Archive for July, 2010

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

July 26, 2010

Errors in medication administration can be fatal to patients. It is extremely important for nursing staff to have the training and experience to administer medication but they also need to pay attention to detail. Not just using the 5 rights when administering medication but using them accurately and correctly. A nurse can go through the motions of the 5 rights but if they are not vigilant in their medication administration they are likely to make an error. Of course an error in medication administration is not the only error that can be made within the hospital that can be harmful to patients.
Another error that is possible to be harmful to patients is negligence. If a nursing assessment is not performed as it should be then a change in patient’s condition could be easily overlooked. Or the onset of something like a bed sore could go unnoticed and undocumented casing harm to the patient because it wasn’t caught early enough. Or the signs of a DVT could be overlooked and the DVT could be come fatal all because the assessment was lacking in care and awareness.
Hospitals are not the only place where an error could bring harm to patients. For example pharmacies are a place that can make easy careless mistakes that lead to harm patients. Working as an RN in family physicians office I have had patients call and say their pharmacy gave them the wrong medication or the wrong dosage. As an RN in a doctors office I must be vigilant in my duties as much as if I worked in a hospital, if I don’t pay attention to detail an error I made could have the potential to be life threatening to a patient I am caring for.
It may lie within the duty of the forensic nurse to participate in the legal side of medication error after it has happened. A forensic nurse may need to testify on what happened leading up to the error or even to what may have cause it. A forensic nurse or any other line of nursing it is imperative to be very oriented to every detail in caring for patients.

Original Post
July 7, 2010
Title: 200,000 Americans Killed Each Year in Hospitals by Medical Error, comment
The advent of medication distribution machines may give health care providers a false sense of security when administering medications to patients. As health care providers, we need to recognize that human error is still a potential part of this new medication administration process. The orders are entered by a human, then checked by a human. As nurses we need to review the 5 rights each and every time we administer a medication to a patient. If we become relaxed because the information is coming from a computer, or the medication pops out of a machine, then we are opening ourselves up to “high-risk” nursing practice. Each and every medication you administer to a patient needs to be considered independently. Medication errors should be reviewed monthly by nursing staff in a “morbidity and mortality conference” type of review meeting in order to educate ourselves and learn from others mistakes rather than shame ourselves with a discreet incident report. This may further bring to light the fact that we are human and we make errors, but accountability is key for us to reduce the numbers and make it a safer environment for providers as well as patients. Using machines and computers as tools, not as a replacement of our own cognitive skills, is the balance we need to embrace to reduce medication errors.

Original Post

March 31, 2010

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

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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Screening for abuse, comment

July 20, 2010

Screening for abuse is a very important element of the nursing assessment.  While screening for abuse should be included in every nursing assessment abuse is seen more frequently within certain patient populations; such as the very young and the very old.  Those patients who are very young or very young are more vulnerable to abuse by their caretakers.  This screening can sometimes be difficult to perform.  There needs to be attention to detail during the interview for any inconsistencies with information given and findings during the assessment.

The nurse assessment of the skin and musculoskeletal systems hold great importance when screening for abuse.  It is during these advanced assessments there may be evidence of abuse may be found.  Any suspicious bruising, welts, or marks that are found should be taken into consideration when screening for abuse.

When a nurse is functioning in the field of forensics their assessments and screenings for abuse may be called into use during a proceeding in court; the nurse may have to testify to their assessment findings.  Forensic nurses will also have to rely on their experience in advanced assessment to accurately screen possible victims for abuse.

Forensic nurse or any other area of nursing this screening for abuse is a vital part of the nursing assessment.  A nurse is responsible for advocating for the patient to their best ability.  Especially in circumstances when the caretaker of the patient is overpowering and does not cooperate with the patient being assessed without them present.

Original Post

September 28, 2009

Title: Screening for abuse, comment

I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, “Do you feel safe at home?” 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

Legal Services regarding abuse

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Effective Measures Toward Pain Management, comment

July 15, 2010

Nurses as caregivers in primary, secondary and tertiary roles play an important part in caring for patients experiencing pain. While assessing pain as nurses, we need to collect a substantial amount of subjective data in order to properly address a patients level of discomfort.  Because pain is influenced by a variety of factors such as culture, chronic verses acute pain, sleep deprivation, individual thresholds and other sensory stimuli, one of the best measures of pain is to pain is what the!?? patient tells you it is.  Visual cues as well as vital signs should be gathered in the assessment to support the patients complaint of pain.  Patients will often compare their pain to other pain they have experienced before, for example.  Documenting the description of pain and initiating a scale by which to continue to assess the relief of pain through medication and other means of providing comfort is the most effective way to ensure relief.  Patients may respond to certain interventions better than others.  If a medication is ineffective in relieving pain, the physician should be notified and the patient should be assessed for another type of analgesic.  The nurses role as an advocate to the patient should always be at the forefront when addressing a patients need for relief from varying degrees of discomfort.  By knowing your patients individual pain thoroughly from assessment nurses are in a position to help decrease and or alleviate suffering early on in intervention.

