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Archive for the ‘Patient safety’ Category

Should a Nurse go to Prison for Reporting Concerns about a Physician? by Pat Iyer

Wednesday, February 17th, 2010

Anne Mitchell RN

Two West Texas nurses faced up to 10 years in prison and a fine of up to $10,000 for reporting concerns about the substandard care of Dr. Rolando Arafiles Jr. How did this happen? Nurse Vicki Galle and Nurse Anne Mitchell were part of the tiny staff of a tiny hospital in a tiny town in West Texas. Winkler County Memorial Hospital has 15 beds, employs 15 registered nurses and 17 licensed practical nurse, and has 7,000-8,000 people in the entire county. Both nurses worked at the hospital for over 20 years. Vicki and Anne reported concerns about Dr. Arafiles to the Texas Medical Board. They, as well as others, were concerned that his practices were inconsistent with the quality of care and patient safety. They were also concerned about his use of non-therapeutic treatments and prescriptions. The two nurses provided medical record numbers to the Board, but no patient names, to support their concerns.

When the physician was notified by the Texas Medical Board that he had been reported to the Board, he filed a complaint with the sheriff (who was one of his patients) alleging that he was being harassed. Sheriff Roberts tracked down the two nurses, who were indicted for misuse of official information and fired. The Texas Medical Board wrote a letter to the District and County Attorneys of Winkler County challenging the notion that the information provided to them was for nongovernmental purposes. They explained that the Board was exempt from HIPAA requirements and is a governmental agency.

Nevertheless, the case proceeded. Nurses throughout the country responded with an outpouring of support and dollars to build up the legal fund for the nurses. Patient advocacy, specifically reporting concerns about a practitioner’s standard of care, is protected under Texas laws and supported by the Nursing Code of Ethics. The case was seen as having the potential to affect the future of patient safety throughout the entire country.

The criminal case against Nurse Galle was dismissed on 2/1/2010, a week before trial was to start. But the case against Nurse Mitchell proceeded. The jury heard details of the cases of substandard care. During cross-examination, Dr. Arafiles struggled to define “standard of care”.

Doctor Rolando Arafiles said he supports the reporting process, but not in this case, because he felt Anne Mitchell was harassing him when she sent an anonymous complaint to the Texas Medical Board. The defense grilled the doctor about medical mistakes he made including one where he injected a needle into the bone of a patient and another where he sent a child with appendicitis home without treatment. The prosecution and defense agreed to nickname the instances on record in which Dr. Arafiles made medical mistakes. Those cases are being called, “Turkey Toe”, “Appendix Boy”, “Rubber Finger Tip”, and “Skin Graft”. “Rubber Finger Tip” references the instance when Dr. Arafiles sewed a part of a suturing kit onto a patient. It was a part of the kit not meant to be used on patients. During testimony, Dr. Arafiles said he meant to use it as a brace and accidentally sewed it to the patient.

During his cross-examination, Dr. Arafiles discussed the nutritional supplement called “Zrii” that he recommended to patients. The doctor admitted that Sheriff Roberts sold Zrii and even held meetings at the local Pizza Hut to recruit others to sell the product. According to the defense, the main ingredient in Zrii is white grape juice and it sells for around $40 a bottle.

At one point Dr. Arafiles was asked whether diabetic patients might have a tendency to heal worse than patients without diabetes. To the dismay of the audience, he said no, that there is no difference. The audience gasped, after which point Hon. Judge James Rex told the audience to keep quiet or else risk being thrown out of the courtroom.

It took the jury less than an hour to return a not guilty verdict on 2/11/2010. The jury foreman said the panel of six men and six women voted unanimously on the first ballot, and questioned why Nurse Mitchell had ever been arrested. “We just did not see the wrongdoing of sending the file numbers in, since she’s a nurse” said the foreman. After the verdict, the nurses’ lawyers quickly turned to the lawsuits they filed in federal court against the county, the hospital, and various officials, charging that the firings and indictments amounted to a violation of due process and their First Amendment rights. Nurse Mitchell’s lawyer said, “We are glad that this phase of this ordeal has ended and that Anne has been restored to her liberty, but there was great damage done in this case, and this does not make them whole.”

