Archive for March, 2010

200,000 Americans killed each year in hospitals by medical errors, comment

March 31, 2010

I definitely think this is a drastic number and being on the front lines, I can see how this happens. Especially in today’s ever changing healthcare field. First, you have EMR which has completely changed our world. There have been so many changes recently that it is very hard to keep up with it all. Not only they way we chart things, but how we administer medications. Caremobile, the pt scanning device, is supposed to help catch errors. But with the Electronic charting, the charts and orders are not getting checked like they were because it is too difficult to do and navigate around. Not to mention that there are alot of issues with connectivity, timeliness of entering meds by pharmacy, etc. That by the time the med could be given, alot of unnecessary time has passed, so you may just do a work around to get the task accomplished which defeats the purpose of using Caremobile to begin with! Throw long hours, after hours "catch-up", high acuity, understaffing, and a whole slew of other issues that are dealt with daily, it is easy to see how these unfortunate things could take place. I definitely think that issues that are causing unnecessary deaths should take precedence over anything else. And fix what is the current problem before you add something else into the mix.

Original Post
March 29, 2010
Title: 200,000 Americans killed each year in hospitals by medical errors, comment
There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

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Substance Abuse, comment

March 31, 2010

I do think that substance abuse is out of hand now days. It seems to be so prevalent in today’s society. It seems okay to be able to take pills to "make things better" when there could be other ways for the person to cope. Because of the easy access to prescriptions,we have in a way created this problem in our society. There seem to be alot of people with addictive personalities and unfortunately those are the ones who wind up abusing something that was originally meant to help them. I think that there needs to be stricter laws governing the use of such freely written prescriptions. And there should be other options for those people rather than popping a pill.

Original Post
March 26, 2010
Title: Substance Abuse, comment
Substance abuse is out of control. We are quick to medicate for every unpleasant situation in our lives. Screening is very important but not realistic because of the very fine line of functional and abusive behavior. Who makes that decision? If I “popped“ 10 pills every morning just to make it through the day I would be comatose whereas others who don’t take their medication would not even be able to leave their houses.

Original Post
December 30, 2009
Title: Substance Abuse
Although there are mild cases, substance abuse can be a major problem that leads to other issues such as child abuse, elder abuse, or sexual assault. These issues are reasons that make substance abuse a serious problem. Substance abusers should put this under control as soon as possible. Alcohol treatment programs are designed to help those that want and need help be successful at this. As a nurse, assessment skills are imperative in diagnosing a substance abuse problem. Skills in the assessment of mental health cannot be forgotten, since they focus on emotional and psychological well being. A good mental health assessment could reveal the underlying problem(s) of substance abuse.

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200,000 Americans Killed Each Year in Hospitals by Medical Errors, comment

March 29, 2010

There is no simple answer to why medication errors occur. People die every year from preventable medical errors; wrong limbs are amputated, wrong organs removed, people receive the wrong medications, orders are incorrectly transcribed, medication reconciliation is often flawed, the list could go on forever. Errors are a result of human nature. While every effort is made to minimize and prevent errors, they still occur. Nursing education, annual and ongoing review of the Joint Commission National Patient Safety Goals, time outs prior to surgical procedures, are all great ways to work to prevent errors from occurring. Responses to errors should not be punitive; they are situations from which we learn. Errors result because processes fail.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

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Birth Injuries

March 29, 2010

A birth injury refers to any trauma an infant endures during the birthing process. Most birth injuries occur as a result of the infant’s size or position during labor and delivery. For example, the birth canal may be too small, the fetus may be too large, or the fetus may be lying in an abnormal position in the uterus prior to birth. Common injuries as to the infant may include: swelling and bruising of the scalp, cephalohematoma, bone injury (fracture of the clavicle is most common, humerus fracture, femur fracture), intracranial hemorrhage, nerve injury (injury to brachial plexus is most common), perinatal asphyxia, and injury to skin and soft tissues. Markings on the skin, such as bruising, pink marks, may occur as well as a result of forceps use. Long-term conditions, such as brain injury and cerebral palsy, may also arise as a result of birthing injuries. The December 2nd 1999 issue of the New England Journal of Medicine contained a study done by Towner on birth injury due to the various methods of delivery. The study was conducted on 600,000 average weight infants born from 1992-1994 in the state of California. In the study, 66.5% were delivered by spontaneous vaginal delivery, 20.1% by cesarean delivery, 10.2% by vacuum extraction, 2.7% by forceps and 0.5% delivered by both vacuum and forceps. Results from the study with regards to death at birth due to these procedures were as follows: vaginal delivery death rate was 1 per 5000, vacuum extraction delivery death rate was 1 per 3333 and the forceps delivery death rate was 1 per 2000. Intercranial hemorrhages caused by these same procedures were also studied. Statistics were found as follows: 1 per 1900 for vaginal births, 1 per 860 for vacuum delivery, and 1 per 664 forceps delivery. The rate of birth injuries overall is much lower than it has been in previous decades. Improved prenatal assessments that include ultrasonograpy have allowed physicians to determine the best method of delivery for the infant that will produce the least amount of harm. In many cases, cesarean deliveries are done to lessen the chances of trauma to the infant during the birthing process.

