Archive for August, 2008

Massage Pathology and Forensic Nursing Courses

August 27, 2008

Does your Massage Pathology course fulfill the requirements of the National Certification Board for Therapeutic Massage & Bodywork (NCBTMB) to take the National Certification Examination for Therapeutic Massage and Bodywork (NCETMB) and the National Certification Examination for Therapeutic Massage (NCETM)?

Does your Massage Pathology course fulfill the requirements of the Federation of State Massage Therapy Boards to take the Massage & Bodywork Licensing Examination (MBLEx)?

Will your Forensic Nursing course assist me in preparing for and taking the exams listed above?

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Protection of Healthcare Information, comment

August 26, 2008

This was a very interesting article. All though this is a convenience for the physicians we must always respect the rights of our patients. At our hospital we did have an RN that was terminated for looking up lab results on her ex-husband. This was not tolerated at our hospital. I support the decision that was made to terminate this individual. I would not want my information to be looked at by someone who had no reason to look at it. This is where we all need to be accountable for our actions. When you cross the line you should expect consequences. Everyone in healthcare has an obligation to respect patient’s rights. I will never cross the line to put a patient at risk by sharing information that is not mine to share. Thanks.

Original Post:
March 5, 2008
Patient information can now be found on paper as well as in the computer. The computer has made it easier for doctors and medical personnel to access patient information. A doctor can pull up labs, x-rays, etc right from his office or home. Our physicians have PDA’s and can look up information at lunch. While this makes the information more accessible, it also makes it a target for liability issues. Nurses have been terminated for looking up labs on a co-worker. With the right code you can pull up about anything. Hospitals and medical offices have had to implement rules concerning discussing patients in emails, etc. Most hospitals now have policies regarding looking up information on the computer to where you can not even look up your own information. Computer information has made patient care quicker and easier, but we have to make sure it is not costing our patients their right to privacy.

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Six rights of drug administration, comment

August 21, 2008

The 6 rights of drug administration did not prevent the cause of death. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or “what happened” and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, “know your patient and the medications being administered”.

Original Post:
Feb. 26, 2008
Adhering to the 6 right of medication administration is really the only sure way of preventing medication errors the best way we can. As a nurse who works on very busy and fast-paced area, it is very easy to overlook the 6 rights, especially when you are pulling meds from a medication-dispensing machine. An incident similar to this one occurred on my unit not too long ago. Fortunately, it did not result in patient harm or death. Misoprostil is used on my unit for cervical ripening. The M.D. ordered for the nurse to place 25mcg of misoprostil. The tablets normally come in 100mcg or 200mcg form. As far as everyone knew, we never had 200mcg tablets. The nurse pulled a 200mcg tablet, and without looking at the label, cut the tablet into 4’s. The patient ended up getting twice the correct dose. The pharmacy had stocked the wrong amount even though the nurse thought she was getting 100mcg. So, it is very important to read labels on medication prior to giving them to the patient, even if you think you are getting the right thing.

Original Post:
September 24, 2007
In 2006, a Wisconsin nurse administered the incorrect medication to a 16-year old girl who was in labor. The medication killed the girl almost instantly. The nurse had been working in the field for 15 years and was described as very competent. Following this incident, it was determined that the medication was labeled incorrectly. The nurse was subsequently charged with involuntary manslaughter.

In reading about the 6 Rights of Drug Administration, I couldn’t help but think of this case and so many other cases with similar circumstances. Any system is going to have flaws as humans are the ones designing the system and entering the data into the system. The 6 Rights can be adhered to, which will greatly reduce these types of occurrences, but they won’t be eliminated.

The charges against the nurse were dropped, but it’s something that she will have to live with for the rest of her life…that’s more punishment than any court could have imposed on her.

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Documentation of our assessment

August 20, 2008

In this era, it seems as if everyone is sue happy. Documentation of our assessment is vital for assuring a court of law that we did something. In 2008, CMS has passed a law that they will not pay a hospital when a patient develops a bed sore or a urinary infection while hospitalized for something else. My institution has learned the value of documentation. If we fail to chart that a bedsore already existed on admission, we will not be paid. This is really an eye opener for the admission nurse. Sometimes a nurse in a hurry would not turn the patient over and examine their back side. We do a thorough exam now. It must be documented and noted or it essentially was never done in a court of law.

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Massage Pathology, comment

August 20, 2008

Yes, a higher level of Massage Pathology is available. It is at the graduate level. If there is an interest, a post-graduate level of Massage Pathology will be instituted.

Original Post:
August 12, 2008
Once we finish your massage pathology course, is there a higher level course next? I too want to further my education of massage pathology within forensic nursing.

Original Post:
July 23, 2008
Massage therapy is my occupational field. Forensic nursing is my educational study. I see a strong link between massage pathology and forensic nursing. I will be taking the massage pathology course that you offer online. This will help me to be more confident in identifying and handling suspicious pathology. Thank you for offering your massage pathology class.

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Patient Health Care & Forensic Nursing Assessment

August 14, 2008

There are two forces that have had a separate but parallel interest that has now merged and these two forces are increased rate of interpersonal violence in the United States and televisions exposure of criminal forensics. Patient health care extends beyond the traditional type of emergent treatment as a result of these forces. Trauma personnel routinely contact physical evidence. Some common types of evidence are: clothing, casings, projectiles, blood stains, hairs, fibers and fragments such as glass, metal, paint and wood. The handling of these items has gained the attention of medical administrators and law enforcement officials.