Original Post

July 12, 2010

Title: Effective Measures Toward Pain Management, comment

Nursing assessment plays a significant role in the management of pain in caring for a patient.  Pain being a very subjective area to measure you can not only take the subjective level of pain you must also take into account the objective level of pain observed.  The level of pain is a grey area; it is not as simple as being in pain or not being in pain.  There are different levels to the pain and this varies from patient to patient.  Each patient has their own level of pain tolerance.  For example; in the practice I work in now we use a NIBP to measure the patients’ blood pressure in which most patients are not affected by this instrument.  However there are some patients that cannot tolerate the NIBP, it is too painful for them to use to measure their blood pressure; these patients have a lower threshold for pain.  They experience pain in a different way, however their pain is real.  As a nurse you need to be alert and conscious of each patient’s pain threshold.

An accurate pain assessment holds such an imperative function of a nurses advanced health assessment when caring for their patients.  When a nurse is functioning in the role of some area of forensic nursing their experience and knowledge of pain assessment may be called upon to use in their responsibility as a forensic nurse.  For example; if a forensic nurse is being called upon in the court of law to provide testimony in a legal matter they may have to incorporate this experience and knowledge of assessing pain to give an honest and accurate testimony.  Another example of pain assessment being incorporated into forensic nursing would be when a forensic nurse is assessing a possible victim of abuse; the victim may downplay their pain.  As a victim they may try to hide their pain and the forensic nurse will be required to be able to observe accurately any objective signs of pain to give the victim the care they need.

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.

Online Forensic Nursing introduction course
Online Forensic Nursing certificate program
Online Nursing Assessment undergraduate education
Online Nursing Assessment graduate class

Alcohol addiction is a disease, comment

July 15, 2010

When assessing a patient with potential or actual alcohol abuse it is important to assess their mental health status as well and realize how closely alcohol abuse and mental illness go hand in hand. In obtaining information clients should feel a good level of comfort with the nurse in order to disclose information willingly about alcohol intake. Many patients with mental illnesses such as depression and bipolar disorder that are undiagnosed will self medicate with alcohol. Obtaining a good family mental health history as well as collecting an inventory about emotions and feelings may help the nurse identify patients at risk for alcoholism. A nurse should also be aware at risk factors for depression and anxiety and collect good subjective and objective data during the patient interview. A persons ability to care for themselves and personal hygiene are good examples of objective data collection. Another piece of valuable information is a patients support system and living arrangements. A nurse should document a patients orientation, memory, communication skills and reasoning. The Audit and Cage tests can be used in a more structured assessment for alcohol abuse as additional supportive data. Alcoholism is a complicated disease that has many factors to address when helping a patient to find the resources to overcome it. Treating a patient holistically when considering alcoholism will allow the nurse to identify predisposing or precipitating factors of this disease.

Original Post
July 9, 2010
Title: Alcohol addiction is a disease, comment
Alcohol impacts the lives of many individuals. Alcohol is a dangerous drug that is widely used and abused. There is evidence everywhere in our society, advertisements, socials events, sporting events, alcohol is everywhere. While there are many who can drink responsibly and not get to the point of alcohol being a problem in their life, there is a large percent of our population that has alcoholism. This is a very difficult disease, since there is no cure, no medicine it is something a patient has to overcome this disease using willpower and other methods requiring mental strength.

The nurse’s assessment plays a role in identifying if alcohol or any other substance may be controlling and having a negative effect on a patient’s life. During the assessment the nurse can identify alcohol dependence, abuse, or addictions. The patient may not even realize they have an alcohol problem the nurse can not only assist the patient in identifying a problem they can provide education to assist the patient in finding and evaluating treatment options. The nurse can also educate the patient during the assessment on how alcohol affects the body and mind short term and long term.

Advanced nursing assessment and forensic nursing may overlap on matters that may be related in some emergency situations caused from alcohol abuse. A forensic nurse may be involved in the care of a patient in the ER from an alcohol related incident. In this circumstance a forensic nurse would be required to utilize her advanced assessment skills to care for the patient as well as fulfill her role as a forensic nurse.

