LEGAL LIABILITY
New study alerts RNs to daily practice risks
According to an extensive study analyzing 8,151 nursing professional liability claims from January 1, 1997 through December 3, 2007, your risk exposures may be significantly reduced by following three key recommendations:
* Perform timely patient assessments and document your findings for every patient interaction.
* Communicate all changes in your patient's status to the primary healthcare provider and document those changes.
* Advocate for your patient and use the proper chain of command to ensure appropriate and timely care when the primary healthcare provider isn't available.
The study, issued by CNA Insurance Companies in collaboration with the Nurses Service Organization, provides data on trends related to nursing claims over the past 10 years based on data submitted by CNA-insured nurses. As highly skilled and educated professionals, nurses are charged with making clinical observations, exercising discretion, and taking appropriate treatment actions based on a patient's changing clinical condition. The enhanced role of the nursing profession reflects the increasing number and importance of nursing specialties and areas of condition.
Ironically, the growing prestige and accountability of nurses resulted in greater vulnerability to medical malpractice lawsuits. Examples of claims against nurses cited in the study include the following:
* After an older adult falls, a nurse is sued for failing to change his care plan despite increasing problems with gait and behavior.
* A nurse is sued for failing to note a patient's risk of skin breakdown and initiate appropriate preventive interventions.
* After a patient experiences adverse drug reactions, the family alleges that the nurse failed to administer the drug correctly.
The study also provides risk management recommendations for 12 specific areas of nursing practice, including medication administration, documentation, informed consent, advance directives, cancer screening and diagnosis, and higher-risk specialties (obstetrics/gynecology, emergency medicine, gerontology, cosmetic services, and home care). For a closer look at the study's data analysis and recommendations, visit http://www.nso.com/rnclaimstudy.
Source: CNA HealthPro Nurse Claims Study: An Analysis of Claims with Risk Management Recommendations 1997-2007.http://www.nso.com/rnclaimstudy.
NEEDLE/SYRINGE SAFETY
Stick with the One & Only Campaign
The Safe Injection Practices Coalition, a group of professional and patient advocacy organizations, has launched the One & Only Campaign to remind healthcare workers to use one needle and one syringe only one time. Unsafe needle and syringe practices have exposed more than 60,000 patients to hepatitis B virus or hepatitis C virus during the last 10 years, according to a study released in January by the CDC. The patients were exposed at various hospital and nonhospital settings, including outpatient clinics, hemodialysis centers, and long-term-care facilities. Of those patients, 448 developed hepatitis C viral infection due to poor adherence to "fundamental principles of infection control and aseptic technique," such as reuse of needles or lances.
"As healthcare providers, we interact with people when they are at their most vulnerable," said Jackie Rowles, CRNA, MA, MBA, FAAPM, president of the American Association of Nurse Anesthetists and a promoter of the One & Only Campaign. "[I]t is our duty to follow the highest standards of care, especially with something as basic as providing a safe, sterile injection. There isn't a single reason to reuse-not a single one."
For more information, visit http://www.OneandOnlyCampaign.org.
OBESITY CONTROL
Gastric bypass resolves diabetes
Besides obesity control, gastric bypass surgery can have another significant benefit: Many patients with type 2 diabetes before surgery remain free from the disease for as long as 16 years afterward, according to research presented at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery in Dallas, Tex.
The study involved 177 patients with type 2 diabetes who had gastric bypass surgery between 1993 and 2003. Following them for 5 to 15 years, researchers found that 89% experienced total resolution of their diabetes. These patients also had an average drop in body mass index from 50.2 to 31.3.
Patients with less severe diabetes were more likely to have their condition resolved after surgery. Their likelihood of remaining free of diabetes for a long period broke down as follows:
* diet-controlled diabetes before surgery, 75%
* diabetes controlled with oral medication before surgery, 65%
* diabetes controlled with insulin before surgery, 28%.
Long-term resolution of diabetes correlated with weight loss maintenance. Men were more likely than women (90% to 82%) to resolve their diabetes and remain disease-free for a long time.
CARDIAC REHABILITATION
Music soothes the savage beat
Cardiovascular rhythms and other autonomic responses synchronize with music, new research shows, lending support to the value of music in cardiac rehabilitation therapy. In an innovative experiment, 24 healthy young subjects listened in random order to various selections of operatic or orchestral classical music, or to silence. Half were musicians; the others were nonmusical control subjects. During the experiment, researchers monitored each subject's heart rate, respiration, BP, middle cerebral artery flow velocity, and skin vasomotion. They found that vocal and orchestral crescendos produced "significant correlations" with cardiovascular and respiratory responses. When music gradually increased in volume and intensity, blood vessels constricted and heart rate increased. Conversely, soft, soothing music produced vasodilation and reductions in BP and heart rate. Also, two rhythmic musical phrases from the composer Verdi appeared to synchronize people's cardiovascular rhythms. The musical phrases were about 10 seconds long, which is similar to the standard oscillations in BP. Researchers found no difference in autonomic responses between musical and nonmusical subjects.
Experts say the study not only supports playing soothing music for patients in cardiovascular units, but may also have clinical implications for improving response in patients with disabilities who listen to music during exercise therapy.
