Editor’s note: This blog post originally appeared on the Patient Safety Monitor blog.
On August 8, The Joint Commission issued a Sentinel Event Alert regarding specific steps hospitals should take to prevent complications or deaths from opioid use. Opioids can cause adverse reactions such as nausea, vomiting, delirium, and respiratory depression, according to the Alert. Opioids are also commonly implicated in adverse drug reactions.
Lack of familiarity with different opioid potency, inappropriate prescribing and administration, and failure to properly monitor patients on opioids were among the causes cited by The Joint Commission for adverse events associated with opioid use. Nearly half of all the opioid-related adverse drug events reported to The Joint Commission between 2004 and 2011 were related to wrong dose medication errors.
The Joint Commission recommended the following safety measures for minimizing the risk of an adverse event:
- Assessing patients for risk factors of respiratory depression, which include sleep apnea, snoring, morbid obesity, older age, preexisting pulmonary or cardiac disease, and receipt of other sedating drugs
- Evaluating a patient’s previous history of painkiller use or abuse
- Checking for an implanted drug delivery system or infusion pump by conducting a full body skin assessment before opioid administration
- Employing individualized treatment plans for pain management
Giving additional consideration to patients who have never used opioids or are resuming opioid use. The Joint Commission also recommended that hospitals establish various policies and procedures to minimize the risk of opioid-related adverse events. The full text of the Sentinel Event Alert can be found here.
More than one-third of U.S. adults are obese, according to the Centers for Disease Control and Prevention, and many speculate that percentage will continue growing in the coming years. With so many health issues linked to being overweight or obese, it is in the best interest of patients to listen to their healthcare professionals’ advice and move toward a healthier lifestyle and a lower weight. But what happens when physicians, nurses, and other healthcare professionals are the ones with the extra pounds?
Two students from Johns Hopkins School of Medicine asked this question, and responded by establishing The Patient Promise, an initiative aimed at addressing clinician health and encouraging physicians and other healthcare professionals to adopt the healthier habits they prescribe to their patients. The initiative’s website cited data that found 63% of physicians and 55% of nurses were overweight or obese, and pointed to additional research that showed physicians who live healthier lifestyles and are at healthier weights are more likely to address weight issues with their patients. Within a few weeks of launching The Patient Promise, 300 healthcare professionals and medical students across the country had signed the pledge to show their support.
Earlier this year, we posted on the blog about a study from the University of Maryland that examined the impacts of job stress and irregular work hours on nurses’ weight. The obesity issue, and more broadly the issue of leading a healthy lifestyle, is one that needs to be addressed, and projects like The Patient Promise are steps in the right direction. As the Patient Promise website says, “Hippocrates, not hypocrisy.” Nurses and physicians have the opportunity to lead by example and make a positive change in both their own lives and the lives of their patients; it is an opportunity that should not be wasted.
Leave a comment and let us know about any initiatives your organization has in place or is considering for promoting a healthier lifestyle among your nurses and physicians.
Editor’s note: The following is a press release from Bare Root, Inc.
Blossoming Appreciation for Nurses: “Buy a Rose” to Decorate Inaugural “Nurses’ Float” at 2013 Tournament of Roses Parade
Funds Raised through $25 Donations to Support Nursing Programs, Scholarships and Grants
PASADENA, Calif. (July 19, 2012) – Bare Root, the nonprofit organization consisting of five California-based nurses who independently spearheaded the effort to build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide, announced today that they’re providing the opportunity for others to individually honor nurses by donating roses on their behalf via the foundation’s web site at www.flowers4thefloat.org.
“When we decided to build a float to honor Sally, we realized that we also wanted to honor nurses everywhere. Nurses are really the unsung heroes of healthcare and healing,” said Monica Weisbrich, RN, president of Bare Root. “So many people have approached us asking how they can honor a special nurse in their life. We thought this would be a wonderful way to allow them to express gratitude and to share their story if they would like to.”
Visitors of the Flowers for the Float web site have the ability to access the online store and select a quantity of roses to purchase for $25 each. During the donation process online, users have the ability to indicate the name of the nurse they are honoring and also provide a story if they would like. These stories are being shared on the web site’s “Celebrate a Nurse” page. The roses purchased will be labeled with the names provided and placed on the float during live decoration.
The theme of the float, “A Healing Place,” serves as a metaphor for the healing environments nurses create through the use of their qualities and skills. “A Healing Place” is created anywhere there is a nurse and a patient – from the hospital to the battlefield; from a school to a home; from a clinic to a specialty care center. The words that surround and support the float explain those qualities.
“There are so many people in the world who have been touched in their lives by a special nurse,” said Weisbrich. “This is just one way we can bring all of those good messages and thoughts together in a single place.”