President of the American Nurses Association Rebecca Patton called the verdict “a resounding win on behalf of patient safety. The message the jury sent is clear: the freedom for nurses to report a physician’s unsafe medical practices is non-negotiable.”
Sources:
http://www.nytimes.com/2010/02/12/us/12nurses.html
http://www.texasnurses.org
cbs7news, Beau Berman

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Tags: Anne Mitchell RN, patient advocate, Rolando Arafiles MD, whistleblower, Winkler County
Posted in Communication skills, Medical malpractice, Patient safety | No Comments »

Why inexperienced people make mistakes

Tuesday, January 26th, 2010

A group of residents eagerly perform complex surgery in the middle of the night while the attending surgeons who are supposed to supervise them are happily sleeping at home. Why is this very real scenario a bad idea? Why do interns, residents, nurses, and others make errors that injure patients? The answer lies in learning theory.

The Dreyfus Model of Skill Acquisition used by Pat Benner, a nursing theorist, breaks knowledge into two components: “techne” and “phronesis”. Techne knowledge is book knowledge: the information that is captured from procedural or scientific knowledge. The student must be given safe and clear directions on how to proceed, as there is no previous experience on which to draw. For example, a student nurse I supervised discovered her patient was short of breath. She attributed the symptom to anxiety, talked to the patient about her concerns, and held her hand. A more experienced person would have applied oxygen.

The second kind of knowledge is phronesis, which is acquired through learning in the practice setting. A nurse who makes a series of rapid decisions during an emergency draws on phronesis. The rapid response team members in hospitals are made up of experts who use this kind of knowledge.

The evolution of the expert practitioner passes through stages

Benner’s model of expertise, which is based on the Dreyfus model, describes how an individual may pass through five stages in developing expertise. Not everyone reaches the proficient or expert stage.

The novice rigidly adheres to rules or plans, has little situational perception and can’t make judgments. This individual is learning skills in clinical settings and must be closely supervised when delivering patient care.

The advanced beginner is a new graduate. The person functions with limited situational perception (the ability to put clues together to make decisions) and has difficulty discriminating between what is important.

The competent practitioner can see his or her actions within a broader context, and is capable of making sounder judgments. Conscious deliberate planning takes place along with standardized and routine procedures.

The proficient individual sees the situation holistically rather than in terms of its component parts. This individual more readily makes decisions, perceives differences from the normal pattern of a patient, and functions better with ambiguity. The proficient person has learned from experience and has an easier time making decisions.

The expert practitioner no longer relies on rules, guidelines or maxims, and intuitively grasps what is important in a situation. A registered nurse with expert knowledge may well exceed the knowledge of inexperienced physicians and may save a patient’s life by insisting on evaluation, diagnostic testing, change in medication, or another needed course.

A clinically experienced person enters a new healthcare setting as a new employee without knowledge of the politics, procedures, and policies. It takes time to learn “how we do it here.”

And thus we face the dilemma in health care: an inexperienced person will not learn without the opportunity to do so. He or she has to start somewhere. Yet, we don’t want that person to learn on us, our mother or father or child. When my husband had a triple bypass three months ago, the cardiac surgeon at Johns Hopkins proactively told us that he performed surgery. He said he had people in the operating room helping him, but he did the surgery. We were relieved to hear that.

A fair number of medical or nursing malpractice cases that come into Med League involve errors made by inexperienced people, whether they are new employees or new healthcare practitioners. Here are my suggestions:

Attorneys handling medical or nursing malpractice cases should be careful to determine the level of experience of the defendant. Determine the degree of supervision that should have been provided versus what was actually provided.
Ask about the orientation program the new employee should have received. Determine how much orientation staff agency employees received.
Ask the defendant if he or she sought help. Some of us, whether because of age, culture, or personality, would rather try to solve problems without help. This can be a recipe for disaster.
If you or a loved one needs care, seek the most experienced practitioner or hospital you can find.
If you or a loved one detects the person assigned to your care seems unfamiliar with your needs or medical equipment, insist that individual seek help from a more experienced person. Be an advocate for safety.
If you or a loved one needs surgery in a teaching hospital, insist that the attending physician be present. You may even cross off the consent form that allows residents and interns to perform parts of the surgery.

What do you think? How should inexperienced people learn? Send us a comment.

Parts of this blog post came from Moniaree Parker Jones, “Nursing Expertise: A Look at Theory and the LNCC certification Exam”, Journal of Legal Nurse Consulting, Spring 2007. Other parts came from the School of Hard Knocks.

