The DASH Eating Plan
The DASH plan has been clinically proven to significantly reduce blood pressure. Two studies have revealed how elevated blood pressure levels have been reduced with a diet low in total fat, saturated fat, and cholesterol, and rich in fruits, vegetables, and low-fat dairy products. The eating plan is called the Dietary Approaches to Stop Hypertension (DASH). Clinicians can use the information from the National Heart, Lung, and Blood Institute (NHLBI) Web site (http://www.nhlbi.nih.gov; see last paragraph for full address) to help educate and instruct patients on eating healthy and reducing their total sodium intake. Included in the information are sample menus and easy-to-follow recipes.
The DASH study included 459 adults with systolic blood pressures of less than 160 mmHg and diastolic pressures of 80 to 95 mmHg. Approximately 27% of these adults had received a diagnosis of hypertension. About 50% were women and 60% were African Americans. The DASH study compared three eating plans: a plan that was similar in nutrients to what many Americans consume; a plan similar to what Americans consume but higher in fruits and vegetables; and the DASH eating plan. Each of the three plans included about 3,000 milligrams of sodium daily. In addition to a diet low in fats and cholesterol and high in fruits and vegetables, the DASH plan also included whole-grain products, fish, poultry, and nuts. Red meat, sweets, and sugar-containing beverages were limited. The diet is rich in magnesium, potassium, and calcium and includes protein and fiber.
The results were remarkable. The fruits and vegetable plan and the DASH eating plan reduced blood pressure, but the DASH eating plan had the greatest success, especially with those with high blood pressure. Reduction in blood pressure came quickly, within 2 weeks of starting the plan.
DASH-Sodium was the second study conducted, and it included 412 participants with systolic blood pressures between 120 and 159 mm Hg and diastolic readings averaging 80 to 95 mm Hg. Approximately 41% had high blood pressure; 57% were women and about 57% were African Americans. Participants in this study followed either the DASH eating plan or an eating plan typical of what many Americans consume. They were randomly assigned to one of the two plans and were followed for a month at each of three sodium levels. The three levels were: a higher intake of about 3,300 milligrams per day (the level of the diet of most Americans); one of about 2,400 milligrams per day; and the lower intake of approximately 1,500 milligrams per day.
Results from this study were positive in reducing dietary sodium for both of the eating plans. What was revealing is that at each sodium level, the blood pressure was lowered for those on the DASH eating plan as compared with those on the typical diet. The greatest reduction in blood pressure was found on the DASH eating plan with a sodium intake of 1,500 milligrams per day. Final outcome of the DASH-Sodium study demonstrated the importance of consuming a diet low in sodium, no matter what eating plan you follow. However, for a win-win situation, following the DASH eating plan and lowering salt and sodium intake has the greatest benefit.
Information regarding this and the entire DASH eating plan can be found at the NHLBI Web site at http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/. The plan was last updated November 2005 and includes a 24-page document available for download. Along with the diet and recipes, there is useful information on dining out, comparing food labels, and a form for tracking eating habits before beginning the DASH eating plan.
Using Medication Reconciliation to Prevent Errors
"A systemic approach to reconciling medications must be the foundation for all efforts to prevent drug errors," says JCAHO President Dennis O'Leary. The Joint Commission is encouraging all healthcare providers across the continuum of care to reconcile their patient's medications as they transition from one provider to another. This includes ambulatory, emergency and urgent care, long-term care, and home care, as well as inpatient services. Typically, medication errors occur at the "interfaces of care," where a patient is admitted to, transferred within, or discharged from a healthcare facility.
The United States Pharmacopeia (USP) added three new "Causes of Error" to its MEDMARX reporting program in September 2004. In a period from September 2004 to July 2005, 2,022 reports of medication reconciliation errors were received. Sixty-six percent of these errors occurred during the patient's transition or transfer to another level of care, 22% occurred during the patient's admission to the facility, and 12% occurred at the time of discharge. The Joint Commission stated in its Sentinel Event Alert Issue 35, dated January 23, 2006, "accurate and complete medication reconciliation can prevent numerous prescribing and administration errors."
Medication reconciliation includes five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare these two lists; (4) make clinical decisions based on comparisons; and (5) communicate the new list to the patient and appropriate caregivers. Requirements at a minimum include conducting a reconciliation when orders are rewritten; when a patient changes service, setting, provider or level of care; and when new medication orders are written. These requirements are included in the Joint Commission's 2005 National Patient Safety Goal 8, and agencies are to have these requirements implemented by January 2006.
Additional recommendations include placing the medication list in a highly visible location in the patient's medical record for easy access and viewing by all clinicians involved in the care of the patient. At discharge, the patient and/or caregiver should be provided with a complete list of medications the patient is currently taking, or if the patient is being transferred to another provider of care, a current listing should be provided to the facility.
If you want to read the January 23, 2006, Sentinel Event Alert outlining additional risk reduction strategies and the Joint Commission requirements and recommendations regarding medication reconciliation, log on to the JCAHO Web site at http://www.jcaho.org/about+us/news+letters/sentinel+event+alert/print/sea_35.htm.
HHN's Clipboard is coordinated by
Doris J. Mosocco, RN, BSN, CHCE, COSC