About Bare Root and the Nurses’ Float
In 2007 five registered nurses in California formed a nonprofit organization, “Bare Root,” to raise money and build a float to honor 2013 Tournament of Roses president Sally Bixby, RN, and nursing professionals worldwide for their tireless efforts.
2013 will be the first time that a nurse will be president of the Tournament of Roses, and only the second time that a woman was named to the top role.
To date, Bare Root has raised more than $300,000. One hundred percent of funds raised supported the development of the Nurses’ Float, with continued fundraising efforts being used for scholarships and grants to qualifying organizations.
The Los Angeles Times reported this week that healthcare firms are increasingly shifting clinical services and decision-making on medical care overseas, including nursing functions. WellPoint, Inc., a major health insurer, has begun to outsource pre-service nursing jobs, in which “nurses at insurance firms … help assess patient needs and determine treatment methods,” according to the article. This is a huge step beyond sending some data-processing or accounting services overseas, and it has raised some concerns among nursing organizations.
Beyond the issue of foreign insurers having a say in patient care, the outsourcing of healthcare jobs raises concerns about patient privacy. According to the article, the Iowa Health System and several other hospitals throughout the country have begun outsourcing the job of transcribing physician’s notes and other records. Despite claims that “nearly all countries have laws for protecting patient privacy,” it seems like a risk that outweighs the potential cost-savings. But one could see the appeal, particularly as electronic health records become the standard and eliminate the need for patient information to be stored physically.
Proponents of outsourcing argue that it not only cuts costs, but also enables U.S. companies to “tap global talent and efficiencies” and turn a greater profit. Ultimately, this is supposed to create more opportunities for American workers while keeping costs low for consumers. Perhaps that’s the case for industries such as manufacturing or technology, but it seems like healthcare is something that should be kept closer to home.
What are your thoughts on outsourcing healthcare jobs to other countries? Are there certain healthcare tasks that can be outsourced? Leave a comment to weigh in.
Nurses’ adoption and use of clinical practice guidelines is largely affected by external barriers such as social and organizational factors, according to a study published in this month’s issue of American Journal of Nursing. Clinical practice guidelines, which the Institute of Medicine defines as “systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances,” are designed to close the gap between evidence for best practice and actual patient care. Researchers chose to focus on nurses’ applications of clinical practice guidelines due to several previous studies that found that nurses were most often identified as being primarily responsible for ensuring patient safety.
Researchers examined responses to open-ended survey questions asking nurses about barriers and facilitators to using clinical practice guidelines. The top three most-identified categories for facilitating the use of guidelines were education/orientation/training, communication, and time/staffing/workload; similarly, these were also identified as categories in which there were barriers to guideline use. 44% of nurses responded that their ability to use guidelines was impeded by a lack of time and a heavy workload, while 25% cited a lack of education, orientation, and training and 22% cited poor communication as barriers. Researchers found that 91% of nurses identified at least one external barrier, or those outside of the individual nurse’s control, and 53% of nurses identified more than one external barrier. Fewer than 10% of nurses identified internal barriers such as lack of awareness of guidelines or willingness to change practice to better adhere to guidelines.
The research suggests that social and organizational factors can be crucial in the use of clinical practice guidelines. Organization leaders should find ways to ensure that nurses receive sufficient education and adequate time to successfully implement guidelines. In addition, effective communication and cooperative teamwork should be encouraged and practiced by everyone within an organization. The study’s researchers conclude that nurses should ideally be involved in all stages of guideline development, implementation, and use.
How do your nurses respond to clinical practice guidelines? What are some ways you have found to ensure guideline use among your nurses? Share your thoughts in the comments section!
American Medical News released a story last month highlighting four ways that social media can be used to improve a medical practice. By now, many people in the healthcare industry recognize that social media can be a powerful tool for communicating with patients, albeit a tool that can have terrible consequences when used incorrectly. The article from American Medical News focuses its attention on social media as a business intelligence resource and customer service tool, as well as a means for reporting to move toward improved care and outcomes. Although the article is primarily focused on how physicians can use social media, the principles discussed can be applied by any leaders within a healthcare organization.
One of the main topics of discussion in the article is using social media to gain insight into what services patients are seeking and what obstacles patients are facing. By identifying health trends and reacting with targeted programs and informational posts, healthcare leaders can use social media to address patient needs quickly and effectively.
Similarly, social media can be a platform for addressing complaints, negative comments, and feedback from patients. Practitioners should exercise caution in keeping specific details about patients offline and out of the public sphere, but can nonetheless use social media channels to provide an apology and offer to correct a situation. Ideally, the disgruntled patient feels as though his or her complaints are being addressed in a timely manner, while other patients see that customer service is a priority for the organization.
Given the ubiquity of social media in most patients’ lives, as well as the nearly non-existent cost of creating and maintaining social media sites, using these resources makes sense for any organization looking to improve patient engagement and interaction. As for any business, developing and implementing an effective social media initiative for a healthcare organization requires careful planning, proper management, and constant monitoring and maintenance. But the benefits of improving overall quality and patient satisfaction could make social media engagement well worth the effort.
