A woman comes to the hospital lobby asking to visit a friend who has recently had surgery. The visitor is coughing heavily and appears to be sick. Do you let her in to see her friend? Most hospitals would say no; a well-meaning but sick friend or relative could have a devastating effect on an immunocompromised patient.
Meanwhile, a nurse arrives for his shift with the exact same cough as the sick visitor. Do you let him go to work, potentially treating the exact same immunocompromised patients you’re trying to protect?
More healthcare personnel (HCP) are getting their flu shots, according to a Centers for Disease Control and Prevention (CDC) study, but there are still large gaps in immunization. During the 2014-2015 flu season, 77% of HCPs were vaccinated against the flu, a 14% increase from the previous season. The highest rates of immunization—at 90.4%–was with HCPs working in hospitals.
While the increase is a positive step, it was also revealed that only 75% of nonclinical personnel had received the vaccine, including food service workers, laundry workers, janitors, housekeeping staff, and maintenance staff. The numbers were even lower for aides and assistants, with only 64% immunized. [more]
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing a popular post full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
Yesterday we looked at the purpose of the incident report and the value of documenting facts as well as the patient’s responses to care in the nursing progress notes (see Incident Reports: Part One). Today we’ll look at eight risk reduction recommendations you should follow to limit the number of incidents you face. We’ll also give you a check list of tips for writing incident reports should adverse events occur. (I’ll make the checklist available as a PDF download in a few days, so check back for the link.)
RISK REDUCTION RECOMMENDATIONS FOR NURSE MANAGERS
- Be sure that everyone is clear as to who is managing the patient. This is especially critical in complicated cases with numerous consults. One of the major factors in adverse events is fragmentation or lack of clear communication between providers. Therefore, use the medical record as a communication tool for all providers and encourage your staff to read notes from other providers and disciplines.
- Be sure staff understand and utilize the chain of command when necessary. They are considered patient advocates and must speak on behalf of the patient to ensure quality patient care. Documentation of the chain of command process should be factual and blameless.
- Advise your staff never to create notes at home concerning the event. They should not discuss the event with other care providers without having someone from risk management present, unless the discussion is in a quality-review process or in the presence of the facility’s attorney.
- If an adverse event occurs, the staff must know that attention to patient needs is first and foremost. If a patient is injured, nursing and medical interventions take precedence over everything else.
- Follow the organization’s policy on medical-event disclosure. It is important that staff understand who is designated to inform the patient/family. Documentation should include who was present during the discussion, what information was discussed, and all of the patient/family responses.
- Ensure that the patient/family receives compassionate care and that everyone involved maintains a professional relationship.
- If an adverse event occurs, contact the risk manager. Discuss the case discretely, because conversations are not protected under a quality statute or attorney-client privilege, and therefore may be discoverable.
- Work with the risk manager. The risk manager can help you and your staff promote patient safety and proactive strategies to avoid injuries.
Incidents reports are a pain to fill out, but vital for documenting what happened and for protecting yourself and your staff. This week, we’re republishing installments of a popular post chock full of best practices, provided by Patricia A. Duclos-Miller, MS, RN, CNA, BC.
We work in high-stress, fast-paced environments. It is your responsibility as a member of the nursing management team to understand the importance of incident reports, to ensure that your staff completes them, and to investigate incidents to avoid any further occurrences. Your investigation will also provide possible defense if during your investigation you identify a system failure and take the necessary corrective action(s).
The purpose of the incident report is to refresh the memories of both the nurse manager/supervisor and the staff nurse. While the clinical record is patient-focused, the incident report is incident-focused. The benefit to you and your staff is [more]
A good news follow-up on my February post that focused on nurses’ on-the-job injuries.
In a news release on healthcare inspections last week, OSHA put hospitals and nursing homes on notice. Inspectors will add new enforcement on some key hazards for healthcare workers, including musculoskeletal disorders, bloodborne pathogens, workplace violence, tuberculosis and slips, trips, and falls. Hospitals will be penalized for gaps in training, use of assistive devices, and low quality treatment for staff who move patients.
Evidently, OSHA was inspired by the NPR [more]
You know that the Joint Commission and other regulatory agencies have standards that require your hospital to have a plan to reduce the risk of deadly infections and make sure your medical equipment is in good working order.
So why risk incurring costly lawsuits and fines—not to mention the possibility of destroying your hospital’s accreditation and reputation—if an improperly disinfected GI scope causes a patient to contract a life-threatening infection?
It’s happening right now to Virginia Mason Hospital in Seattle (read more here), where 11 people died after contracting deadly infections from improperly disinfected diagnostic scopes, and it could happen to your facility, too.
Let infection control experts Peggy Prinz Luebbert, MS, (MT)ASCP, CIC, CHSP, CBSPD, and Terry Micheels, MSN, RN, CIC, show you everything your organization needs to know to ensure proper GI scope disinfection and protect the lives of your patients.
Register for “Proper GI Scope Disinfection: How to Avoid Becoming a Statistic,” a 90-minute webcast that will cover the critical steps of high-level disinfection that must be met each and every day. Don’t miss out on this opportunity to ensure your organization complies with requirements set by The Joint Commission and CMS.
For more information or to register, check out the HCPro Marketplace, here.
HCPro is celebrating and recognizing nurses all week long with special giveaways, prizes, and promotions, but we don’t want to wait until Wednesday to start the celebration!
Starting today, you can use our special Nurses Week discount code to save on any and all nursing books, videos, and webinars… Just use discount code NRSWK2015 at checkout to receive 20% off your selections.