As clients come into the trauma unit the staff does not know if injuries are self-inflicted, accidental or criminal incident. The primary responsibility is to render medical attention to the individual, whether or not they are considered to be a victim or a suspect by law enforcement officials. While the patient is in the trauma unit his body needs to be considered a part of the crime scene. The staff now has the additional burden of responsibility to aid in evidence collection process while concurrently administering medical care. The problem of collecting evidence is often hampered by a lack of training and facility guidelines for these tasks. Traditional role of trauma unit staff has not been evidence collection and not all unit staff embraces additional work tasks. The increased role of forensic expertise in health care is greatly dependent upon continued education and training. The end application of forensic knowledge, technology and procedures is impacting the number of cases won or lost based on the handling of evidence in the hospital.

In the ideal world the forensic nurse will be part of the triage team and do a visual observation of the patient upon arrival. While the appropriate medical attention is given to the patient the forensic nurse could gather gunshot residue samples from wounds or hands. She would be the one to cut clothing off that would not cut through areas important to the investigation. The clothing would be handled so as not to contaminate it. This is done by placing the clothing in a paper bag that is labeled. Labeling would typical include patient name, medical number, hospital, staff bagging, date, time. The information would need to be duplicated in the patient chart. Then it needs to be sealed in a manner that show if tampering had occurred. The next hurdle for the trauma staff is then putting the bagged and sealed evidence in an area that is secure. This area would need stringent policies on access and turning evidence over to law enforcement. If these polices are not in place the integrity of the evidence could be questioned with the end result of criminal not be prosecuted successful for a crime.

The responsibilities for assessment of patient-trauma-related injuries deserve the attention of staff trained in forensic science. Forensic science needs to be part of continued education to medical personnel, the application of forensic knowledge, technology and procedures is impacting the number of cases won or lost based on the proper handling of evidence in the trauma unit. The forensic nurse is in an ideal position to formulate hospital policies and provide education to hospital staff. The nurse serves as liaison between the hospital, law enforcement and the judicial system. The end goal is competent handling of forensic evidence that may be the deciding factor in whether a violent offender is found guilty or released. It is the responsibility as patient advocates that the ensuring patients’ rights are upheld.

References:

Lynch, VA, “Clinical forensic nursing: A new perspective in the management of crime victims from trauma to trail,” Critical Care Nursing Clinics of North America 7(September 1995) 489-506.

Evans, Mary M, “Maintaining the chain of custody: evidence handling in forensic-cases.” AORN Journal (October 2003)

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Sudden Infant Death Syndrome versus Child Abuse

August 13, 2008

The topic of this discussion is the assessment findings that would distinguish between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse. It is in the realm of forensic nursing to share the responsibility of rendering a medicolegal opinion as to the cause of death.
The interview assessment will need to include the epidemiology trends identified with SIDS. Some of these are: early gestation, low birth weight, mother who used tobacco or recreational drugs during pregnancy. Post birth incidences of thrush, pneumonia, cyanotic spells and vomiting. It will also be important to note last visit to pediatrician and any immunizations received. Current thinking is having one child with SIDS does not predispose future children to SIDS, however, it would be important to know if considering abuse.
The mother needs to be questioned regarding psychiatric disturbances, postpartum depression or history of maltreatment themselves. There is an epidemiology trend indicating that a mother with one of these histories has a tendency to infanticide.
New standards of markers to check in the autopsy have increased as SIDS is studied in greater detail. Some but not all are:
• Develop a timeline for baby illness as it is trended many of these babies who subsequently died had previous hospitalizations for failure to thrive.
• Check for patterns of viral infections as respiratory syncytial virus, cytomegalovirus, Hepatitis.
• Forensic nurse could also have a role in the investigation of the child’s home for environmental risk factors. The crib will need to be assessed for cleanliness, repair, type of pillows, blankets, type of sheets, check stuffed toys for tight seams to hold stuffing, strings of any type the baby could get in the airway or around the neck. The environmental assessed for cleanliness and observe family members interaction with each other.
• Pathology review needs to include assessing the brainstems for glial nodules as there is speculation these may affect cardiorespiratory control.
o Intrathoracic petechia is a controversial marker for SIDS that should be observed for.
o Samples need to be taken of body fluids such as: vitreous humor, CSF, blood, urine and stool. Tissue needs to be taken from the brain, liver, kidney heart, adrenals, pancreas skin, and muscle
o Chemistry panels would be required due to thoughts on metabolic diseases accounting for SIDS in infants with fatty livers.
o Radiology studies would need to complete to rule out past or recent physical abuse with residual injuries to skeletal system.
o
A nurse trained in forensics could serve as a pivotal member of a trauma response team for a infant brought by EMS. The staff all need maintain a supportive approach to parents during the death review process. The forensics training would allow timely gathering of evidence such as bed linens, clothes, and initial reactions from care giver, photograph any contusions or physical signs of maltreatment before the body is taken to the morgue. Photographs could help determine postmortem lividity from bruising or other skin lesions. Reports emphasize the need for evaluation that includes thorough physical examinations, autopsies, and death scene investigation. The information compiled by means of the detailed investigation suggested could provide a greater determination of cause and manner of death. Overall minimize mistakes in determining the cause and manner of death in these tragic cases.

References:

Peterson DR Clinical implications of sudden infant death syndrome epidemiology Pediatrician1988;15:198-203

Reece DR Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision Pediatrics Vol 91 February 1993

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Massage Pathology, comment

August 12, 2008

Once we finish your massage pathology course, is there a higher level course next? I too want to further my education of massage pathology within forensic nursing.

Original Post:
July 23, 2008
Massage therapy is my occupational field. Forensic nursing is my educational study. I see a strong link between massage pathology and forensic nursing. I will be taking the massage pathology course that you offer online. This will help me to be more confident in identifying and handling suspicious pathology. Thank you for offering your massage pathology class.

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