safety

Administering A Dose of Gratitude

by Nursetopia on March 4, 2014

It’s easy to point out the wrong in health care. It’s all around us. Despite the brokeness, there are dozens hundreds of processes and moments that do work well.

Praise is limited for the on-time surgery with appropriate and accurate “time-outs;” reconciled instrument counts; providers utilizing the just-in-time stocked supplies that took months to pare down without impacting patient outcomes and negotiating sustainable contracts; post-operative nurses who self-scheduled to improve their own satisfaction while curbing rising staffing costs; pharmacy technicians who verify drug counts remain consistent from shift to shift and unit to unit; health information management teams who adequately code and bill for procedures as they weed through  hundreds of thousands of data points; lab team members that quickly, efficiently, and safely process pathology specimens as dozens of  additional patient body fluids and tissues whiz through the system; leaders who make time for people despite the tug of tasks; and on and on.

q4PRN

 

Everyday health care has its awful moments. In no way am I trying to minimize healthcare errors; they’re catastrophic – even fatal – in our industry. Yet, for every one of those you-didn’t-do-this-right notifications, there are myriad more wow-that-worked-awesomely instances.

 

 

Gratitude is potent no matter the route. What’s important is that it’s actually administered.

 

 

 

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Remembrance

by Nursetopia on September 11, 2013

I remember.           I remember.

09.11.2001.             09.11.2001

Four planes.          Four planes.

2,977 victims.       2,977 victims.

I remember.          I remember.

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Care to Get Patients Back on their Feet

by Nursetopia on May 21, 2013

As a runner, I realize the tremendous difference the right pair of shoes makes on my performance as well as my comfort. But as a nurse – what about my patients who are not only living with their disease but also the effects the disease may have on their foot health? Are they wearing the right shoes to positively impact their own daily performance, safety, and comfort?

Diabetes, arthritis, gout, plantar fasciitis – you name it and our patients have to face a multitude of problems impacting their feet, which impacts their balance, gait, pain, and circulation. Helllloooo, safety concerns! Foot health can even affect ankle and leg health, as well. It’s that good ‘ole kinetic chain in which everything is linked and needs to be in alignment, working together. Therapeutic footwear, which protects and help correct feet problems, is prescribed by podiatrists and other providers to ensure patients get back on their feet – literally.

As nurses, we rarely assess patients’ shoes, socks, and shoe inserts, which can all be therapeutic. With the ever-increasing comorbidities among our patients, we should take the time to assess these details more thoroughly and advocate for our patients if we think therapeutic footwear will help with their safety and/or comfort.

Disclosure: This article is sponsored by www.drcomfort.com.

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I Have No Clue What I’m Doing

by Nursetopia on July 6, 2012

It was a quintessential plot. It all happened in slow motion. I picked up one of my beautiful, square-cut diamond stud earrings (which I wear all the time), and somehow it escaped my pincher grasp. Three bounces around the sink, and it was gone. Down the drain. Five nights of late night painting cutting into my precious sleep may have had something to do with my slow reflexes.* Needless to say, first-time home ownership has been an adventure!

Don’t use my sink. My earring fell down the drain. You don’t have to do anything with it right now. Just don’t use my sink. My husband’s tired eyes pop open and before I know it, he’s examining the pipes beneath the sink. After a few minutes of tinkering, he tiredly says, “I have no clue what I’m doing.” It looked like he could fall asleep in the bathroom floor.

It made my morning. I’m still laughing. I shooed him back to bed so I could finish my morning routine. I’ll Google it later. Don’t use my sink.

This is an earring, which does have some sentimental value but is quite easily replaced; it is an object. However, this situation and my husband’s response made me think about nurses, hospitals, and safety. If only more people would confess their inadequacies and uncertainties (and/or gross lack of sleep), we might have safer hospitals, fewer errors, decreased deaths, and happier healthcare workers.

*I have no direct patient care today. My stated tiredness may impact meetings, but it will not impact the health of another person.

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Priming Time

by Nursetopia on June 21, 2012

Preparation. The word hangs in the air. We all know what it means. Time. It takes time to prepare, to prime, whatever it is we are about to do, work on, etc.

Time. There is never enough of it, or so it seems these days. We all want more of it to do whatever it is we do, work on, etc.

“Preparation” is never done quickly, yet our world moves at a break-neck speed. “Hurry” and “busy” are typical, every day words, even in health care where we know deliberate time is important to patient safety. “Preparation” is rarely viewed as actual work; it is always something that precedes work.

Take the time to prepare. It is, indeed, work. It is vital work. Excel in your preparation; work will follow in step.

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You Are Safe with Me

by Nursetopia on May 10, 2012

Thousands of people place their lives in the hands of pilots and flight crews daily; the large majority arrive safely and soundly at their destinations. When an airplane crashes, it is breaking news and numerous organizations get involved to learn from the crash-causing errors to ensure they are prevented in the future. With nearly 100,000 people dying annually from preventable medical errors – the equivalent of one, full aircraft crashing every single day – hundreds of health care systems are turning to the airline industry’s safety methods and processes.