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Tags: making mistakes, medical errors, Medical malpractice, personal effectiveness
Posted in Healthcare Risk Management, Legal nurse consulting, Medical malpractice, Nursing malpractice, Patient safety, medical errors | No Comments »

Emergency Medicine On Board

Monday, January 11th, 2010

I was sleeping on a flight to Brazil when my husband woke me up and told me a passenger needed medical attention. I walked to the back of the plane where a middle age Brazilian man was holding his chest. Through an interpreter, I found out he had chest pain. He looked pale and frightened; his pulse was rapid.

Giving medical care on an airplane

I asked the flight attendant if she could give him oxygen. She produced an oxygen tank and mask; there was nothing else I could do. The ambulance met the plane in Sao Paulo and he vanished from my life.

Be sure to fly with any medication you might need on a an emergency basis- nitroglycerin, inhalers, and so on. The story below made me think of my Brazilian experience. She discusses the medical and legal aspects of rendering care on a plane.

One physician learns firsthand that you are never really off-duty: An emergency on a flight teaches a young doctor that she’s never off duty by Laura Syndman MD

I met Brent after he was dead.

Neighboring passengers later told me that he took one bite of his sandwich and then his head dropped back. It wasn’t until 10 minutes later, when his wife tried unsuccessfully to wake him, that anybody realized anything was wrong.

I was sitting in Business Class with my parents – a trip to France to celebrate my near-completion of my Intern year in Internal Medicine (just 2 weeks of night float still to go). About 15 minutes after passengers were allowed to unbuckle their seatbelts, a flight attendant ran to the front of the plane, grabbed an AED and raced back down the aisle to Coach.

I was sitting across the aisle from my father, who had 30+ years of medical experience under his belt in comparison to my 11.5 months. “Should we go back there?” I asked, but my father said they would call for a doctor if they needed one.

I decided to check it out anyway.

Behind the curtain was a scene I will never forget: a man lying in the aisle with his feet towards the front of the plane, one flight attendant doing mouth-to-mouth, one doing chest compressions and a third attaching the AED pads. I tapped the last flight attendant on the shoulder, “Do you need help? I’m a doctor.”

“We’re fine,” he said, which surprised me. I wasn’t expecting that. Granted, I was in baggy pants, sneakers and a hooded sweatshirt, but was it protocol to decline help from a physician in a medical emergency aboard an aircraft?

Use of Technology to Save Time by Pat Iyer

Monday, October 5th, 2009

analog devices

Consider how much technology has changed our personal lives. Would we go out without a cell phone? Would we use a travel agent to make flight arrangements? Would we go to the bank to transfer money when we could do so on line? I realized just how much technology affects us when I described the usefulness of OneNote, a Microsoft program, to one of my 26-year-old son’s friends. OneNote enables you to set up sections of notebooks and collect the stray bits of information that drift into your life. My son’s friend was grateful to know there was a digital solution for collecting and organizing data. He said, with a look of horror, that before I told him about One Note, he had been considering “going analog”. It took me a few seconds to realize he was discussing what was to him the most archaic of practices- writing something with a pen.

Nurses are relying increasingly on mobile applications as patient safety and productivity tools, a recent survey showed. “Nurses can quickly look up clinical information on their mobile device right at the patient’s bedside, which helps reduce medication errors and save precious time,” Snyder said. Pam Davis, RN, program director for Centennial Medical Center’s bariatric surgery product line, agreed. She has been using Epocrates for the past four years, initially as a case manager. In her current position, she provides educational information for her patients. This program can be downloaded for free onto Blackberrys, Iphones, Palm Pilots and Windows Mobile devices.

Instead of hauling out the hefty paper drug reference, Davis can search for updated medication information “at her fingertips,” she said. Davis is not alone. More than half of the survey respondents noted they look up drug or disease information on their mobile devices during patient consultations. “Technology makes the processes more efficient,” Davis said. “It makes encounters with patients more effective.” Forty-eight percent of respondents said they have saved more than 30 minutes per day using Epocrates’ drug formulary and reference. Using a mobile application has reduced the time spent on labor-intensive paper charting, Davis said. Davis said that Nashville-based Centennial Medical Center has felt the constraints of the nursing shortage, although the health system has not had to lay off any nurses because of the economic recession. Having health IT has helped nurses do more with less, she said. If nurses are fully trained and the technology is utilized appropriately, mobile device applications are “definitely a time saver,” she said.