——OTHER RECENT POSTS——
⇒ 5/4: Who inspires you? There’s still time to submit your favorite quotes in posted comments, here.
⇒ 5/6: A thank you to our favorite nurses, from Boston. Here’s the post.
Editor’s note: This column was first published on HCPro’s OSHA Healthcare Advisor blog on May 30, 2014.
By: John Palmer
By now, you’ve likely heard that the CDC backed down yesterday on its official number of U.S. cases of confirmed MERS patients. This may confuse a lot of people in the healthcare world—especially those in the smaller medical clinics who are concerned that they may be on the front lines in dealing with any future victims of this mysterious new respiratory illness from the Middle East.
The CDC now officially says there are only two confirmed cases, down from three last week. The third was a man who was a business associate of the first patient, a healthcare worker who fell ill in Indiana after traveling from the Middle East. This third patient apparently had a two-hour business meeting with the first guy, but he never got sick. He was tested preliminarily, and after more tests he never got sick, and that’s why they backed down on the case count.
Here’s a link to the official CDC press release regarding the MERS situation: http://www.cdc.gov/media/releases/2014/p0528-mers.html
I had a lengthy phone call yesterday with Dr. J. Todd Weber, a chief of prevention and response at the CDC, and he gave me their official stance on what’s going on and what healthcare providers should be doing to prepare.
MERS is a coronavirus that originated in camels and over the last two years has somehow made the jump to humans. For the time being, the worst of it seems to be isolated to the Arabian Peninsula and it seems to be affecting mainly healthcare workers who are dealing with patients.
That’s the good news. The bad news is that it reportedly kills about 30% of its victims. Hardly a common cold. A high death count like that brings back memories of the 1918 flu epidemic, the Swine flu and Bird flu, and the big SARS outbreak that devastated Toronto.
The even more good news, Weber told me, is that this is not the flu. I am no virologist here, but Dr. Weber says a Coronavirus lacks the genetic ability to mutate the way the Influenza virus does – which explains why the flu can make a jump so quickly from animals to humans.
What does all this mean for you, the healthcare provider? Do what you always do. Be on the lookout for patients who present with both fever and upper respiratory infections. And make sure you play detective and ask questions. Did the patient travel to the Middle East within the last 14 days, or have contact with someone who did?
And as always—practice good infection control measures. Isolate those who are sick, disinfect your surfaces, and wear your PPE such as masks and gloves.
Dr. Weber stopped short of saying we are out of the woods—a good doctor never does that. There’s always a chance this will find a way to mutate quicker, and as we have seen, the virus can travel on airplanes to other places in the world. But panic never helps, and the CDC did the right thing by backing down their previous warnings.
Needleless connectors for IV catheters have reduced the risk of needlestick injuries among healthcare providers but could lead to additional risks such as a catheter-related bloodstream infection, according to an article in the November issue of the American Journal of Nursing. In the article, Lynn Hadaway, Med, RNC, CRNI, describes the differences between the various types of needleless connectors currently used and lists potential complications. The article lists the following risk factors associated with needleless connectors:
Device design: The report notes that opaque or colored external housing could make it difficult to see residual blood or particulate matter, while the shape of the connection surface could cause contamination or cause difficulty in cleaning prior to connection.
User knowledge deficits: According to the report, staff training on the correct method for flushing and clamping needleless connectors is often inadequate. A 2011 survey of healthcare workers revealed that more than a quarter of respondents did not know the specific type of needleless connector they used with short peripheral or central venous catheters, while nearly half of respondents did not understand the correct method for flushing and clamping a catheter.
Inattention to system management: Inadequate hand hygiene, nonsterile access devices, and frequent manipulation must be addressed in policies and guidelines, according to the report.
The report recommends that nurses and other staff are trained in the proper use of needleless connectors and syringes, and that facilities create written policies and procedures that address the specific types of connectors in use at that facility. Taking proper precautions could reduce the risk of infection associated with needleless connectors.
It happens to everyone at some point: you wake up with a cough, a headache, or a stuffy nose, and all you want to do is go right back to sleep. But more often than not, something pulls you out of bed and you force yourself through the daily grind. After all, you can’t afford to miss that meeting or leave your colleagues in the lurch, right?
But your illness could affect those around you, particularly if you are working in a healthcare setting with patients whose immune systems may already be compromised. According to a survey published this month in the Archives of Internal Medicine, more than 50% of residents reported working at least once when sick with flu-like symptom, while 16% reported working at least three times while sick. The survey included 150 resident physicians from 20 internal medicine programs in Illinois.
The survey asked residents their reasons for working when sick, and the most common responses were that residents felt an obligation to colleagues and an obligation to patient care. Second-year residents were more likely than first-year residents to state that patient care prevented them from taking time off due to sickness, and female residents were more likely than their male colleagues to list patient care as their reason for working while sick.
In light of this research, we posted a poll on StrategiesforNurseManagers.com asking readers how often they worked when sick. More than 60% of participants responded that they often go into work when sick, and 20% said they always go into work regardless of feeling sick. Only 2% responded that they always stay home when sick, with the remaining 18% of respondents reporting that they rarely go into work when sick.
While it may seem harmless to suffer through a day at work despite a few sniffles or a bad cough, healthcare professionals who work while sick risk passing their illness along to patients, which could put patients at risk. A cold that seems mild in someone with a healthy immune system could have devastating consequences for an elderly or frail patient. Researchers involved in the study noted that working while sick could also cloud judgment and lead to poor decisions with regard to patient care.
Do nurses and others in your organization often work while sick? What is the typical response to those who come in when they clearly should have stayed home? Share your thoughts in the comments section!