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Monday, January 31, 2011

Institute For Safe Medication Practices

Newsletters Professional Development

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NEW Standard Concentrations of Neonatal Drug Infusions

FDA and ISMP List of Drug Names with Tall Man Letters

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Monday, November 29, 2010

The New, Well-informed Patient - NurseZone

The New, Well-informed Patient

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Annette Moore-Mitchell, MSN, RN, CMSRN, suggests removing distractions and assessing to be sure patients are ready to listen before beginning any teaching session related to their condition and care.
“When patients are fully informed, it helps relieve anxiety and uncertainty,” said Annette Moore-Mitchell, MSN, RN, CMSRN, clinical instructor of nursing at Oklahoma City University in Oklahoma.

Children require special attention to decrease stress levels. Not only must parents understand the plan of care, the patient and siblings also want to know what is happening. Child life specialists at Children’s Medical Center Dallas provide supportive care by using developmentally appropriate education, preparation and therapeutic activities to improve patients’ emotional well-being.

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Wednesday, November 17, 2010

Nurse Leaders as Change Agents, Are We Up to the Challenge? By Beth Boynton, RN, MS

Nurse Leaders as Change Agents

11.02.2010 09:26 PM

Are We Up to the Challenge?

By Beth Boynton, RN, MS

Most of the work I do as a consultant, author and teacher is grounded in my belief that nurses are intelligent, capable and compassionate professionals who have a huge potential and daunting responsibility to improve healthcare. I believe that efforts to communicate respectfully and create respectful work environments will directly and indirectly lead to providing safe, quality care and experiencing long-term rewarding career paths in nursing. In fact, (at the time of this writing) I am working on a keynote address that focuses on this message for the ANA-WA leadership conference in September.
Yet, there are times when I work as a per diem staff nurse, I feel frustrated, powerless and despairing. I have one hundred urgent things to do and time to do about 60 of them if I am going to follow protocols and take the time to listen respectfully to all parties. I can take short cuts and do about 80 of them. Add to that an environment with chair alarms, bed alarms, exit-seeking alarms, endless interruptions, new problems and wasted time looking for supplies, and by the end of my shift I am emotionally, physically and intellectually exhausted. And, I didn't do everything I should have.
Patients, families, physicians, colleagues and administrators have the right to expect skilled, timely and compassionate care, don't they? And I have a right to expect all of these stakeholders to contribute to positive or at least optimal outcomes, don't I? Yet horizontal and vertical violence are huge problems and many of our workplace relationships are dysfunctional. This keeps us fragmented and isolated. Collaboration seems like an obvious way to reclaim our power and have more impact on our system.
But when resources are not there, how far will respectful communication take us? Sometimes I feel so certain and sometimes I don't know. It seems far too easy for a microscopic view of one of those 100 things that I don't do or do incorrectly to reflect poorly on me rather than the very-broken system I am working in.
I love teaching assertiveness and facilitating tough discussions during workshops on effective communication, workplace violence, or inspiring nurse professionals. But in all honesty, when I practice what I teach, I realize how hard it is!
Not long ago I was faced with a situation where my work assignment was unsafe. At first I was stunned to find out I was supposed to be supervising a medication assistant on an adjacent unit. I had my hands full on my own unit and was angry and overwhelmed by this additional responsibility. It was an evening shift and I made it through, but went home exasperated.
I struggled with coming up with respectful language and process for addressing the issue. I felt some internal inadequacy that I could own and I also felt a sense of disrespect for the work I do coming from the organization. It felt like a set up and I did not sleep well.
The next morning I called the Nurse Manager and expressed my concerns. She advised me that it was part of my job expectation and encouraged me to talk with the Director of Nurses. I also called the scheduler and left a voicemail message that I did not feel safe supervising in that situation. I said I would be happy to discuss it, but that I would not accept an assignment in that capacity in the future. He didn't call me back, but when I went in several days later, he approached me and told me that he couldn't make any promises.
I took a deep breath and asked him whom I needed to talk with, as it was not an acceptable answer. He referred me to the DON and I took a deeper breath and knocked on her door. I felt heard and respected at this juncture and have not been placed in this position again. Has it impacted scheduling/staffing in other ways for me? I am not sure.
I am a national presenter, with a graduate degree and book published and I want you to know that the process of taking this concern up the ladder was extraordinarily challenging for me. In the trenches I see my colleagues and support staff working so hard. They have families to take care of, bills to pay, and hopelessness about their ability to change things.
I know that I am role modeling healthy communication skills, providing the best care I can and making a difference. I also know I am asking nurses to stretch in personal and professional growth areas that are extremely difficult.
More and more I see nurse leaders and educators in such critical positions as change agents. Safe and respectful work environments for our staff and patients are critical priorities. Role modeling effective communication, owning our contribution to problems, and providing transformational leadership is indeed, daunting. We need leaders who will help to slow things down and bring back a balance of caring and collaboration into healthcare. I do think we can and I do think we will, maybe not tomorrow, but eventually. And who knows, maybe our efforts will seep into other areas of our world that are moving too fast.