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H1N1 Pandemic, comment

March 26, 2010

I work in an ER and we had to rent a trailer to handle all of the patients with flu like symptoms. These people where truly frightened. This fear was unnecessary. We see more deaths from the yearly flu then we did from H1N1. I feel the fear was media driven with little education provided.

Original Post
November 24, 2009
Title: Are we Ready for a Pandemic
I am a student at a major University and it seems everywhere you turn the phrase H1N1 can be heard. We have had two deaths from H1N1 at our university alone since the start of the fall semester. Talk of a vaccine gave hope to many students that they would be protected from the virus. However, once the vaccine arrived many students chose not to get the immunization. As stressed in our book, infectious disease is a leading cause of mortality around the world. Two of the top ten leading causes of death are infectious diseases. With this fact in mind, it is important that the United States population be educated on how vital it is to keep infectious disease under control. If the H1N1 virus is not contained, it could easily become a pandemic. The concept of a pandemic is not new to our society however. Pandemics can be traced back to the early beginnings of life. However, through technological advances such as immunizations, human immunity has been augmented giving the individuals the ability to fight off disease. The emergence of the H1N1 vaccine is yet another example of how technology has assisted our culture in evading a pandemic once again.

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Substance Abuse, comment

March 26, 2010

Substance abuse is out of control. We are quick to medicate for every unpleasant situation in our lives. Screening is very important but not realistic because of the very fine line of functional and abusive behavior. Who makes that decision? If I “popped“ 10 pills every morning just to make it through the day I would be comatose whereas others who don’t take their medication would not even be able to leave their houses.

Original Post
December 30, 2009
Title: Substance Abuse
Although there are mild cases, substance abuse can be a major problem that leads to other issues such as child abuse, elder abuse, or sexual assault. These issues are reasons that make substance abuse a serious problem. Substance abusers should put this under control as soon as possible. Alcohol treatment programs are designed to help those that want and need help be successful at this. As a nurse, assessment skills are imperative in diagnosing a substance abuse problem. Skills in the assessment of mental health cannot be forgotten, since they focus on emotional and psychological well being. A good mental health assessment could reveal the underlying problem(s) of substance abuse.

Online Forensic Nursing Course

Online Forensic Nursing Certificate Program

Substance Abuse Lawyer Attorney

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Effective Measures Towards Pain Management, comment

March 24, 2010

According to JCAHO guidelines, accountability for pain management is shifted from the individual practitioner to the organization. Nurses are called to examine their own views and cultural beliefs regarding pain management and to rethink them if they are in conflict with their employer’s standard. Often patients complain of having to call frequently for medicine, having to wait unrealistic time frames for medicine and of receiving too little pain medicine or none at all. If pain assessment is truly "the fifth vital sign," then we must assess pain just as we would assess other vital signs – every few hours and prn. If the patient’s blood pressure were elevated, we would act on it. The same holds true for the pain assessment – we must act on it. When the patient becomes anxious and fearful that the pain will return, it complicates pain relief because of that anxiety and fear; therefore, at least initially, it is often necessary to give pain medication on a fixed schedule. Usually by the time the patient calls, they are already hurting and pain is more difficult to control. Two areas of self-assessment are important for the nurse to examine. The first is pain management in the drug addicted individual. Often nurses refer to individuals requiring frequent pain relief as "drug seeking." The patient who has a history of drug use will often require greater amounts of pain medicine. Drug abusers still have the intrinsic right to adequate pain management and the nurse must advocate for the patient, suppressing any personal feelings about drug abuse and knowing that drug abusers feel pain the same as (or sometimes more intensely than) any patient. While we must use discretion in our pain assessments, giving narcotics only when indicated, we are also morally obligated to do no harm, which includes withholding needed medicines. We must believe the subjective report of our patient and not withhold medications because we fear enabling the abuser. The other area needing self-awareness is in the care of the dying patient. Caregivers sometimes withhold opiods near the end of life because they do not want to give "the fatal dose." In the patient whose death is imminent it is inhumane to allow them to end their life in suffering when the nurse has the tools to provide the relaxation and peace experienced through the relief of pain. Death is something we all will face one day, and most of us fear dying. Hospice nurses assess the patient’s expectations of the dying experience upon admission, and most patients desire to be pain free when death occurs. When death is near, many patients cannot communicate the need for pain relief, so the nurse must be especially vigilant in attending to the patient’s needs.