What are your thoughts on social media as a tool for healthcare organizations? Does your organization use social media in the ways described here? Leave a comment and share your thoughts!
The American Academy for Preceptor Advancement (AAPA) has selected The College Network® and LearnScale™ Solutions to develop core curricula and examinations for certifying individuals as preceptors. A lack of national standards, national certification, and consistency in development has made it difficult for the healthcare industry to validate the abilities of preceptors. AAPA, The College Network, and LearnScale aim to prepare nurses and other healthcare providers for successful careers as certified preceptors following the completion of their formal education, according to a June 14 press release from The College Network.
“Precepting is a unique specialty with its own core of knowledge and expertise associated with competent and engaged preceptors,” Diana Swihart, PhD, DMin, MSN, APN CS, RN-BC, said in the press release. Swihart has written multiple books on nurse preceptor programs and training, and has spoken at national conferences on topics related to nursing, shared governance, and staff development.
AAPA started out in 2009 as The Preceptor Certification Steering Committee, which began developing drafts of standards for preceptors, criteria for preceptor advancement, and core curriculum for certifications. AAPA was officially established earlier this year. Swihart serves as chief executive officer for the group, with Solimar Figueroa, MSN, MHA, BSN, RN, acting as chief nursing officer.
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!
Most nurses would agree that a typical shift requires a high level of focus on tasks, good time management, and a positive attitude when interacting with patients. But according to a study published recently in the journal Clinical Nurse Specialist, 18% of nurses experience depressive symptoms, a rate that is twice as high as that of the general public. Symptoms of depression include low mood, difficulty concentrating, and lower total output in the workplace. Those experiencing depression are also more accident-prone and less able to perform mental or interpersonal tasks, a fact that concerns researchers due to the likelihood that a nurse’s depression could have serious ramifications for coworkers and patient care.
Nurses who are experiencing depression and are unable to perform their jobs at the high level required of healthcare professionals pose a risk to patients, as an inability to concentrate could lead to serious or fatal medical errors. Depressed nurses need to receive treatment for their illness, not only because of the potential for lower quality of patient care, but also for the personal well-being of the depressed nurse. Researchers involved in the study noted that advanced practice nurses may be the key to recognizing depression in staff nurses and educating nurses about screening and treatment for depression. By raising awareness about the prevalence of depression in nurses and treatment options, advanced practice nurses and other leaders in the organization can move the topic of depression from the realm of taboo subjects. If nurses realize that their depression will be handled confidentially in a sensitive and supportive environment, they may be more likely to seek treatment.
Does your organization have a policy for handling depression? Have you ever needed to address a concern of depression among your nurses? Please leave us a comment and share your experience.
In terms of better quality of care (and perception thereof by the patient), healthcare reform is still an ongoing and debated process. HCAHPS and 30-day readmissions for certain conditions are already linked to reimbursement. Hospitals now publicly report all types of data to Hospital Compare, to the chagrin of many.
Quality of care is tied to reimbursement; we know what’s implemented, we know what’s coming, and we know it’s hotly debated. Should patient surveys determine reimbursement, considering surveys are inherently subjective (and perception easily manipulated)? We know one poor customer service—not clinical care—related incident might lead a post-discharge patient to rate a hospital badly. Should this count as much as it does? Should readmissions be tied to reimbursement, considering hospitals face incredibly different challenges throughout the nation? Is this a good idea?
It might be worth looking at how these rules have already begun to change the way hospitals educate, operate, build, and generally conduct their business.
Should hospitals install welcome signs in 10 languages, valet parking and free Wi-Fi like Maimonides Medical Center in Brooklyn? Should they buy state-of-the-art patient communication systems whose developers cling to the tie in reimbursement as their main selling argument? Should they train nurses and physicians to communicate better, even through the repetitive use of certain key words found on the survey? Should they work on creating a quieter environment?
Should these hotel-like amenities be the focus? They may seem small and unrelated to the real issue at hand—excellent clinical care free of patient harm. But if they don’t negatively affect care, or take away from that focus—in short, if they do no harm to care, these initiatives might be important. These new reimbursement rules are forcing hospitals to think differently, to try different things. Some will work, some will not, but we will find out and learn from it. Hopefully, we will figure out what makes for a better environment, better communication, and maybe even which fun new software and other technology gadgets might be worth investing in.
The worry, I think, is ensuring clinical care doesn’t get left behind or overshadowed by new patient rooms or fancy software systems that may or may not actually aid communication. Hospitals must be vigilant and ensure that both clinical and satisfaction scores rise together in one tide. Strategic alignment toward one goal – a healthy and happy patient – must be the focus.
Editor’s note: This blog post originally appeared on the Patient Safety Monitor Blog.