Posts Tagged ‘Healthcare Security’

Pandemic influenza (H5N1)

September 25, 2008

I work in Alaska on the Aleutian island occasionally.
Recently a village had a ‘dry run’ to practice giving immunizations incase the pandemic flu strikes here. Alaska is a threat because of migration of birds. It is felt that Alaska will be one of the first hit with the avian flu.
This small village was able to immunize 68 people in 4 hours.
The staff was eight people but they probably could have done it with six because they used two people to evaluate and work on spousal and child abuse issues with the ‘dry run’
One person was an intake at the door of the community center to guide the people through and help fill out forms.
Two people took vital signs and screened to make sure the person receiving the immunization had never been allergic to other flu shots or allergic to eggs.
Two people gave the vaccines; one person helped the person go out of the clinic and answered any other questions.
The village thought this ‘dry run ‘ was a success.

Original Post:
November 29, 2007
If/when a pandemic takes place, clinical nurses will need to use advanced assessment skills to recognize those who have been infected as well as those at risk. The symptoms of H5N1 have been shown to mimic the pandemic flu of 1918. Early symptoms of H5N1 mimic that of regular seasonal flu. However, the disease process of the H5N1 appears to be more inflammatory in nature leading to a mortality rate >50% affecting those with healthy immune systems. There is no rapid method to test for H5N1 and no vaccine. A person with seasonal flu or a regular cold has upper respiratory symptoms and an increased WBC count. A person with H5N1 has upper respiratory symptoms and a low WBC count. Could these clinical markers be used as an effective screening tool to triage and disperse available treatments (anti-virals, ventilators, etc.) in the throws of a full blown pandemic? If/When H5N1 mutates to develop human-to-human transmission initiating the pandemic, could the virulence decrease?

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Nursing Assessment Liability

December 31, 2007

The legal issues are enormous surrounding health care provider all the time. It is necessary to avoid being sued for liability issues. The health care organization such as the hospitals should teach the health care professionals such as nurses who provide the nursing assessment some basics about law and why they have to become responsible for such situations and their actions. However, there must also be some legal protection for nurses as is for the patients. There should be similar education for the public, that they go to health care providers to be taken care of not to sue them, which is encouraged by advertisement on TV and radio about suing your health care provider. The public should also be aware that their action as a patient may have legal consequences. For example a DT person who become violent towards the nursing staff, when they come to the hospital for treatment should be treated as a nurse doing something wrong to the patient.

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Pandemic influenza (H5N1)

November 29, 2007

If/when a pandemic takes place, clinical nurses will need to use advanced assessment skills to recognize those who have been infected as well as those at risk. The symptoms of H5N1 have been shown to mimic the pandemic flu of 1918. Early symptoms of H5N1 mimic that of regular seasonal flu. However, the disease process of the H5N1 appears to be more inflammatory in nature leading to a mortality rate >50% affecting those with healthy immune systems. There is no rapid method to test for H5N1 and no vaccine. A person with seasonal flu or a regular cold has upper respiratory symptoms and an increased WBC count. A person with H5N1 has upper respiratory symptoms and a low WBC count. Could these clinical markers be used as an effective screening tool to triage and disperse available treatments (anti-virals, ventilators, etc.) in the throws of a full blown pandemic? If/When H5N1 mutates to develop human-to-human transmission initiating the pandemic, could the virulence decrease?

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Education in Conflict Management

September 18, 2007

Chapter 4 of the textbook “Health Promotion Through Out the Life Span” discusses the importance of the communication process. However, it does not discuss the conflict management aspect of communication.
Recent articles that I have read state that nurses experience 3 times more violence in the work place than any other service workers. Another report I read stated that of nurses surveyed, 30% reported being victims of work place violence. Patients, physicians and other staff members incurred the violence that included both physical and verbal aggression. As a supervisor in a hospital I have seen and heard of many acts of violence in hospitals. Some have caused permanent back injuries among other physical injuries. Although violence should not be tolerated in the work place, I do not believe there is enough education in conflict management in the schools of nursing.

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Measures to protect patient information

September 11, 2007

1- Administrative safeguards:
a. Implementing practices to reduce identified risks;
b. Instituting a system to regularly review records of information system activity, such as
i. audit logs,
ii. access reports,
iii. and security incident tracking reports;
c. Developing a policy to sanction staff members who violate the offices security procedures;
d. Designating one staff person to be the Security Officer (similar to the designation of a Privacy Office as required by the HIPAA Privacy Rule);
e. Establishing who on staff has appropriate need to access patient records, and who does not;
f. Establishing and providing a security-training program for office staff.

2- Physical safeguards:
a. Hospital departments should be kept secure from intruders—with locks, alarm systems and other security devices and systems –the department is not open for business;
b. When the department is open for business, unattended areas are still kept secure with locks and other devices if possible, but at least closed doors;
c. Physical access to filing cabinets, computers and printers, photocopiers, fax machines and any other areas or equipment where patient information may be present should be controlled and monitored;
d. All workers should wear the organization identification badges at all times;
e. Patients and visitors should be appropriately escorted to ensure that they do not access restricted areas, and unidentified persons in restricted areas are (politely) challenged for identification;
f. When a person no longer works at the organization, keys and identification badge should be returned, alarm codes are changed, and computer access should be removed within one day.

3- Technical safeguards:
a. Computer passwords should be kept secure, and changed regularly;
b. Computer access tokens (such as key cards or USB keys), if used, should also be kept secure;
c. Computer screens should not be in plain view, where anyone other than staff can easily see them;
d. Users should log in to computer systems or terminals only with their own user ID, password or token; these only may be shared in extraordinary situations.
e. If there is no password-protected screensaver on the computer, log off when a computer system or terminal is unattended, even if it is only for a short time.
f. Computer systems should be used only for work-related functions (“playing” can provide a way in for viruses and other computer bugs);
g. Portable computing devices (laptops, PDAs) should be kept secure by remaining in the department or by password protection.
h. When a person no longer works in the organization, his/her computer use IDs and passwords should be immediately deleted, and any access tokens should be returned.
i. Use of computer-based patient information should be limited to the minimum necessary to get the job done. (Minimal security rule)
j. PHI (protected health information) should be stored on the secure servers in secure zone.

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Security and the Lack of Feeling for the Patients

April 11, 2007

As I read “Introduction to Computers for Healthcare Professionals” by Irene Joos, the completeness of the subjects was very appropriate. It covered everything that we in the IS departments are dealing with; whether a small hospital like mines or a huge hospital in Florida where I have a friend working. She emailed me last week about the provider order manager module they are bringing up and the EHR we are currently beginning. Security, yet availability to everyone has become the hot topic. Safety and checks is the same be it for physician, nurse or patient. AARP had a great article this month about checking the safety of your hospital and what to watch for. Everyone is watching and we need to have access to this safety. The huge safety net for all of us that the “computers” are supposed to be giving us can provide “all of their help.”

The security net I am referring to is the bedside medication verification system that we have implemented and approximately 5-10% of other hospitals to date. The pharmacy has rules written for many conditions and warnings are given to the nurse. However inherent in any program is the lack of expertise (medical) involved in the development. One of the ones that come to mind; is if the drug has been given recently why are you not flagged – it’s the nurse’s responsibility to look. If the morphine is not the right amount it will still let you give it, it just tells you it may be the wrong amount. Again, problems begin to be developed if no medical person is involved in the writing of the program.

Nurses try everyday to “cheat” the system, I just think it is part of a game like playing in Vegas almost!

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