Original Post
November 9, 2009
Title: Effective Measures Towards Pain Management, comment
Being culturally sensitive is paramount in the assessment and treatment of pain. It begins before any contact with the patient. It begins with self awareness of how the nurse views pain and the understanding that the nurse’s beliefs are formed by his/her own culture. By self actualization, a nurse is better prepared to interact more therapeutically in the patient’s behalf. The Joint Commission requires that a patient be assessed and reassessed ongoing to pain relief, taking into account the patient’s cultural, spiritual and ethnic beliefs. According to McCaffery (1999), pain is whatever the experiencing person says it is, existing whenever the experiencing person says it does. It is a combined phenomenon with sensory, emotional, cognitive and physical parameters. Pain assessment and pain relief however, may be different for every patient. Nurses should educate their patients and families to report the pain, and to expect relief. It is far more likely that a patient’s pain will be under treated due to withholding or inappropriate prescribing of opioids. The nurse should very familiar with the pain tools and use them consistently, taking into account cultural differences. The signs and systems of pain should be assessed carefully. The nurse should not second guess the patient or family and should not dismiss what is being said. They should also listen carefully to their patients and look for contributing factors. The nurse will want to ask the patient regarding their belief about pain and satisfaction with the current pain level. This information will direct the actions that the nurse will take, both pharmacologically and in providing comfort measures.

Original Post
September 8, 2009
Title: Effective measures toward pain management, comment
This post reminds us that the measurement of pain is primarily subjective. As providers, we must always remember that people respond to and express pain very differently. We must be culturally sensitive when assessing and treating pain. Pain is the 5th vital sign. Pain affects the physical and psychological well-being of our patients. It is our responsibility to ensure that our patients’ pain is being well managed. We must know our own biases and misconceptions and leave them at the door.

Original Post
September 2, 2009
Title: Effective measures toward Pain Management
Pain is an alteration in ones comfort level, which can significantly impact the physical, emotional, and psychological well-being. Pain is a subjective experience that can only be explained by the patient. Cultural and ethnicity are a few factors that influences patients response to pain, to improve outcomes nurses must be able to understand pain from a cultural perceptive. People respond to and view pain differently. Among various groups for various reasons emotions may or may not accompany pain it is viewed by some as an act of punishment or as a spiritual test. Having knowledge of patient’s views and how they define pain is very valuable in that it can assist the nurse in achieving positive outcomes by incorporating this information in the plan of care. Nurses who ignore or refuse to develop cultural sensitivity not only do they violate patients’ rights but also a chance of having a trustful relationship and without this you can expect poor outcomes. Pain is often poorly assessed and poorly managed due to reasons like misconceptions and nurses lack knowledge. This usually leads to under medications and poor outcomes, such as the post-op abdominal surgery patient that develop pneumonia because is unable to perform cough and deep breath exercises every 2hrs secondary to pain because of the nurses’ misconceptions about administering pain medication to a patient with history substance abuse. To achieve goals of effective pain management nurses must first be aware of their values and personal beliefs concerning pain and the behaviors associated with it, this will assist in developing an awareness and sensitivity to the patient’s need. Nurses must be knowledgeable and skilled in collection of both subjective and objective data (by accepting the patients’ assessment of pain by using pain assessment tools and observation of emotional behaviors such as crying or moaning), which will assist in identifying the intensity of patients’ pain and promote better outcomes. Misconceptions must be explored and addressed because these also impact outcomes, such as administering pain med on regular basis will lead to addiction or those who abuse drugs usually over exaggerate their pain, by acknowledging these misconceptions nurses will be able address patients’ pain related issues more professionally and improve steps toward effective pain management.