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Tags: healthcare technology
Posted in Medication errors, Patient safety, medical errors | No Comments »

Emergency Department Mistakes by Pat Iyer

Monday, September 21st, 2009

Errors in the Emergency Department

Most of the mistakes in the emergency department (ED) that have the potential to compromise patient safety are caused by human error, according to a study published online September 18 in BMC Emergency Medicine. “[EDs] are challenging hospital settings with regard to patient safety. There is an increased sense of urgency to take effective countermeasures in order to improve patient safety,” Marleen Smits, MD, from the Netherlands Institute for Health Services Research, Utrecht, and colleagues write. “This can only be achieved if interventions tackle the dominant underlying causes.”

The aim of this study was to examine the nature and causes of unintended events in EDs and the relationship between type of event and causal factor structure. The study evaluated medical errors in the EDs of 10 hospitals in the Netherlands (1 university hospital, 3 tertiary teaching hospitals, and 6 general hospitals) for 8 to 10 weeks. ED staff members were asked to report all unintended events, no matter how trivial or commonplace, that could have harmed or did harm a patient. A total of 522 events were reported, ranging from 46 to 71 per ED, for an average of 52 reports. Most of the reports (85%) were made by nurses; resident physicians or consultants reported 13% of the unintended events, and clerical staff reported 2%. The reporter was directly involved in 83% of the unintended events. Most occurred during daytime hours (44%); 34% occurred during evening and night, and for 22% of the unintended events, the time of occurrence was unknown or unspecified by the reporter.

Most errors occurred during medical examinations or lab tests (36%). More than half of the unintended events (56%) had consequences for the patient, and in 45% of these instances, the patient suffered some inconvenience, such as prolonged waiting time. One third of patients received suboptimal care, such as a delay in starting antibiotic treatment. The consequences of error were more severe in the 8% of patients who required an extra intervention, the 6% of patients who suffered pain, and the 3% of patients who suffered a physical injury, Dr. Smits and colleagues write.

Most root causes of error were human (60%), followed by organizational (25%) and technical (11%) causes. Nearly half of the root causes could be attributed to other departments either in or outside of the hospital. In citing limitations to their study, the investigators note that, because the reporting was not anonymous, it is possible that certain mistakes were underreported. “This may have biased the results towards the reporting of less significant events, events without consequences for the patient, and errors originating in other departments, because these are ’safer’ to report.”

In addition, most errors were reported by nurses, and therefore the study results give information about events that are mainly related to nursing care and less to care by residents and specialists in the ED. Although the majority of errors had no consequences for the patient or resulted in only minor inconveniences, their accumulated effect on patient well-being is likely to be large, the authors write. They conclude: “Event reporting gives insight into diverse unintended events. The information on unintended events may help target research and interventions to increase patient safety. It seems worthwhile to direct interventions on the collaboration between the ED and other hospital departments.”
BMC Emerg Med. Published online September 18, 2009.

Comments: The results of the study are intriguing. Are nurses really making the majority of errors, or are they more likely to report errors than physicians?

I am moderating a webinar on the topic of emergency department liability on September 30. Our panel consists of an emergency department physician, an emergency department nurse, and a plaintiff’s attorney. We’ll share case studies and discuss what makes a valid case for the plaintiff or an easily defensible case. Join us!

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Tags: emergency department medical errors, emergency room errors
Posted in Medical malpractice, Nursing malpractice, Patient safety, medical errors | No Comments »

2010 National Patient Safety Goals by Pat Iyer

Wednesday, September 16th, 2009

MRSA skin infection

The Joint Commission has released the 2010 National Patient Safety Goals. The Joint Commission sets standards for, evaluates, and accredits more than 16,000 healthcare organizations and programs in the United States. These include hospitals and home health agencies as well as ambulatory care services, behavioral health programs, clinical laboratories, and long term care organizations. In addition, The Joint Commission provides certification of disease-specific care programs, primary stroke centers, and health care staffing services.

