Archive for June, 2007

Nurse-Corner to Forensic Consultant: One Emergency Nurse’s Experience

June 13, 2007

Marion Cumming RN, BCFE is owner of the consulting firms Corner/Medical Examiner Resources and Living Forensic in Pembine Wisconsin and ED staff nurse at Holy Family Memorial Medical Center in Manitowoc Wisconsin. She writes in Journal of Emergency Nursing that nursing is excellent background for becoming a forensic nurse death investigator. In 1973 she became curious about the coroner and wanted to know about coroner’s role and responsibilities and how death investigation was conducted. A coroner invited her to become his deputy. Then three years later the coroner did not seek reelection and so she ran for the office. She became the first female nurse-coroner and saw many opportunities to improve the services provided to families, health care agencies and communities. Her philosophy is “the coroner is the protector of the living through the investigation of death.” During her career she did education on SIDS, helped catalyze the development of crisis intervention, spoke with seniors about geriatric suicide, and she was appointed co-chair of the Wisconsin Coroners Medical Examiners Association (WCMEA) committee on standards of practice. She founded the Manitowoc County Critical Incident Stress Debriefing (CISD) team. Then in 1993 she started her consulting firm. She writes imagine the impact forensic nurse-coroners could have in improving death investigation systems worldwide. Forensic nurses are not only likely to improve the recognition, preservation, and documentation of evidence, they will also contribute to enhancing our systems of health care and aid in solving public health dilemmas. The forensic nurse will find that the trail of death investigation is open-ended with respect to want needs to be done for the deceased, the survivors and the community at large.

Cumming: J Emerg Nurs, Volume 22(6).December1996.494-497

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Sexual assault nurse examiners – comment

June 12, 2007

I have never heard of the SANE nurses. However, this certainly seems like a great program to have. I think that society still in some ways looks at sexual assault as not a crime. It is! And it is a very violent crime. It affects every aspect of your “self”. The SANE nurse certainly would have a challenging position. I would think they would need more education than just going through nursing school. Some criminal investigation and law classes maybe, as well as what to say to these victims. Maybe, in the future, in order to be a level-1 trauma center ER’s would need to have this program.

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The Passing of Demerol

June 8, 2007

There is plenty of literature stating the cons of Demerol use for pain management but usage still remains high in the hospital setting. I have had little success in my career to change physicians ordering practices except when I can demonstrate the side effects or poor outcomes produced by Demerol on a patient-by-patient basis. It seems not to matter the short duration of action; induced confusion in the elderly or the potential Demerol has to produce nuerotoxicity due to the accumulation of normeperidine.

As nurses it is our duty to be an advocate for our patients. To help ensure patients receive the best possible care we as nurses need to arm ourselves with knowledge. It is important to possess the basic concepts of pain management to accurately assess and document your patient’s pain and to know the classifications of pain. The nurse must understand basic pharmacologic pain management principles including the use of an equianalgesic table. Working with the medical staff to develop pain management protocols can help decrease Demerol usage and provide an effective pain management program in your hospital.

Demerol seems to be dying a slow death but as hospitals and healthcare workers embrace evident based medicine it is only a matter of time when this “lumbering dinosaur” will be come extinct.

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FORENSIC TOXICOLOGY

June 7, 2007

Poisoning happens to be one of the oldest methods of killing and drug overdose. Forensic toxicology is the use of toxicology to aid medicolegal investigation of death, poisoning, and drug use.

The forensic toxicologist must determine which toxic substances are present, in what concentrations, and the probable effect of those chemicals on the person. The body’s natural processes often complicate determining the substance ingested, as it is rare for a chemical to remain in its original form once in the body. For example: heroin is almost immediately metabolised into morphine, making detailed investigation into factors such as injection marks and chemical purity necessary to confirm diagnosis.

Laboratory analysis can identify and measure the levels of drugs, alcohols and poisons in biological samples such as blood, urine or tissue. The information may then be used by counsel and the courts to help determine if laws have been broken and/or if criminal charges are warranted. The forensic nurse may aid in collecting blood, urine, hair, tissue and other bodily fluid samples.

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Medication Errors, Comment

June 6, 2007

In my hospital we do have an electronic system that goes through the pharmacy and is checked. I, however do not think that our electronic charting on the med page is very good. Nursing can change times on meds if the med is late. Which is not always a good thing. I don’t think we should be able to do this at all! Also don’t assume that because the order went through pharmacy makes it always correct. In our neonatal unit we had a drug withdrawal baby that was receiving morphine for the withdrawal. He was down to such a small dose that pharmacy was drawing it up and diluting it for us to give. Usually the infant would take it pretty well orally. This one particular time he would not -pharmacy had diluted it with rubbing alcohol – which was caught by the nurse from noticing the infant’s reaction to it. Plus I think some of the old systems still work too. A red wrist band for drug allergies. Whatever happened to talking with the patient to tell them what you are giving them? Instead of just saying here take this. Communication is a big key especially with the patient. I think many younger nurses need to work on this to decrease those med errors.

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