in the U.S.?

Language was a definite barrier. The nurses spoke virtually no English but I was able to communicate with them through the interpreter. The physicians were somewhat more fluent in English medical terminology so it was less difficult communicating with them. When all else failed, hand gestures worked well.

 The care my colleague received, once we found the right place to be, was very good. The physicians and nurses appeared to be very knowledgable and skilled at their jobs despite having minimal supplies and staff.  

What lessons did I learn?

1.We often take supplies, cleanliness and being able to communicate with our patients for granted here in the U.S. In the rest of the world, that simply is not the case.

2. If you travel to a foreign country where you can't speak the native language, you better know where to find an interpreter.

3. Always carry a credit card or local money so you can pay for services.

4. If possible, travel with a nurse or other health care professional, they may save your life.

 

And finally, on the flight home, you guessed it, another medical emergency. And yes, I was the only health care provider on the plane.

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

Posted: 1/27/2011 9:07:48 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


In case of emergency

As nurses, it is in our nature to want to intervene and “make things better.” Add fundamental medical knowledge and clinical skills to that desire to help and we are the ideal candidates to promptly respond to any emergency situation or mass casualty incident. Right? Not always.

Desire and clinical expertise are not enough when it comes to volunteering during or after a disaster. Preparation is an essential component that cannot be overlooked. If you’ve tried to help in the past but weren’t able, or think you might be interested in being a disaster volunteer in the future, now is the time to look into becoming part of an established disaster response team. Start your research by visiting the websites of organizations such as the National Disaster Medical System, American Red Cross, and Medical Reserve Corps.

Does anyone already belong to any of these groups? Have you been part of disaster relief efforts in the past? What advice can you share with us?

Reference: Adams, L.M. (2010). It’s a Disaster! How can I help? Nursing2011 Critical Care, 6(1).

Posted: 1/11/2011 8:34:48 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Family meetings

I can remember a patient with an upper GI bleed, Minnesota tube in place, on maximum vent support and two pressors, who clearly was not doing well. I was checking yet another blood product with a nurse colleague, when a consulting clinician came in and told the family members at the bedside that “his numbers look good.” He then smiled and walked out of the room. The family responded with sighs of relief and “thank goodnesses” while the other nurse and I looked at each other as if to say “what just happened here?”

Have you experienced similar situations? I hesitate to name the clinician’s area of expertise because I don’t want to give any specialty a bad rap or make a generalization. However, the point is that sometimes a person not directly involved with a patient’s day-to-day care can make an observation to patients or families and give them a message that may not be correct. It isn’t always one of false hope either; perhaps a patient is doing better, yet his _______ (you can fill in the blank - rash, glucose level, wound, etc.) is not healing or normalizing and a caregiver might focus on that one clinical finding when talking with the patient and his family members.

It is for this reason that I was both surprised and discouraged when I read the results of a recent study published in Chest, “Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients.” In this study, 135 ICU patients received ‘usual care’ and 346 ICU patients had weekly family meetings where the patient’s progress and goals were discussed. The investigators were looking at the impact of this intervention on length of stay and no significant difference between the two groups was found.

Despite the negative findings of this study, it is important to remember the positives, or benefits, of sitting down with families for formal meetings where information can be shared and questions can be answered. For example, regular family meetings can allow you to:

• Provide personal contact
• Give updates on the patient’s medical condition and treatment options
• Discuss his prognosis
• Learn about the patient and family, including expectations and wishes
• Gain the opportunity to formulate a trusting and caring relationship
• Tailor the treatment plan according to the input of all staff and the patient’s family.

Please allow me to share the following quote from the authors in their conclusion of this study:

"Even if the use of regular formal family meetings does not alter resource use in all settings, the literature is replete with evidence of other beneficial effects of providing families with time to sit in a quiet location and talk at some length about the patient's goals and preferences and to explore issues related to quality of life, and providing families with consistent support as they face difficult decisions."

What is the standard procedure for initiating, scheduling, and attending family meetings where you work?

Posted: 12/20/2010 8:59:56 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


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 6 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


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