The 2010 effort has streamlined the goals, refined language, and emphasized the importance of the healthcare-associated infections goal. This goal was first released in 2009 and is to be fully implemented in 2010. There has been increased attention paid to the development of healthcare-associated infections due to multi-antibiotic resistant organisms. Some states collect information from hospitals and report on the incidence of such infections. Some plaintiff attorneys have filed suits related to hospital-acquired infections, under these theories of liability:

Transmission of infection to the patient
Delay in diagnosis of infection
Improper treatment of infection

The 2010 Goal applies to methicillin-resistant staphylococcus aureus (MRSA), clostridium difficile (c-diff), Vancomycin-resistant enterococci, multidrug-resistant gram-negative bacteria, among others organisms. The goal focuses on:

Conduction of periodic risk assessments for multidrug-resistant organism acquisition and transmission
Provision of education for staff at the time of hire and annually thereafter
Education of patients and families who are infected or colonized with a multidrug –resistant organism about healthcare-associated infection strategies
Implementation of a surveillance program for multidrug-resistant organisms based on the risk assessment
Measurement and monitoring of prevention processes
Provision of multidrug-resistant organism process and outcome data to key stakeholders, including leaders, licensed independent practitioners, nursing staff and other clinicians
Implementation of policies and practices aimed at reducing the risk of transmitting multidrug-resistant organisms
When indicated by the risk assessment, implementation of a laboratory-based alert system that identifies new patients with multidrug-resistant organisms
When indicated by the risk assessment, implementation of an alert system that identifies readmitted or transferred patients who are known to be positive for multidrug-resistant organisms

What can you do to protect yourself and your loved ones in a healthcare environment? The single biggest action you can take is to insist that healthcare providers wash their hands before contact with the patient. This is not the time to be shy. Speak up. This is an issue foremost in my mind this week as my husband prepares to enter the hospital for a triple bypass. I’ll be washing my hands before touching him and trusting that the healthcare providers will do the same.

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Tags: hospital-acquired infection, MRSA, National Patient Safety Goals, nosocomical infections
Posted in Damages, Healthcare Risk Management, Joint Commission, Medical malpractice, Patient safety | No Comments »

Using technology to make patient care safe by Pat Iyer

Monday, September 14th, 2009

A recent issue of Healthcare Informatics provides hope that technological advances can improve patient safety. One of the most significant barriers to care delivery is communication. Nurses, says Turisco, are often placed in the middle of the communication loop, where they constantly receive and place calls to physicians, pharmacy and lab, all while trying to tend to patients. Fran Turisco is research principal in the Waltham, Mass.-based Emerging Practices Healthcare Group of CSC (Falls Church, Va.) “So the issue is how you cut out some of the middle men in these communication loops,” she says. “And how do you shorten the time frame between when a nurse needs to talk to someone and when she actually gets to talk to that person, then either make a care decision or figure out what needs to get done next.” Nurses act as the hub in the wheel, and communicate with every other department in a healthcare facility. This communication is vital but time-consuming.

A hands-free voice activated badge in use at University Hospitals Case Medical Center in Cleveland, leadership addressed the problem by rolling out hands-free communication systems from San Jose, Calif.-based Vocera in the NICU. The technology enabled clinicians to call for assistance or answer pages by using a voice recognition button. With the badges, which run on the hospital’s wireless platform, nurses can call for help or communicate with colleagues across departments. This innovation addresses the ongoing issue of placing calls to others, and being interrupted when the call is returned.

Bar-code technology is gaining ground as a way to reduce medication errors. The medication is scanned at the bedside and verified as being correct for the patient, whose arm band is also scanned. The system catches errors at the point of administration, the last step before the medication enters the patient.

Another common theme in patient safety is workflow issues. A number of organizations are addressing the problem by deploying patient flow systems to provide nurses with improved visibility of both bed availability and patient status. With these solutions, instead of making several calls and chasing down charts, nurses can look at a screen to find out what rooms are available, how long patients have been waiting to see a physician, and when patients need to be turned.

When I was a nursing quality assurance coordinator, we tackled the seemingly simple issue of getting beds ready after a discharge. The backup of patients in emergency departments, medical surgical units, and recovery rooms waiting for a bed has important quality of care issues. One of the biggest selling points for patient flow systems, according to Turisco, is the ease of use factor. “It’s one of these technologies that you almost think is too good to be true because it’s not that hard to install. You can configure it in a short period of time to do exactly what you want.”

Here are the take home messages:

The proliferation of wireless technologies in the hospital setting has significantly impacted the way nurses deliver care.
The primary goals chief information officers are looking to achieve in implementing wireless technologies are to improve communication, workflow efficiency and patient safety.
Organizations that have successfully implemented wireless technologies have had nursing leaders involved in every key step of the process.

Read more about 10 common errors and what is being done to make patient care safer here.