This collision of aviation and health care safety met an ironic twist last week as I traveled to New Orleans to attend the Oncology Nursing Society‘s 37th Annual Congress. I sat down in my window seat, still listening to my audio book, and an off-shift pilot sat right next to me, a cup of coffee and newspaper in hand. I planned to listen to my audio book, and I thought my nestled ear buds might be a clue to others, but my pilot seat-mate had other plans.

[Smiles largely] Business or pleasure?

[Removes ear buds.] A little of both. I’m an oncology nurse, and I’m on my way to a conference in New Orleans.

Ah! New Orleans! [Pauses; leans closer] So, oncology. That’s…what?…

[Quickly.] Cancer. I’m a cancer nurse.

Right. That’s what I thought. Do you want to read part of the paper? I’m finished with this section. [Offers a folded paper to me.]

No thanks. I’m good. [Puts up iPad and ear buds as the flight crew requests. Looks out window.]

So, when are you supposed to start having that colonoscopy thing? I’ll be 56 in a few months.

Before we left the tarmac I explained screening recommendations, debunked a few myths, and relieved concerns about embarrassment. Less than 30 minutes later we landed at our connection city. Our parting words included my strong encouragement for him to see his provider for a colonoscopy and his thanks and promise to do so.

Within one minute of him finding out I am an oncology nurse, we were discussing colonoscopies. I certainly didn’t mind; I was glad I could share. It’s my job and my passion, and the conversation reiterated how much people trust nurses – even those not in uniform. I am glad he felt safe with me. It’s a responsibility and honor I cherish.

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Win a Nursing 2012 Drug Handbook [Giveaway]

by Nursetopia on January 4, 2012

It is amazing how quickly the medication market changes. There are always new drugs to know, drugs we should never use again, new-found indications and contraindications, and so on. Needless to say, an updated drug handbook is essential for every nurse. The Nursing 2012 Drug Handbook is best-selling nursing drug book. I have used the Nursing Drug Handbook throughout my nursing career – starting with nursing school. It’s one of those books to which I always turn as it is easy to flip through and understand, seeing important drug information clearly categorized and at a glance. Thanks to publisher Wolters Kluwer Health, one Nursetopia reader will win a Nursing 2012 Drug Handbook to start the New Year.

Giveaway details:

1. Enter your contact information into the entry form below. Only one entry per person will be accepted via the entry form.

2. You can get two additional entries into the drawing via the two following methods:

A) Leave a comment about your experience with previous years’ editions of the Nursing 2012 Drug Handbook and/or why the Nursing 2012 Drug Handbook is important to you in your day-to-day profession.

B) “Like” Nursing Drug Handbook on Facebook. (Tell me in the comments, too, and I’ll validate it.)

3. I will randomly select one person via random.org on Thursday, January 12, 2012, at 8 PM CST.

4. I will contact the winner, validate the contact information, and have the book shipped to the winner.

What ‘cha waiting for? Enter now.

Giveaway Entry

Disclosure: I have not received any compensation or product for this post. All comments here are my own, though.

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This is part seven of the Nursing Research Challenge.

The Article: Donaldson, N. & Shapiro, S. (2010). Impact of California mandated acute care hospital nurse staffing ratios: A literature synthesis. Policy, Politics, & Nursing Practice, 11(3): 184-201.

Big Idea: “California is the first state to enact legislation mandating minimum nurse-to-patient ratios at all times in acute care hospitals,” creating a natural experiment (p.184). This study examines 12 studies researching the impact of the mandated ratios. To be included in the research synthesis, studies had to have a pre-post design (comparing outcomes both before and after the law implementation). Cross-sectional studies, which study data at any given point – like  snapshot – were excluded from this literature synthesis. The research looked at the impact of the California ratio mandates on the nursing workforce and acute care hospitals – operations, processes, structure, patient care costs, and clinical outcomes.

Survey Says!: The mandate reduced the number of patients per nurse and increased the number of nursing hours per patient per day, which are the most obvious purposes of the legislation. According to this article, the staffing measures did not significantly improve nursing quality indicators and patient safety indicators across hospitals throughout the state. Of particular interest, though, even as patient severity increased in California hospitals after the implementation of the legislation, adverse outcomes did not increase.

Quotable: “Collectively, the investigators are multidisciplinary and multimethod in their approach, clearly diverse in aims and yet bound together in the common quest to explore evidence revealing the impact of California’s legislatively mandated ratios on cost, quality, safety, and outcomes of patient care in acute care hospitals” (p. 185).

In regard to the patient severity increasing without adverse outcomes increasing: “We cautiously posit that this finding may actually suggest an impact of ratios in preventing adverse  events in the presence of increased patient risk” (p. 196).

