NewsView
Article Outline
- Directors of Nursing (DONs) Know How to Do It!
- Nurses at Increased Risk for Injury
- Extended Work Shifts Substantially Increase the Likelihood of Medical Errors
- Guided Care Study Launched for Seniors With Chronic Conditions
- Inappropriate Medication Use in the Elderly Continues
- Beginning-of-the-Month Error Spike
- A New Type of Computer “Virus”
- EPA’s Aging Initiative
- Recalls
- Resources
- Congratulations
- Passages
Directors of Nursing (DONs) Know How to Do It!
Editor Priscilla Ebersole, RN, PhD, FAAN, reports on her attendance at the annual convention of the National Association of Directors of Nursing in Long Term Care (NADONA/LTC), held in New Orleans June 24-29, 2005. The celebratory atmosphere persisted throughout the conference, amplified by excellent presentations, numerous exhibitors, sponsors for all meals and receptions, and awards and recognition for outstanding job performance. The highlights of the event were the presentation of colors by 3 U.S. Marines in full dress uniform during the opening ceremony, followed by a National Association of Directors of Nursing Administration member from each state carrying the state flag; a riverboat trip; the awards banquet; and a 600-strong DON march through several downtown blocks wearing Mardi Gras beads, lead by a band and clowns on stilts—all with a police escort! These folks know how to have fun as they learn and grow in professional stature.
Nurses at Increased Risk for Injury
According to a study authored by Jane Lipscomb, PhD, RN, FAAN (associate professor at the University of Maryland, Baltimore, School of Nursing), published in the October 2004 issue of the American Journal of Public Health, increased injuries among RNs may be due to organizational changes within the health care system. In the study that looked at more than 1000 RNs, neck, shoulder, and back injuries are increasing as nurses are expected to work longer shifts and provide more care to more patients. Almost one-third of the nurses surveyed had suffered a back injury, 20% had suffered a neck injury, and an additional 17% reported having a shoulder injury. These types of injuries were nearly 4 times more likely to occur when nurses were working under health system changes—such as being asked to care for sicker patients and working longer hours. The study provides further evidence for the need for a systemic approach to improving working conditions in the health care industry.
Extended Work Shifts Substantially Increase the Likelihood of Medical Errors
Along similar lines, an article in Health Affairs (“The working hours of hospital staff nurses and patient safety,” Rogers et al., 2004;23:203-12) cited that long hours worked can dramatically increase the likelihood of medical errors. With no state or federal regulations restricting the number of hours a nurse may work in a 24-hour or 7-day period, hospitals have extended work shifts and overtime to cope with the shortage of registered nurses. Some nurses work a shift lasting 12 hours or longer, which according to the study triples the likelihood of medical error. Working overtime doubled the odds of making at least 1 error, regardless of how long the shift was originally scheduled. Working more than 40 hours per week significantly increased the risks of an error or near error.
Guided Care Study Launched for Seniors With Chronic Conditions
Researchers at the Johns Hopkins Bloomberg School of Public Health recently announced the launch of a 5-year study of a new approach to health care—Guided Care. The study places specially trained registered nurses in primary care practices in the Baltimore–Washington, D.C., area and northern Virginia. In Guided Care, a specially trained RN helps 2 to 4 primary care physicians provide coordinated comprehensive health care for chronically ill older patients. The study will measure the effects of Guided Care on the quality of life and on the overall health care costs and is supported by grants from the U.S. Agency for Healthcare Research and Quality, the National Institute on Aging, the John A. Hartford Foundation of New York City, and the Jacob and Valeria Langeloth Foundation.
Inappropriate Medication Use in the Elderly Continues
In a recent study funded by the Agency for Healthcare Research and Quality (AHRQ), pharmacy data for more than 157,000 elderly members from 10 geographically diverse health maintenance organizations (HMOs) were calculated. The researchers studied the use of 33 potentially inappropriate medications from January 2000 through June 2001 in these patients. The results were disturbing: despite more than a decade of concern and recommendations against the use of potentially inappropriate medications in the elderly, 29% of HMO enrollees 65 years of age or older received at least 1 of the 33 potentially inappropriate medications during the period of the study. For the full study, see the article in the Journal of the American Geriatrics Society (Simon et al., 2005;53:227-32).
Beginning-of-the-Month Error Spike
In an article published in the January issue of Pharmacotherapy, the journal of the American College of Clinical Pharmacy, sociologist David Phillips from the University of California at San Diego documented the first study to demonstrate a beginning-of-the-month spike in deaths attributed to mistakes in prescription drugs. In the first few days of each month, fatalities due to medication errors rise by as much as 25%. The primary suspect is the increase in pharmacy workloads at the beginning of the month and a consequent increase in error rates. Government assistance payments to the elderly and sick are typically received at the beginning of the month, and thus there is generally a corresponding spike in the purchase of prescription medicines at that time. As the pharmacy workload increases, the error rates go up as well. Suggested solutions for the problem include increasing staffing levels at the beginning of the month and government assistance payments being spread out over the month.