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Tags: technology and patient safety
Posted in Communication skills, Patient safety | No Comments »

How a medical malpractice suit can make a difference by Pat Iyer

Thursday, September 10th, 2009

The story of Josie King

Why do people file medical malpractice suits? One reason is to get answers about what happened to result in the injury. Another is to prevent the same thing from happening to another person. Although risk managers, practitioners, and administrators may make changes after a bad outcome has occurred, it is not often that the plaintiff gets the satisfaction of knowing that. It is even rarer the terms of a settlement to solidify a plan to share the details of a medical tragedy.

A recent Oregon case shows the power of sharing a lesson that will protect other patients. The plaintiff was an 8-month-old infant who entered a hospital for removal of a cyst that extended through his nose to his brain. The surgery was without complications. After surgery, the infant had fevers, pneumonia, and showed signs of a possible cerebral spinal fluid leak. The discharging physician was a first year resident; the attending neurosurgeon did not see the infant on the day he was discharged. Eight hours after discharge, the infant was taken to the emergency department of another hospital because he was vomiting and lethargic. The emergency department physician called the defendant hospital and was advised that the infant was probably having a medication reaction. The parents returned eleven hours later, when their child was profoundly ill. There was no clear evidence of a systemic infection and possible brain damage.

The infant was emergently transported back to the defendant hospital. He was diagnosed with meningitis, brain damage, and organ failure and suffered a stroke. He requires a ventilator twelve to twenty hours a day, is tube fed, and without effective use of his legs or left arm. He is profoundly developmentally delayed and does not talk. A $12.2 million settlement was reached. The hospital also committed to use the case as a teaching example for its residents for the next ten years and to provide certification of this to the plaintiff’s parents each year from the president of the university.

Source: Lewis Laska, “Infant discharged following brain surgery without being seen by anyone other than junior resident”, Medical Malpractice Verdicts, Settlements, and Experts, February 2009, page 19

The power of sharing the lessons learned from a tragedy of this nature is huge. Unfortunately, it is rare for plaintiffs to achieve this kind of gain. I can think of another case – one we handled at Med League-in which this occurred. I was involved in a Philadelphia case of a young man who developed leg pain and shortness of breath on the day of discharge. The nurse did not inform the physicians, and the man was discharged via telephone order. He collapsed at home and died from a pulmonary embolism. As part of the settlement, the hospital made a policy that a patient had to be seen in person on the day of discharge. They also agreed to use this case in teaching each group of interns and residents.

Anyone not familiar with the story of Josie King, an 18-month-old child who died as a result of medication error, should visit the Josie King Foundation . I heard Sorrel King, Josie’s mother, talk three years ago. Her story lingers. Sorrel took the settlement money provided by Johns Hopkins, the hospital where the incident occurred, and put it back into patient safety efforts. Her work has saved lives of people all over the world. A new book pictured above, has just been released, which describes her crusade.

The key to educate, change, and inspire healthcare professionals with lessons learned so that deaths and injuries make a difference in daily practice.

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Tags: Josie King, Medical malpractice, medication error, why people sue
Posted in Damages, Healthcare Risk Management, Medical malpractice, Medication errors, Nursing malpractice, Patient safety | No Comments »

Has the Nursing Shortage Gone Away? By Pat Iyer

Wednesday, August 19th, 2009

Your life may depend on a nurse

Prior to the recession, dire predictions about the coming shortages of nurses and faculty stressed the need to recruit and retain more nurses. Then, spouses lost jobs and non-working nurses returned to the workplace. Fully staffed facilities, layoffs, and financial collapse and closure of some hospitals have resulted in difficulty finding nursing positions.

Can we relax about the nursing shortage? Unfortunately not. The numbers are working against us. Both nurses and nursing faculty are aging. Take New Jersey, which is likely typical of the nationwide problem. More than half of New Jersey’s nurses are between the ages of 46 and 60, with an average age of 50. This means that nearly a third of the state’s workforce will reach retirement age in the next decade. Simple- just educate more people to become nurses, right? Unfortunately not. Nursing faculty are in short supply, and their average age is 55. The nursing curriculum requires extensive clinical experience and prevents a large number of students (more than 10) to be assigned to a clinical instructor. Nursing schools must limit the number of students who can be safely supervised. More than half of New Jersey’s schools of nursing already restrict student enrollment because of limited numbers of faculty, and thus are turning away people who want to go into nursing.

Several studies performed by Dr. Linda Aiken of University of Pennsylvania have directly tied the quality of care with the number of registered nurses. The more patients the nurse is responsible for, the worse the care. The availability of well educated and experienced nurses has a direct impact on the quality of nursing care and the outcomes for patients. Many of the medical or nursing malpractice cases our company has been involved are associated in some way with inexperienced nurses.

