RSSArchive for May, 2011

ANA praises Joint Commission standards for nurse-led medical homes

The American Nurses Association (ANA) issued a press release applauding The Joint Commission for implementing standards that allow nurse-led practices to qualify as primary care medical homes.

Beginning July 1, The Joint Commission will use a set of ambulatory care guidelines to accredit primary care medical homes, a decision the ANA says will give advanced practice registered nurses (APRNs) the opportunity to provide services to patients under an innovative care delivery model.

Medical homes have been encouraged by the Affordable Care Act (ACA) as a way to provide more cost-effective, high-quality, patient-centered care, as well as more choice and access to patients seeking care.

According to a statement on the Joint Commission website, the new primary care medical home (PCMH) option will focus mostly on education and self-management of the patient. Care provided by other clinicians and facilities is tracked and coordinated by a primary care clinician and an interdisciplinary team, and evidence-based treatment practices guide their care. The PCMH opportunity is also aimed at improving patient satisfaction and patient outcomes.

Applications are now being accepted from organizations ready for survey.

Click here to read the ANA news release.

Preceptor perspectives: Reporting a near miss event

by Julie Harris, RN, MSN

Who likes to get in trouble? I know that I sure don’t! Yet, reporting a near miss event sometimes feels like that. Let’s look at a scenario that demonstrates this feeling:

One night Mason noticed a medication error from the pharmacy. They sent up the wrong dose of medication for his patient. After sending the medication back to the pharmacy, Mason filled out an occurrence form and placed it in his manager’s box. Several days later, the manager called him into a meeting with the pharmacy and other managers. They wanted him to explain the near miss event. He did and then was excused from the remainder of the meeting. Mason left feeling like he received a slap on the hand for reporting the near miss. He wondered if he should bother reporting any other near misses in the future.

This scenario is common throughout hospitals and healthcare facilities. Mason felt like he was in trouble for reporting the near miss event.

Many nurses, like Mason, do not see the “big picture” when it comes to reporting a near miss. And many times, this is due to a lack of just culture training from the hospital. Nurses are told they have to report near miss events. But, they are not told why to report such events or the outcomes of their report.

Preceptors can help solve this problem by training orientees and other staff members on the “big picture” of near miss reporting. This training should include:

  • The importance of reporting a near miss event
  • What qualifies as a near miss event
  • How to report a near miss event (i.e. how to fill out the form)
  • Where the report goes after it leaves the nurse
  • Who to contact for follow up
  • Examples of near miss events and their outcomes involving process change, patient safety, etc.

High-quality, safe patient care is the goal for all hospitals and healthcare facilities. Reporting near miss events is one avenue for nurses, especially preceptors, to take in order to achieve this goal!

Commanding respect from disrespectful physicians

by Wendy Leebov, Ed.D.

“I work days and try to have everything ready when the doctors come in (labs in charts, vitals done, etc.). But they are immediately demanding everything at once, not giving me a minute to collect my thoughts and focus on the patient in question. Then, they treat me like I’m stupid when I don’t give the answers almost before they ask the question!”

Alan Rosenstein did a revealing study about nurse-physician relationships.

A few findings that struck me:

  • More than 92% of nurses had witnessed disrespectful and/or disruptive behavior by physicians.  The most common behaviors cited include yelling, raising the voice, condescension, berating colleagues, berating patients, and use of abusive language.
  • Common generalizations about abusive behavior on the part of physicians make it seem as if most physicians are “abusive.”   However, in Rosenstein’s study, nurses clarify that very few physicians are abusive. The vast majority are not. I think that’s VERY important to remember.

Still, the instances of abuse stick in the craw of not only the people on the receiving end, but also on people who witness it.  So, it’s important to address this behavior, so that it doesn’t erode morale, teamwork and patient outcomes. Of course, that’s not so easy, because many caregivers feel intimidated about speaking up to stop respectful or abusive behavior because of fear of retaliation, lack of assertiveness, and/or a sense of hopelessness that the person’s behavior will ever change.

What to Do?

There’s a lot an organization can do, and should do, such as:

  • Commit to and make explicit a code of conduct and link it to your vision, values and standards. Highlight the impact of teamwork, collaboration and communication on quality, patient satisfaction, risk reduction, safety, and outcomes.
  • Zero tolerance. Institute and enforce a zero tolerance policy about coworker disrespect.
  • Adopt a “respect” signal. Decide on something anyone can say when they witness inappropriate behavior—a signal that means “You have crossed the line.”  Stopped in their tracks, many people become more aware of their behavior and more accountable for it.  My favorite signals:

o     “Time out.”

o     “How about a cup of coffee?”