“The synthesis did not find evidence of an expected effect of mandated minimum staffing ratios on clinical and specific nursing sensitive outcomes. Efforts by investigators to explore these possible relationships are important, given the robust body of work derived from cross-sectional studies of large data sets that reports just such relationships…” (p. 198).

So What?: This is a lovely, neatly wrapped synthesis of the California mandated ratio-related studies. It includes several tables comparing the included studies. and anyone interested in mandated nurse ratios – no matter your position – should read the article. The synthesis pointed out numerous barriers impacting overall evaluation of the California mandate as well as identified both conflicting and supporting findings among included studies. Still, more research is needed to evaluate the impact of mandated ratios on the nursing workforce, the healthcare system, and patient outcomes.

Just Plain Interesting: This study was commissioned and funded by the Robert Wood Johnson Foundation for the Institute of Medicine Future of Nursing Committee.

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Rapid Cycle Change Projects Improve Quality of Care

by Nursetopia on March 18, 2011

This is part six of the Nursing Research Challenge.

The Article: Valente, S. (2011). Rapid cycle change projects improve quality of care. Journal of Nursing Care Quality, 26(1): 54-60.

Big Idea: Transforming Care at the Bedside (TCAB) is a national initiative to engage frontline nurses to improve care within medical-surgical units. Basically, it involves brainstorming, implementing small ideas, and evaluating them. If they work, the change happens on a bigger scale. If the ideas fail, they get scrapped and another idea is tested. In this study, the Greater Los Angeles Veterans Administration Medical Center, a tertiary care center, selected two units to serve as TCAB units. The TCAB teams focused on: improving storage and access to supplies, reducing wasted time, placing a TCAB banner on the units, improving pain medication order processes for all postoperative patients, a welcome banner for patients (which are Veterans, remember) with their permission, courtesy trays outside of meal hours, a unit quiet hour, an online orientation for physicians and trainees rotating to the TCAB units, hourly patient rounds, “Please Do Not Interrupt the Medication Nurse” poster/process, and several other great projects.

Survey Says!: Improvements have occurred all around – among nurses, patients, and family members. RN turnover for the units have decreased a whopping 58% percent! Direct patient care among TCAB RNs increased 10%, the number of certified nurses on the TCAB units increased 200%, and waste, falls, use of restraints, pressure ulcers, and codes have all decreased.

Quotable: “Rapid cycle change encourages the staff to try a potential change and test its effectiveness with 1 nurse, 1 shift, and 1 patient.”

“Nurse vitality has grown, and nurses have embraced their ability to have power and influence over change to improve care delivery for their patients. They have discovered that they can identify a problem and create, implement, and test the solution. They have also spread these innovative changes…to other units.”

So What?: No one better ask this “So What?” question. There are numerous other articles highlighting the effectiveness of Transforming Care at the Bedside. It is good for healthcare, good for business, and good for nurses. Let’s follow the evidence. Why isn’t every facility implementing TCAB?

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This is part five of the Nursing Research Challenge.

The Article: Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y., & Han, K. (2011). Nurses’ work schedule characteristics, nurse staffing, and patient mortality. Nursing Research, 60(1): 1-8.

The Big Idea: Nurses work crazy hours – 10, 12, and 16 hour shifts. Some nurses have mandatory overtime and call schedules, and some nurses work swing shifts – alternating between day and night shifts. Lack of sleep and decreased time away from the hospital impact nursing care. Staffing (e.g. patients per nurse) has been proven to impact patient mortality, but when staffing is controlled, does the nurse’s work schedule correlate to mortality, too?

Survey Says!: Most definitely. When researchers controlled for variables in staffing and hospital characteristics, they found nurses’ work schedules related significantly to patient mortality. Hospitals in which nurses reported working long hours or decreased time away from work (i.e. working two or more 16-hour shifts in a row, etc.) had more patient deaths from pneumonia. Lack of time away from work was also correlated with increased abdominal aortic aneurysm deaths. Presenteeism, or nurses working while sick, was significantly related with increased congestive heart failure patient mortality. And, acute myocardial infarction was significantly related to nurses’ weekly work burden, or hours per week and days in a row.

Quotable: “In addition to staffing, nurses’ work schedules are associated independently with patient mortality.”

“The continued vigilance required of nurses can be affected by excessive work hours, limiting their ability to detect adverse changes in patients in time to address them and prevent consequences.”

“Attention to work schedule is now warranted on the basis of the impact of scheduling on patients as well as nurses.”

So What? Again, breaks are good for nurses and patients. Nurses, managers, and the C-suite should think about nurses’ schedules as a patient safety issue and revise policies accordingly. And, if you’re reading this but aren’t a healthcare professional, it would be wise for you to know your nurse (or your healthcare provider’s) work schedule. You just might rethink a few things.

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