Original Post

September 28, 2009

Title: Alcohol addiction is a disease

Alcohol is the most commonly used and abused psychoactive drug in the United States. Of those seeking treatment 50% will relapse in the first few months of therapy. Everyone around these patients is effected by this disease. Nursing is on the forefront of the battle these individuals undertake. Alcohol use is broken down into two categories abuse and dependence. Alcohol abuse is characterized as a pattern of use leading to one or more manifestations in a period of a year such as a failure to fulfill major roles or obligations at work, school or home. Recurrent alcohol related legal problems or being in physically hazardous situations and continued use despite problems with relationships caused by or exacerbated by alcohol. Alcohol dependence is a pattern of three or more manifestations in a year such as having a tolerance to alcohol, showing signs of withdrawal, consuming larger amounts or over longer periods than had intended. Continued use of alcohol despite desire or failed attempts to cut down consumption. Drinking and recovering from use takes up more and more time. Continued use despite knowing it is doing damage physically or psychologically, as well as those listed above for abuse. Alcohol not only effects those who are abusing or dependent on the drug, but everyone around them. As a child I remember the late night phone call my mother received that her father, only 49 years old, had passed away after having too much to drink, vomited and aspirated his stomach contents. He was an abuser, a weekend social drinker whose life alcohol had very little impact on until that night, then it had the ultimate impact. A patient I took care of many years ago had a similar experience, he was a young man in his early 30’s, he too aspirated after vomiting, he survived this initially only to be left with damage to his brain from a lack of oxygen. He would live the rest of his life in a coma like state, with a grieving wife and child. Alcohol is a treatable disease, when a patient comes to a hospital or clinic, they have chosen to undertake the battle of their lives. They are not able to do this alone, the attitudes of family and nurses as well as others they may come into contact with are crucial. A compassionate nurse can change the life of a patient, as well as an unsympathetic nurse whose attitude may be “they did this to themselves.” Alcohol dependence or abuse should be seen for what it is a real disease that needs real treatment. These patients need all the support they can get from those around them, and education on the subject is paramount to recognizing the signs and symptoms that manifest. Education for healthcare workers so they understand these patients, as well as how to successfully treat them with medications, together with the patient’s desire to enter therapy will hopefully change that 50% to 25% or better 0% relapse in first few months.

Legal Services for Alcohol Abuse Addiction

Patient Education & Counseling online course

Public Health Nursing online certificate program

Forensic Nursing Online Certificate Program

Forensic Nursing Online Introduction Course

Online Advanced Nursing Health Assessment Course

Effective Measures Toward Pain Management, comment

July 12, 2010

Nursing assessment plays a significant role in the management of pain in caring for a patient.  Pain being a very subjective area to measure you can not only take the subjective level of pain you must also take into account the objective level of pain observed.  The level of pain is a grey area; it is not as simple as being in pain or not being in pain.  There are different levels to the pain and this varies from patient to patient.  Each patient has their own level of pain tolerance.  For example; in the practice I work in now we use a NIBP to measure the patients’ blood pressure in which most patients are not affected by this instrument.  However there are some patients that cannot tolerate the NIBP, it is too painful for them to use to measure their blood pressure; these patients have a lower threshold for pain.  They experience pain in a different way, however their pain is real.  As a nurse you need to be alert and conscious of each patient’s pain threshold.

An accurate pain assessment holds such an imperative function of a nurses advanced health assessment when caring for their patients.  When a nurse is functioning in the role of some area of forensic nursing their experience and knowledge of pain assessment may be called upon to use in their responsibility as a forensic nurse.  For example; if a forensic nurse is being called upon in the court of law to provide testimony in a legal matter they may have to incorporate this experience and knowledge of assessing pain to give an honest and accurate testimony.  Another example of pain assessment being incorporated into forensic nursing would be when a forensic nurse is assessing a possible victim of abuse; the victim may downplay their pain.  As a victim they may try to hide their pain and the forensic nurse will be required to be able to observe accurately any objective signs of pain to give the victim the care they need.

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.

Online Forensic Nursing introduction course
Online Forensic Nursing certificate program
Online Nursing Assessment undergraduate education
Online Nursing Assessment graduate class

Alcohol addiction is a disease, comment

July 9, 2010

Alcohol impacts the lives of many individuals.  Alcohol is a dangerous drug that is widely used and abused.  There is evidence everywhere in our society, advertisements, socials events, sporting events, alcohol is everywhere.  While there are many who can drink responsibly and not get to the point of alcohol being a problem in their life, there is a large percent of our population that has alcoholism.  This is a very difficult disease, since there is no cure, no medicine it is something a patient has to overcome this disease using willpower and other methods requiring mental strength.