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Nursing satisfaction and work-related stress

March 18, 2010

Satisfaction and happiness by definition are closely related. In adults, satisfaction is usually a derivative from two major spheres, work and family. However, both are frequently sources of stress too (Tennant, 2001). In today’s ever-changing work environment, work-related stress and distress is becoming more and more common every day and quickly taking a toll on our workforces and their lives. Sadly, work satisfaction and happiness is swiftly becoming a thing of the past. The implications of these stressors are of significant importance to both employees and employers alike. Negative bodily and emotional effects of work related stress in nurses are plentiful. Previous research shows positive relationships between chronic work stress and negative health outcomes (McNeely, 2005;R & T., 1990;Sauter, Murphy, & eds., 1995). According to Olson (2008) in Forbes, America is in the top 10 for hardest working countries in the world. Americans on a whole, work about 1,797 hours per year (Olson, 2008). That is about 5 hours every day for the rest of one’s life. One may equate this with increased productivity, however not directly because it depends on many more factors (Sharma, 2007). Yet studies have shown a positive relationship between overtime and extended hours with increased incidence of hypertension, cardiovascular disease, fatigue, stress and many other ailments (Dembe et al.,2005; Schaufeli et al., 2008; McNeely, 2005;Karasek & Theorel, 1990;Sauter, Murphy, & eds., 1995). The healthcare setting is no different, but special circumstances, apply. Nursing, in hospitals, is the largest part of the labor force (Stone, et al., 2007). The literature is quite extensive on the stress and emotional burden of managing illness, suffering and death (J.F., 1987; Poncet, et al., 2007; McNeely, 2005; Marine, et al., 2009; Stone, et al., 2007). In fact, studies show that levels of work related distress, dissatisfaction and burnout are quite high in healthcare workers. Healthcare workers, particularly nurses, additionally experience elevated job-related stress resulting from high expectations, inadequate time, resources and/or support. These stress factors enhance health dangers and lead to dissatisfaction and burnout among nurses (Marine, Ruotsalainen, Serra, & Verbeek, 2009). Consequently, negative effects on mental and physical health, ultimately, leads to absenteeism, turnover, associated economic costs and finally, employer liability related to patient safety (Tennant, 2001; Marine et al, 2009;Stone, et al., 2007). Therefore, the health and mental well-being of nurses directly affects organizational and patient outcomes. Awareness of stress dynamics can lead to improved employee health, productivity, patient safety and overall organizational outcomes. Recognizing signs and symptoms of distressed and unsatisfied employees can help identify nurses with potential risks. A hospital’s largest labor force directly influence larger outcomes, thus, making it the organizations greatest asset or biggest liability. Identification and understanding of the dynamics behind work related stress in nursing is critical and should be a focus for hospitals, clinicians and other institutional leaders.

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Medication Errors

March 18, 2010

Improving outcomes related to medications errors requires not only the nurse but the entire organization. Attitudes need to change about the acceptability of rushing. Healthcare is big business and rushing patients in and out of the hospital has become a culture imposed on nurses and doctors by the need for increased productivity. Doctors and nurses alike have been forced into boxes about how quickly they should operate. Now because there have been negative outcomes reported regulatory organizations are stepping in, resulting in more demands on clinicians. At some point everyone, including the institution, has to realize that there is no substitute to slowing down. The culture has to permit it and stop making so many demands at one time. Slower has to be good and an acceptable norm again. I know from my own experience that saying "wait I’m not keeping up" or "I need a break" is frown upon, which enables the "now and hurry up" culture in hospitals to continue to proliferate. No one is allowed to take their time anymore even if it would be better for everyone.

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“200,000 Americans Killed Each Year in Hospitals by Medical Error” (comment)

March 15, 2010

Medication errors do occur due to poor staff, poor handwriting, and even lack of sleep, but the way nursing students are taught in nursing school is the real problem. Nursing schools are turning out "prima donnas" and not reliable hard working individuals. We "spoon feed" the new nurses instead of making them accountable.

Original Post
March 4, 2010
Title: “200,000 Americans Killed Each Year in Hospitals by Medical Error”
Listed in the above are common causes of medication errors: lack of sleep in caregivers, poor communication, illegible handwriting, poor staffing. These problems are encountered in all areas of patient care. There are never enough nurses, nurses have too many patients, work too many hours, and in reality are often rushed . Home medications are often not reported accurately and many physicians (who are also often rushed) write poorly. Several of the 2010 National Patient Safety Goals focus on medication administration as a result of reported medication errors. How do we change this? Change begins with education. Nurses must continue to learn about new medications and review old ones, never hesitating to consult resources if unsure about any aspect of a medication. As the last line of defense between the patient and a medication error, nurses must be dedicated to practicing the 5 Rights and the nursing process as it relates to medication administration, providing thorough assessments and evaluations even when rushed. Patients must be educated as well, and taught to ask and know about their medications, to report untoward effects and to learn about lifestyle changes which could reduce or eliminate the need for some medications. As nurses, we must continue to promote better nurse to patient ratio in all areas of care. We must exhibit professional and safe medication administration in our own practice and in mentoring new nurses just beginning their profession. The amount of reported medication errors is a sobering fact which should incite a call to all nurses and facilities to performance improvement in this area.

Forensic Healthcare Medication Error Attorney Lawyer

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