Beth Boynton is an organizational development consultant specializing in issues that impact nurses and other healthcare professionals. She is a coach, facilitator and trainer for topics related to communication, conflict management, teambuilding and leadership development, and author of the book Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. She is an adjunct faculty member with New England College’s graduate program in Healthcare Administration and contributing University of Florida faculty for the Forensic Science for Nurses certificate program. She has also taught for Antioch University and McIntosh College. She has published several professional articles and her newsletter, Confident Voices, has drawn audiences from across the nation for addressing communication, conflict and workplace dynamics. Her website — www.bethboynton.com — offers more information.

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Tuesday, November 16, 2010

Hospital care fatal for some Medicare patients - USATODAY.com

An estimated 15,000 Medicare patients die each month in part because of care they receive in the hospital, says a government study released today.

The study is the first of its kind aimed at understanding "adverse events" in hospitals — essentially, any medical care that causes harm to a patient, according to the Department of Health and Human Services' Office of Inspector General.

Patients in the study, a nationally representative sample that focused on 780 Medicare patients discharged from hospitals in October 2008, suffered such problems as bed sores, infections and excessive bleeding from blood-thinning drugs, the report found. The federal Agency for Healthcare Research and Quality called the results "alarming."

"Reducing the incidence of adverse events in hospitals is a critical component of efforts to improve patient safety and quality care" in the U.S., the inspector general wrote.

The findings "tell us exactly what some of us have been afraid of, that we have not made much progress," said Arthur Levin, director of the independent Center for Medical Consumers and a member of an Institute of Medicine committee that wrote a landmark 1999 report on medical errors. "What more do we have to do to make sure that sick people can rest assured that they're not going to be harmed by the care they're getting?"

Among the findings in the report obtained by USA TODAY:

•Of the 780 cases, 12 patients died as a result of hospital care. Five were related to blood-thinning medication.

Two other medication-related deaths involved inadequate insulin management resulting in hypoglycemic coma and respiratory failure resulting from oversedation.

•About one in seven Medicare hospital patients — or about 134,000 of the estimated 1 million discharged in October 2008 — were harmed from medical care.

•Another one in seven experienced temporary harm because the problem was caught in time and reversed.

About 47 million Americans are enrolled in Medicare, a government health insurance program for people 65 and older and those of any age with kidney failure.

The adverse events found in the study weren't necessarily due to medical mistakes, said Lee Adler, a University of Central Florida medical professor who was involved in the study. For example, he said, an allergic reaction to a penicillin injection is an adverse event, but it's a medical error only if the patient's allergy was known prior to the shot.

Among the problems identified in the report were Medicare patients who had excessive bleeding following surgery or a procedure. For example, one patient had excessive bleeding after his kidney dialysis needle was inadvertently removed, which resulted in circulatory shock and an emergency insertion of a tube to allow breathing.

When the tube was removed the next day, the patient inhaled foreign material into his lungs and needed lifesaving medical help, the report said.

Peter Pronovost of Johns Hopkins University, co-author of the book Safe Patients, Smart Hospitals, said medical mistakes are "an enormous public- health problem."

"We spend two pennies trying to deliver safe health care for every dollar we spent trying to develop new genes and new drugs," Pronovost said. "We have to invest in the science of health care delivery."

via usatoday.com

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