The nurse’s assessment plays a role in identifying if alcohol or any other substance may be controlling and having a negative effect on a patient’s life.  During the assessment the nurse can identify alcohol dependence, abuse, or addictions.  The patient may not even realize they have an alcohol problem the nurse can not only assist the patient in identifying a problem they can provide education to assist the patient in finding and evaluating treatment options.  The nurse can also educate the patient during the assessment on how alcohol affects the body and mind short term and long term.

Advanced nursing assessment and forensic nursing may overlap on matters that may be related in some emergency situations caused from alcohol abuse.  A forensic nurse may be involved in the care of a patient in the ER from an alcohol related incident.  In this circumstance a forensic nurse would be required to utilize her advanced assessment skills to care for the patient as well as fulfill her role as a forensic nurse.

Original Post

September 28, 2009

Title: Alcohol addiction is a disease

Alcohol is the most commonly used and abused psychoactive drug in the United States. Of those seeking treatment 50% will relapse in the first few months of therapy. Everyone around these patients is effected by this disease. Nursing is on the forefront of the battle these individuals undertake. Alcohol use is broken down into two categories abuse and dependence. Alcohol abuse is characterized as a pattern of use leading to one or more manifestations in a period of a year such as a failure to fulfill major roles or obligations at work, school or home. Recurrent alcohol related legal problems or being in physically hazardous situations and continued use despite problems with relationships caused by or exacerbated by alcohol. Alcohol dependence is a pattern of three or more manifestations in a year such as having a tolerance to alcohol, showing signs of withdrawal, consuming larger amounts or over longer periods than had intended. Continued use of alcohol despite desire or failed attempts to cut down consumption. Drinking and recovering from use takes up more and more time. Continued use despite knowing it is doing damage physically or psychologically, as well as those listed above for abuse. Alcohol not only effects those who are abusing or dependent on the drug, but everyone around them. As a child I remember the late night phone call my mother received that her father, only 49 years old, had passed away after having too much to drink, vomited and aspirated his stomach contents. He was an abuser, a weekend social drinker whose life alcohol had very little impact on until that night, then it had the ultimate impact. A patient I took care of many years ago had a similar experience, he was a young man in his early 30’s, he too aspirated after vomiting, he survived this initially only to be left with damage to his brain from a lack of oxygen. He would live the rest of his life in a coma like state, with a grieving wife and child. Alcohol is a treatable disease, when a patient comes to a hospital or clinic, they have chosen to undertake the battle of their lives. They are not able to do this alone, the attitudes of family and nurses as well as others they may come into contact with are crucial. A compassionate nurse can change the life of a patient, as well as an unsympathetic nurse whose attitude may be “they did this to themselves.” Alcohol dependence or abuse should be seen for what it is a real disease that needs real treatment. These patients need all the support they can get from those around them, and education on the subject is paramount to recognizing the signs and symptoms that manifest. Education for healthcare workers so they understand these patients, as well as how to successfully treat them with medications, together with the patient’s desire to enter therapy will hopefully change that 50% to 25% or better 0% relapse in first few months.

Legal Services for Alcohol Abuse Addiction

Patient Education & Counseling online course

Public Health Nursing online certificate program

Forensic Nursing Online Certificate Program

Forensic Nursing Online Introduction Course

Online Advanced Nursing Health Assessment Course

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

July 7, 2010

The advent of medication distribution machines may give health care providers a false sense of security when administering medications to patients.  As health care providers, we need to recognize that human error is still a potential part of this new medication administration process.  The orders are entered by a human, then checked by a human.  As nurses we need to review the 5 rights each and every time we administer a medication to a patient.  If we become relaxed because the information is coming from a computer, or the medication pops out of a machine, then we are opening ourselves up to “high-risk” nursing practice.   Each and every medication you administer to a patient needs to be considered independently.  Medication errors should be reviewed monthly by nursing staff in a “morbidity and mortality conference” type of review meeting in order to educate ourselves and learn from others mistakes rather than shame ourselves with a discreet incident report.  This may further bring to light the fact that we are human and we make errors, but accountability is key for us to reduce the numbers and make it a safer environment for providers as well as patients. Using machines and computers as tools, not as a replacement of our own cognitive skills, is the balance we need to embrace to reduce medication errors.