How are we going to fix the nursing shortage? Some grant money is becoming available to help subsidize education for developing more faculty. Schools must be able to pay faculty a decent wage to compete with the higher levels of compensation earned by nurse practitioners. Work environments must respect the unique contributions of nurses and make them an integral and valued part of the healthcare team. Retention programs must flourish. Let your state elected officials know you support funds for nursing education. Your life may depend on having a nurse at the bedside.

Source of statistics: Innovative public/private partnership launches in state legislative hearing, New Jersey Nurse, July/August 2009

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Tags: Linda Aiken, Nursing malpractice, nursing shortage
Posted in Medical malpractice, Nursing malpractice, Patient safety, Priorities | No Comments »

Reducing Distractions is Reducing Medication Errors – by Pat Iyer

Wednesday, August 12th, 2009

The sterile cockpit means no interruptions at critical times

My father was fascinated by airplanes when I was little. I recall going to Idlewild Airport in New Jersey to watch planes land. My father was trained as an aeronautical engineer. Little did I know as a child the lessons of the airline industry would spread to healthcare and set an example for systems to reduce patient errors. Crew or Cockpit Resource Management is a term that began in 1979 as a way of defining ways to reduce pilot error through better use of the crew. The patient safety movement is now taking lessons from the airline industry. The airline industry has defined the sterile cockpit as a place which controls interruptions during critical moments of flight.

Nurses prepare medications in busy hallways of hospitals and nursing homes. It is easy to interrupt and distract a nurse during the critical steps of preparing medications. Some concerned experts in patient safety suggest the use of a vest to be worn by a nurse during medication administration. The bright orange vest says, “Do not disturb.” I first heard about the use of vest when Gary Sculli, a former pilot turned nurse, spoke to the New Jersey chapter of the American Society of Healthcare Risk Management (ASHRM). I have been an ASHRM member for many years.

Nurses at Kaiser South San Francisco Medical Center ordered bright orange, construction-style vests off the Internet, which the nurses thought looked “cheesy.” They also found them hot and resisted sharing them with fellow nurses. “They felt it was demeaning,” said Becky Richards, RN, BSN, MA, adult clinical services director Richards. But of even greater concern, despite education about not interrupting nurses during med passes, the vests seemed to attract attention. The hospital tried again on a renal floor, with separate medication rooms. But again, it just didn’t seem to click. “We were really thinking about abandoning the whole idea, because the nurses did not like it,” Richards said. But when the medication administration data came in at the end of the year, the hospital found that during the four and five months after the pilot finished, those two units combined had a 47 percent decrease in errors. The units had not done anything else to reduce errors, just the education about no distractions and the vests.

“At that point we knew we could not turn our backs on our patients,” Richards said. The quality forum nurses tweaked the program, finding more attractive neon yellow vests and reaching out to the medical staff, housekeeping and other departments for support. Kaiser South San Francisco kicked off the new program hospital-wide in April 2007, with the exception of oncology, which refused to participate, writing letters and signing a petition. The hospital decided not to play hardball.

“We were blown away in May. The hospital experienced a 20 percent decrease in medication errors, even though one unit refused to participate,” Richards said. “And that was the only unit that experienced an increase from their previous month’s error rate.”
Source: Decreasing Disruptions Reduces Medication Errors – NurseZone

This report verifies the importance of creating a safer environment for preparing medications. Controlling interruptions and eliminating distractions saves lives.

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Tags: crew resource management, CRM, medical errors, Medication errors, Patient safety, sterile cockpit
Posted in Medical malpractice, Medication errors, Nursing malpractice, Patient safety | 1 Comment »

Medical-Legal Topics

Archive for the ‘Patient safety’ Category

Should a Nurse go to Prison for Reporting Concerns about a Physician? by Pat Iyer

Why inexperienced people make mistakes

Emergency Medicine On Board

Use of Technology to Save Time by Pat Iyer

Emergency Department Mistakes by Pat Iyer

2010 National Patient Safety Goals by Pat Iyer

Using technology to make patient care safe by Pat Iyer

How a medical malpractice suit can make a difference by Pat Iyer

Has the Nursing Shortage Gone Away? By Pat Iyer

Reducing Distractions is Reducing Medication Errors – by Pat Iyer

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