A New Type of Computer “Virus”
While not a virus, according to a recent study presented at the 15th Annual Sessions of the Society for Healthcare Epidemiology of America in Los Angeles, some potentially harmful bacteria can survive for prolonged periods of time on the keyboards and keyboard covers of computers. The problem is especially important in hospitals and other health care environments where patients are at higher risk of contracting bacterial infections from health care providers who use computers. The authors of the study used bacteria commonly found in the hospital environment: MRSA (methicillin-resistant Staphylococcus aureus), VRE (vancomyin-resistant Enterococcus faecium), and PSAE (Pseudomonas aeruginosa). The bacteria were capable of prolonged survival with growths of the bacteria evident 24 hours after contamination. Infections caused by these 3 bacteria can be life threatening, but usually do not cause problems in healthy people. However, they can be deadly for hospitalized patients whose immune systems are compromised by other disease or illness. In addition, recent outbreaks of MRSA skin infections in otherwise healthy persons (community-acquired MRSA) have raised concern among infectious disease experts. The authors of the study tested the effectiveness of several disinfectants but maintained that the most important disease prevention strategy remains to wash one’s hands with soap and water before patient contact.
EPA’s Aging Initiative
The Environmental Protection Agency’s (EPAs) Aging Initiative, which is working to protect older adults from environmental health risks through the coordination of research, prevention strategies and public education, is available at the EPA’s Web site: www.epa.gov/pesticides. Information on pesticides and tips for pesticide use are available. Remember, in event of poisoning, the National Poison Control Center can be reached at (800) 222-1222.
Recalls
Misbranded Hospital Bed Systems Seized
In March 2005, the Food and Drug Administration (FDA) initiated seizures of all finished Vail 500, 1000, and 2000 Enclosed Bed Systems made by Vail Products of Toledo, Ohio. According to a news release, use of these systems pose a public health risk because patients can become entrapped and suffocate, resulting in severe neurological damage or death. Consumer inquiries should be directed to the toll-free number: (888) INFO-FDA [(888) 463-6332].
Product Recall
The FDA has recently notified health care providers and patients that the Guidant Corporation is recalling certain implantable defibrillators and cardiac resynchronization therapy defibrillators. These devices can develop an internal short circuit without warning, resulting in failure to deliver a shock when needed. Models covered by this recall are the PRIZM 2 DR, Model 1861, manufactured on or before April 16, 2002; CONTAK RENEWAL, Model H135, manufactured on or before August 26, 2004; and CONTAK RENEWAL 2, Model H155, manufactured on or before August 26, 2004.
If you know of patients with these units, they should contact their doctor to determine the best course of action.
Resources
Medicare Prescription Drug Program Information Packets
Drs. Barbara Resnick and Kathleen Jett have recently prepared a comprehensive document for the Coalition of Geriatric Nursing Organizations on the upcoming changes in Medicare/Medicaid prescription drug benefits. The information can be used to help educate clients and their families concerning changes in Medicare and Medicaid prescription drug benefits and is a comprehensive overview of the various options available. The packet of information is available for download at the Hartford Web site: www.hartfordign.org.
Single Source for Patient Safety Findings and Resources
The Agency for Healthcare Research and Quality (AHRQ) has recently launched a new Web site that serves as a 1-stop location for resources pertaining to improving patient safety and preventing medical errors. The new resource represents the first comprehensive effort to help health care providers, administrators, and consumers learn about all aspects of patient safety. Users of the site can customize the site around their unique interests by creating a home page for themselves. Subscribers can access weekly PSNet updates. For additional information, go to the Web site available at http://psnet.ahrq.gov.
Congratulations
Our own Tina M. Marrelli, MSN, MA, RN, section editor for the Home Health Column of Geriatric Nursing for the past several years, has recently been named the new Editor-in-Chief of the Home Healthcare Nurse journal. Marrelli, a graduate of Duke University School of Nursing, holds master’s degrees in health administration and nursing and has more than 25 years of experience. We extend out best wishes to Tina in this new endeavor.
NADONA/LTC recently announced that it has been awarded the ANA-SNAPG (American Nurses Association—Specialty Nursing Association Partners in Geriatrics) implementation grant for the period of February 2005 through January 2007. Only 10 specialty nursing associations are eligible for this grant program according to the group’s vice president, Lepaine Sharp-McHenry, RN, MS, FACDONA, so NADONA/LTC is honored to be among this esteemed group. The grant will be used to further develop 3 regional education programs focused on best practices of geriatric care in long-term care.
In other NADONA/LTC related-news, Charlotte Eliopoulos, a specialist in holistic gerontologic and chronic care nursing, will join NADONA/LTC as their new director of education. In this position, Eliopoulos will collaborate with NADONA members and staff to assess the education needs of the membership and will develop and implement programs to address those needs.
Earlier this year, American Retirement Corporation (ARC), announced that it was providing NADONA memberships to 25 Directors of Nursing at their various ARC facilities. Joan W. Saunders, executive director/founder of NADONA/LTC, says she is thrilled to see leading health care companies actively encouraging the pursuit of professional knowledge and support through NADONA.
Passages
Cynthia Kelly, a leader in the geriatric nursing field, former editor of the American Journal of Nursing (1972–1978), and the inaugural editor of Geriatric Nursing (1979–1986), passed away on June 23, 2005, at Foulkeways, A Friends (Quaker) Retirement Center in Gwynedd, Pennsylvania. (Please see editor’s article on page 271 of this issue).
PII: S0197-4572(05)00227-2
doi:10.1016/j.gerinurse.2005.08.016
