Winston FK, et al. Acute traumatic stress symptoms in child occupants and their parent drivers after crash involvement. Arch Pediatr Adolesc Med. 2005;159:1074-1079.
It is estimated that 1.5 million children are involved in motor vehicle crashes in the United States each year. Previous research has found an association between acute stress disorder (ASD) symptoms, which occur within the first month after a motor vehicle crash, and the later development of posttraumatic stress disorder symptoms that may impair functioning. The purpose of this study was to examine the prevalence of ASD in both injured and uninjured children and their parents.
Using nationwide data derived from State Farm insurance claims made over a 1-year period from 2001 to 2002, the researchers selected a stratified cluster sample of just more than 1,000 crashes involving children between the ages of 5 and 15 years. Parents were contacted via telephone for a 30-minute interview that included questions related to the key symptoms of ASD. Parents were asked about the symptoms with regard to themselves and their child. Crash severity was determined by driver report, and injury was assessed based on the Abbreviated Injury Scale score.
The probability sample represented 1,483 children involved in 1,091 crashes.
Results indicated that 1.6% of the children and 4.7% of the parents were determined to have ASD symptoms, with 81% of the children and 76% of the parents reporting some degree of impairment as a result of the symptoms. Symptom prevalence was higher in parents and children who received inpatient care. For parents, injury severity of the child predicted the likelihood of ASD symptoms, along with Hispanic ethnicity and lower income (<$40,000).
The sample is limited to those subjects who had healthcare insurance. Therefore, the national rates of ASD may be higher in children and parents than reported in this study.
Results of this study suggest that sustaining injury and received inpatient healthcare are strong predictors of ASD symptoms. It is recommended that healthcare professionals ought to consider screening for ASD in children and their parents when children are involved in motor vehicle crashes, particularly if they sustain injury.
Fetzer S, Manning G. Safety and efficacy of the POP technique for restoring patency to occluded PICC catheters. Appl Nurs Res. 2004;17:297-300.
Peripherally inserted central catheters (PICCs) are used in a variety of settings. It is estimated that 25% of all central line occlusions are caused by intraluminal thrombus. These occlusions lead to delayed or missed treatments and expose the patient to increased risks and costs associated with restoring venous access. A mechanical percussive technique has been reported by clinicians as effective in resoling PICC patency. This technique uses a 5- to 10-mL syringe with 1 mL of normal saline attached to the hub of the catheter. The plunger is pulled back and released at 2-second intervals until patency is restored and thrombus is aspirated. Release of the plunger causes a "pop" sound, sending a shock wave down the catheter. Whether this potentially risky technique is effective in restoring patency remains to be determined. Therefore, the purpose of this in vitro pilot study was to determine if the POP technique was effective.
A certified laboratory was used as the setting to answer the research question. Thirty catheters were clotted with human blood. A 10-mL syringe with 1 mL of saline was used as an effort to restore patency with the POP technique for each catheter up to a maximum of 30 attempts. One researcher performed all the POP techniques.
The POP technique restored patency to 26 (86%) of the 30 occluded catheters. In each of the restored catheters, there was no damage to the PICC, the clot was aspirated into the syringe, and there was no thrombus material observed after the procedure. A range of 1 to 28 POP attempts was needed to restore patency.
Results indicated that the POP technique is a safe and effective method for restoring patency to a PICC occluded in vitro. The POP technique creates a combination of negative pressure that moves the serous fluid surrounding the clot within the catheter, followed by a shock wave within the fluid that collectively dislodges the clot.
Only 1 brand and 2 sizes of a catheter were tested with one size syringe in this study. Larger catheters and syringes may pose risks not identified in this study.
What is your experience with this situation? Do you use the POP technique? Has the POP technique been effective? Would you like to study this further? With further research, the POP technique may become the first intervention to be used when a PICC clot is expected.
Balas MC, Scott LD, Rogers AE. The prevalence and nature of errors and near errors reported by hospital staff nurses. Appl Nurs Res. 2004;17:224-230.
The number of people who die each year because of preventable medical errors exceeds the annual mortality rates attributable to motor vehicle crashes, breast cancer, and acquired immunodeficiency syndrome. Previous research has found that registered nurses intercept most (85%) of the potential medication errors. The purpose of this study was to describe the nature and prevalence of all errors and near errors reported by 393 hospital staff nurses.
All the participants were registered nurses who worked full-time, with more than half (52%) working on medical-surgical or intensive care units. Log books were used to collect the information for the study. Nurse participants completed questions on errors, overtime, days off, sleep patterns, and mood for a 2-week period.
Results indicated that 30% of registered nurses reported at least one error. Most (58%) were medication- related incidents. Medication errors frequently involved drugs such as morphine, insulin, and potassium chloride. Approximately 33% of the actual medication errors were because of late administration. Almost 25% of the medication errors were because of administration of the wrong dose. Another 18% of patients received the wrong drug. Other reported errors were procedural (18%), charting (12%), and transcription (6%).
Findings suggest that high patient acuity and heavy workloads hinder nurses' ability to administer medications in a timely manner. Nurses also reported that communication among all healthcare professionals was a contributing factor in both the etiology and prevention of errors. Nurses should not be expected to prepare and/or mix medications in a distracting environment. It was interesting to note that the use of electronic documentation systems did not prevent the nurses from entering wrong patient data into the computer.
The data from this study provide information for further discussion. It has been suggested that the 5 patient rights be extended to 7-right reason and right documentation. Nurses are the leaders in the identification of strategies to reduce errors and near errors.
UPDATE: A recent survey released by the Kaiser Family Foundation found that most Americans are concerned about the safety of the medical care that they or their family members receive, are dissatisfied with the quality of healthcare, had experienced a medical error, and wanted mandatory reporting of medical errors (http://www.kff.org, accessed December 8, 2004).