Sources: Bernardi L, Porta C, Casucci G, et al. Dynamic interactions between musical, cardiovascular, and cerebral rhythms in humans. Circulation. 2009;119:3171-3180; Music can make the heart beat faster. HealthDay. June 22, 2009, http://www.nlm.nih.gov/medlineplus/print/news/fullstory_85924.html.
INFLUENZA VACCINATION
Healthcare workers still lag behind
Among healthcare workers, rates of vaccination for seasonal influenza have remained below 50% for years despite evidence that vaccination protects both them and their patients. Now The Joint Commission (TJC) has collaborated with the CDC and other organizations on a monograph intended to drive up vaccination rates among healthcare workers. It includes information about seasonal influenza and the vaccine, barriers to successful vaccination programs, strategies for overcoming them, and examples of successful initiatives that organizations have used to bolster immunization rates among employees.
Electronic copies of the monograph, "Providing a Safer Environment for Health Care Personnel and Patients through Influenza Vaccination: Strategies from Research and Practice," are available for free from TJC at http://www.jointcommission.org.
PROSTATE CANCER TEST
Reducing false-positive results
Combined with prostate--specific antigen (PSA) screening, a new blood test greatly increases the accuracy of prostate cancer diagnosis, according to research reported at the annual meeting of the American Society of Clinical Oncology in Orlando, Fla. The relatively high risk of false-positive results associated with PSA screening can lead to unnecessary biopsies.
A 2-year study of the blood test involved 484 men: 204 with known prostate cancer, 110 with benign prostatic hypertrophy, and 170 men without prostate problems. The men were split into age-matched training and validation sets. Using both the new 6-gene molecular diagnostic blood test and PSA screening, the researchers accurately detected prostate cancer 90% of the time. The accuracy of the PSA test alone is 60% to 70%. To test the validity of these findings, a larger trial involving 1,000 men is being planned at the Dana-Farber Cancer Institute, an affiliate of the Harvard Medical School in Boston.
ECONOMIC RECESSION
What nursing shortage?
Although a nursing shortage still looms as baby boomers age and retire, the current economic downturn seems to be easing the problem for the moment. Facing financial insecurity, more nurses are delaying retirement, returning to the workforce, or switching from part-time to full-time positions.
According to prominent nursing researcher Peter Buerhaus, avoiding a long-term nursing shortage requires expanding the nursing education system, which since 2002 has turned away at least 30,000 qualified candidates annually. Still, the number of RNs ages 23 to 25 years has reached its highest level in 2 decades, due in part to recent efforts to promote nursing as a career. Read more about this study and five others on the nursing workforce at the online site of the journal Health Affairs, June 12, 2009, http://content.healthaffairs.org/cgi/content/full/hlthaff.28.4.w620/DC2.
HIV TESTING
Too little, too late
Many people with HIV/AIDS don't undergo HIV testing until well into the course of infection, which can limit the effectiveness of some treatments. In a study of people who were diagnosed with HIV between 1996 and 2005, researchers from the CDC found that 45% went on to have a diagnosis of AIDS within 2 to 3 years of their HIV diagnosis, 38% within 1 year, and 7% within 1 to 2 years.
Late HIV diagnosis was more common in racial and ethnic minorities than in white people. Men, people from minority groups, and those diagnosed with HIV at an older age were more likely to progress to AIDS within 3 years of HIV diagnosis.
Healthcare providers should routinely screen all patients older than 13 years for HIV infection and regularly retest patients at risk in accordance with CDC recommendations.
Source: Late HIV Testing-34 States, 1996-2005. MMWR Weekly. 2009; 58(24):661-665.
SURVEY RESPONSES
Making a vaccination recommendation
Nurses who recently visited our Web site answered this question: Do you routinely recommend influenza and pneumococcal vaccines for appropriate patients?
See "Healthcare workers still lag behind" below for more on this topic. Visit http://www.nursingcenter.com/poll to answer our monthly survey question and view results from other surveys.
ALCOHOL CONSUMPTION
Drinking linked to more trips to the hospital
In a study from Scotland, men who drank more than 22 units of alcohol/week had a 20% higher hospital admission rate than nondrinkers. A unit of alcohol was considered to be half a pint of beer (about a cup) or a 4-ounce glass of wine.
Following about 6,000 men for an average of 28 years, researchers tracked alcohol consumption and the occurrence of cardiac conditions, respiratory diseases, stroke, and alcohol-related conditions. At the start of the study, the men, ages 35 to 64, received a comprehensive health exam and were asked about their alcohol consumption. Researchers placed them in five groups according to the volume of weekly alcohol consumption.
Even low levels of alcohol consumption were associated with a higher number of days in the hospital. Among the study findings:
* Length of hospital stay increased as weekly consumption of alcohol went up.
* Men who drank the most spent 58% longer in a hospital than nondrinkers.
* More hospital admissions for stroke occurred with weekly consumption of 15 units of alcohol, and the number rose with heavier drinking.
* Men who drank 22 units or more per week had more admissions for respiratory illness, but the lowest admission rate for coronary heart disease.
* Nondrinkers had the highest rates of coronary heart disease.
* Admissions for mental health conditions began to increase with 22 units or more of alcohol per week, but nondrinkers had higher rates of admission for mental health than men who drank 1 to 14 units/week.
Source: Hart CL, Smith GD. Alcohol consumption and use of acute and mental health hospital services in the West of Scotland Collaborative prospective cohort study. J Epidemiol Community Health. 2009 July 1. [Epub ahead of print]