I found a story on a court case in California where a physician has been charged in speeding the death of a disabled and brain damaged patient in order to harvest organs for donation. Medical ethicists fear that the case may cause organ donations to drop because of the negative publicity. The story is from ABC News here.
Every time a story like this surfaces I shake my head in disbelief. What makes these care givers believe that their actions will not be noticed. In this case, the patient was from a poor family that was not able to be present to oversee care but what about the rest of the care team.
As a nurse, do you monitor the dose levels of drugs in patients who are at risk for abuse or do you just administer what the doctor orders without regard? According to police reports cited in the story, nurses in the room when the respirator was removed said the doctor ordered additional sedative doses when the patient didn’t die right away.
Organ donation programs are quick to point out that this situation is in violation of their program protocols which require a complete separation of the donor / transplant teams from the provision of palliative and end of life care to the patient. In other words, the ICU team should not have any contact with the donor/transplant team until death has been declared.
The article linked above is a good one for anyone in the medical community. It raises some good ethical questions and discussion points for both students and practicing professionals.
Identity theft is a big issue right now. People are having their lives turned upside down by having their financial records compromised. Imagine having your medical records compromised as well.Patients are having their medical safety endangered when their stolen identity got to the hospital ahead of them. Picture this:
The thief receives treatment in someone else’s name
The real person shows up at the hospital and their (fake) record is already on file
thief has no allergies, real person does and has an anaphylactic reaction — Surprise!
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HIPAA has become the bogeyman of the health care profession, used to scare medical professionals in to compliance with confidentiality practices. I’ve never heard of the identity theft card brought in to the discussion, though. This is a very important issue for some at risk patients who may not be able to immediately identify a dangerous discrepancy.
Some tips to avoid mixing up patients:
Don’t assume the prior nurse or the admission clerk got it right
Verify as much information with the patient as you can
Double check allergies each time a new medication is ordered
Prior to procedures, check past medical history for prior procedures or surgeries
A study looking at ways to cut childhood obesity and hypertension found that by cutting dietary salt, they could cut down on the amount of sugared soft drinks consumed by children.
The study was released in Hypertension: Journal of the American Heart Association and was conducted by researchers at St. George’s University of London, England.
The researchers looked at 2000 people between the ages of 4 and 18 who participated in a 1998 dietary survey. They found that children who had low salt diets consumed less liquid. They correlated a decrease of 1 gram of salt with a decrease of 100 mL of fluid intake. The authors further offered that by cutting average salt intake in half, children would consume 2 fewer sweetened soft drinks per week (amounts to 250 kcal less per week).
This is an important look at how simple changes in lifestyle have major long term health effects. This change in food preparation and choices has a long term health effect on development of hypertension and obesity.
Somebody get me the can of worms so I can open it. I found this article based on research that points at cardiac medication non-compliance following myocardial infarctions and patient mortality. The authors of the study conclude that one way to increase compliance is to provide the 4 most commonly prescribed cardiac meds to patients for free following their cardiac event.
These meds include: Aspirin, ACE inhibitors, Beta Blockers, and Statins. While the cost of these medications is not the only reason for patient non-compliance, it is certainly a factor here in the U.S. The removal of the Medicare copay would improve patient outcome and quality of life for some of these patients if it encouraged them to buy their prescribed medications.
The study out of Harvard University, looks at a theoretical basis for its findings and the authors point out that while their findings appear significant and make medical sense, there should be actual trials set up where some patients randomly get their meds for free and others remain under the current system. Who would be more compliant with their meds?
The question is bound to come up sometime — When is the best time to have your heart attack or cardiac arrest when you are in the hospital (it’s important to plan ahead)?
There was a study a year or so ago that focused on the increased mortality rates for cardiac arrest patients in different facilities (rural, urban, suburban) and on different days of the week. Not surprisingly, the study found that small rural hospitals and most hospitals on weekends had poorer survivability from cardiac arrest.
What about the time of day? Well someone else thought to ask and that study has now been released. The authors found in their case review that 15% of cardiac arrest in hospitals survived between the hours of 11 PM and 7 AM compared to 20% during the daytime hours. Again, I’m not terribly surprised. After hours, staffing ratios fall as many patients are asleep. Often in small hospitals, the only doctor in the building is in the emergency department after 8 or 9 PM.
Try running a code simultaneously in the ICU at one end of a building and in the ED at the other. Difficult to do, right? It’s important to review this information for your facility and determine whether a different set of standing orders needs to be in place for after hours care in the onset of acute emergencies requiring ACLS interventions.
Many med-surg nurses don’t maintain their ACLS certifications (because they’re not required to) or perhaps never got them to begin with. There needs to be a code team in place to handle the onset of multiple cardiac events even in — or perhaps especially in — smaller hospitals so that patient care and survivability can reach its full potential.
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In another study about antibiotic effectiveness, the analysis by the Dutch researchers is that the use of antibiotics for the treatment of inner ear in children is not effective in reducing fluid build up or effusion in the middle and inner ear. They recommend that the use of antibiotics as a method of reducing the associated fluid build up during these infections.
Opponents of this report don’t dispute the dangers of overuse of antibiotics but point out that in cases of Otitis Media, these patients are getting their antibiotics not to reduce effusion but to reduce the infection causing the inflammation and pain, something this meta analysis did not look at.
Alternatives may need to focus on pain reduction rather than treatment of infection if indeed the presentation of fluid build up behind the ear drum is happening regardless of treatment and resolves on its own. Look for more articles on this study and further trials to look into the effectiveness of antibiotic treatment for this and other common infections in the future.
The World Health Organization (WHO) released a report that points out the projected cost in human lives related to tobacco use over the rest of this century. According to this report, tobacco use will be responsible for up to 1 billion deaths over the next 100 years.
The statistics cited by the WHO:
100 million people died of tobacco-related causes during the 20th century.
Tobacco currently kills 5.4 million people per year.
Tobacco use makes six of the world’s eight leading causes of death — including heart disease, stroke, and cancer — more likely.
“Of the more than 1 billion smokers alive today, around 500 million will be killed by tobacco,” states the WHO Report on the Global Tobacco Epidemic, 2008.
They urge rapid action to stave off the millions of deaths each year related to tobacco use. Many of these deaths will occur in third world nations without sophisticated treatments for diseases like emphysema and cancer.
The WHO proposes six policies to reduce global tobacco deaths:
Monitor tobacco use and prevention policies.
Protect people from tobacco smoke.
Offer help to quit tobacco use.
Warn about the dangers of tobacco.
Enforce bans on tobacco advertising, promotion, and sponsorship.
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A new spray on liquid bandage with similarities to others already on the market has been cleared for marketing. The product, called Gel-Spray Liquid Bandage, sprays a stream of two polymers that combine to form a gel that forms over the wound area.
The scientists from Rutgers University who developed the Gel-Spray product say it is perfect for use in combat situations where a wounded soldier can use it on injuries until other help arrives.
The product was developed in association with a Georgia company, BioCure, who will handle marketing of the product.
I found a story on a court case in California where a physician has been charged in speeding the death of a disabled and brain damaged patient in order to harvest organs for donation. Medical ethicists fear that the case may cause organ donations to drop because of the negative publicity. The story is from ABC News here.