  • Physician-nurse rounding.  Have physicians and nurses round on patients together and provide training to support effective communication during these rounds.
  • Provide personal coaches for individuals who behave in an outrageous way.
  • Adopt-a-Doc: Have nurses each adopt a physician with whom they will deliberately build a positive relationship and for whom they will act as an advocate.
  • Provide assertiveness training for nurses! This is critical!
  • Discussion forums: Provide forums in which physicians and nurses talk to each other!

BUT, while the organization can work to reduce abusive or disrespectful behavior between nurses and physicians and among colleagues in general, in my view it is essential that the individual who perceives the behavior takes responsibility to address and handle it effectively, one situation and one person at a time.

What can the individual do?

In one of my roles years ago, I was in a position to field physician frustrations every day.  My friends called me the LIVER of the organization, because so many toxins flowed through me.  In my early years, in the face of a hostile physician, I would get defensive or cower.  Both approaches seemed to increase the behavior I was hoping to eliminate.  Then, after spending about $5 million on therapy, I learned other MUCH more effective techniques, and I have had a less stressful life ever since, because these techniques WORK.

Tips from my experience:

  • Alter your own inner monologue. These are the statements you say to yourself.  Look within:  What do you say to yourself when someone is abusive to you?  “This jerk!  How awful!  Poor me!  I hate this!  I don’t deserve this!”  If your inner talk makes you angrier or more defensive, change it.  You CAN decide to think something different, such as, “This is not about me,”  “I deserve respect,” “I don’t have to react,”  “I can stay calm and help this person,”  “I can take the high road here.”
  • Don’t respond in kind. It’s human nature to want to strike back when attacked.  Resist.  Handle the inappropriate behavior respectfully.  Stay on the high road, since this will make you most effective and also enable you to feel good about yourself at the end of the day.  CALMLY SAY, “What is happening is not okay.”
  • Give direct feedback without anger.  “I saw you do this….” or, “I don’t appreciate your tone,”  “I would appreciate your keeping your voice down,”  “When you belittle me in front of our patients, I resent it and it makes it hard for me to support you.”
  • When someone is verbally attacking, instead of getting defensive, make explicit your positive intent. Instead of saying, “WHOA!  Hold it a minute” say, “You know, I really want to help you.”  Then if they persist, say that over and over in a sincere tone, “As I said, I really DO want to help you.” And then wait until they have vented enough to allow them to calm down and address the facts of the situation with you.
  • Use the caring broken record.  In the face of persistent disrespect, repeat your bottom line message each time with caring.  “I hear how frustrated you are, and I really want to support you,”  “I realize you’re under extreme pressure, and I really do want to provide the support you need,”  “I’m sorry this isn’t what you wanted.  I really do want to help.”
  • If the abuse continues, remove yourself from the situation. “I’m hanging up now.  Please call me back when you’re ready to talk with me in a respectful way about this.  I really do want to help you.”
  • “There you go again.” If you’ve addressed the behavior over and over and it still hasn’t changed, when it happens next, say very calmly, “There you go again.  I want to discuss this with you when we can both be respectful.”  And do that EVERY time it happens again.

And with your TEAM:

Talk about the elephant in the room. Work together with your team to identify great ways to respond to the disrespectful or inappropriate behavior you handle most often.  I’ve provided a worksheet to guide your discussions.  You can be sure you’re not alone.  So, the activity will help everybody.

Healthcare environments are inherently stressful and it’s upsetting to think about the times when colleagues add to this stress instead of relieving it.  To be effective and to do your part in altering an atmosphere of disrespect, it takes courage and caring — backbone and heart.

For helpful resources about handling disrespectful behavior, click here.

Research shows simple post-surgical step reduces infections

by Matt Phillion, for the AHAP blog

According to the latest edition of the Archive of Surgery, a basic bedside technique of gently probing a surgical incision to clean the area can result in significantly reduced rates of infection, Internal Medicine News reports.

According to the report, over a three year period, researchers assessed surgical site infections in 76 adults who underwent appendectomy for perforated appendicitis at one hospital. Only 3% of the patients who received the gentle probing contracted an infection, while 19% contracted infection in the control group. In addition, those patients who received the probing technique had their length of stay reduced.

Researchers theorized that allowing for drainage of the wound was the reason behind these better results, though they were unsure the precise reason as to why this practice cut down on infections.