Original Post

March 31, 2010

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

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

Medical Malpractice Related to Nosocomial MRSA Infections, comment

July 7, 2010

Prescreening patients for MRSA prior to admission to the hospital is a very proactive approach to managing this “super bug”.  If we consider this part of our pre-surgical admission assessment rather than a legal issue, we can take some of the unnecessary fear and anxiety that has been instilled in the public from the media regarding MRSA. When patients are screened for Group B Strep prior to a vaginal delivery, it provides health care providers with useful information to treat the patient and potentially the infant prophylactically and could potentially save the hospital, patient and insurance companies money from complications.  We should consider MRSA in a similar scope because it is no longer rare and only nosocomial in nature, but it is commonly acquired in the community as well.  Prescreening patients upon admission, whether it be inpatient or outpatient, can only improve outcomes for patients and healthcare providers.  This does not have to be seen as a legal issue, or a means to panic the community needlessly, but rather a way of arming ourselves with information to provide the best quality care possible.  Protocols need to be established to prevent and control MRSA before it enters our patient environment, while still treating those who are carriers in a non-discriminatory manner.

Original Post

June 7, 2010

Title: MRSA frustrations! (comment)

I feel the same frustrations as posted in the attached! I feel like we, the nurses, are viewed as the Culprit in a patient acquiring a nosocomial infection. Never mind the fact that ‘we’ probably wouldn’t be in this predicament if these wonder drugs, antibiotics, hadn’t been given for every sore throat and cold that walked into the Dr’s office, clinic, or ER. In the hospital where I work, there is an ongoing ‘tally’ of hospital-acquired UTI, VAP, central-line infections, etc., by unit. It’s hard enough to work short-staffed, but to also glove and wash your hands every time you enter a patients presence then leave, just to enter another and wash all over again; takes even more time away from patient care and interactions; all the while someone standing over your shoulder monitoring… The pharmaceuticals have some ownership of this ‘super-bug’ epidemic. I don’t think they invested enough time and research into developing new antibiotics, because it didn’t make the money the other drug classes did. https://forensicnursingcourses.com/2010/05/26/medical-malpractice-related-to-nosocomial-mrsa-infection-comment/

Original Post

May 26, 2010

Title: Medical malpractice related to nosocomial MRSA infection, comment

After reading the posts regarding MRSA acquired during the hospitial stay and how this is a legal issue makes me think of one thing. Nurses need a law degree before stepping foot in a hospital. Well, that may be a little overboard. I see this everyday. Practicing medicine while keeping in mind that we can be sued. We order extra lab work, radiology, ultrasound, MRI, and swabs for MRSA so we cover all the bases and avoid going to court. I can understand the MRSA swabs that may need to be done in order to avoid a lawsuit, but we would have to swab everyone. We really don’t know if the history we are obtaining is inclusive. Is this done in other countries? Are people “sue happy”? This is a foriegn concept to some friends and family that visit the US. Maybe we can invent a body scan that will take photographs head to toe to cover wounds, swab every orifice, lower the beds to 1 foot off the ground, and make it mandatory to wear special non-slip shoes to avoid falls. Again, the above example is out of frustration that we are not only caring for patients, but always are adding new things to do in order to avoid a lawsuit. I wish it were different, but we all know it will only get worse.

Original Post

January 16, 2007

Title: Medical Malpractice Related to Nosocomial MRSA Infections

The media and government have educated the public in the “super bugs” some patients become infected with in the hospital environment. The most widely known “super bug” is methicillin resistant staphylococcus aureus (MRSA). In June 2006 there was a case brought to court regarding the death of patient who had been in the hospital for a knee joint replacement. Since the patient had not been screened for MRSA prior to hospitalization it could not be proved if he picked up the MRSA during the hospital stay. With the documented community acquired MRSA he could have had the bacteria dormant in his body when he was admitted for the planned surgery. The doctor and hospital were not found negligent in this case.

Many hospitals are fearful of similar lawsuits based on nosocomial infections. Some hospitals are now culturing high-risk patients prior to hospital admission to determine if they are colonized. There is now a nasal swab test that has a turn around time of two hours to identify MRSA. Certainly this can be helpful so that colonized patients coming in for elective procedures can have this treated and also be isolated from non-colonized patients. Patients that test positive for MRSA can be cohorted with like patients or put in private rooms. There are multiple hospitals in Europe starting to follow this intervention with positive outcomes in their nosocomial rates.

It would seem to me the hospital administrators would prefer paying for the MRSA culture versus facing the potential of law suits from patients who develop nosocomial MRSA infections while inpatient. If I had a family member going to the hospital I would much prefer they be tested for MRSA prior to a surgery as “knowledge is power” Having the knowledge of colonized MRSA prior to surgical intervention can allow for adjustments that lead to positive outcomes for the hospital, surgeon and patient. I can visualize hospitals even being forced to do it to allow them better leverage in the court system by being able to say, “this person was colonized with MRSA” prior to hospital admission. From the epidemiology stand point it would also allow the opportunity to keep the more virulent strain of community MRSA from entering the hospital environment.

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