Avoid Medication Errors

All medical providers, whether they work in a hospital or in a prehospital setting, constantly fight to avoid medication errors.  The Joint Commission responsible for hospital oversight considers medication errors one of the biggest problems affecting patient safety.

Yet for those of us who work long hours, particularly those working 12 hour shifts overnight and with shorthanded staffing, medication errors are even more difficult to avoid.  Fatigue, lack of focus and concentration, and increased workload all lend to the reasons busy field providers make mistakes.  How do we make ourselves pay attention?

How Focus and Attention Work

This article from CNN Health looks at how me maintain attention span and gives tips on how to train our brains to pay better attention and focus when needed. The authors point out a few ideas on how to maintain better focus.  Some will work for busy nurses and some won’t, but all of them bear a closer look.

• Get More Sleep - Hard to do when you work long hours but when weighed against the expense of losing not only your job, but possibly your career in the current marketplace, it might be a good idea to refocus some free time to power naps and a good night’s sleep on days off.
• Manage Stress and Anger - We’ll be talking about stress management in December’s MedicCast Live podcast, but we all need to plan ways to deal with stress in our lives.  It’s hard to focus on a difficult-to-treat patient when we are worried about a fight with a spouse or a problem with a co-worker.  Learn to recognize stress reactions in yourself and make time for a brisk walk or some time on the treadmill or stairmaster.  Talk with a work counselor or supervisor about some assistance before it gets out of hand.

Read the article for more ideas and links on stress and tune in and join us live on Tuesday, December 9, 2008 at 10 PM ET for the next MedicCast Live episode.

What are your thoughts on dealing with stress, fatigue and attention span?  Share them with the rest of the Nursing Show community by clicking the comments link below and leaving your ideas here.

The U.S. Centers for Disease Control (CDC) released some corrected data on cancer diagnoses related to the Human Papiloma Virus (HPV).  The virus is most often related to cervical cancer and this is the reason for the push for HPV vaccine administration in young girls entering puberty.

The CDC report, however,  also released data that links HPV to other cancers of the anus, mouth and throat in addition to cervical cancer.  A total of 25,000 reported cancers related to HPV per year.  The report may be pointing to wider coverage for the vaccine and possible vacinations of adolescent males and females.

Cervical cancer is the most reported and has been presented as the largest threat to world health because advanced diagnostic screening techniques like pap smears are not widely available in other parts of the world and cause nearly two thirds of the diagnosed cervical cancer cases to result in death.  The focus on other cancers shows the dangers of this sexually transmitted disease to cause cancers in other parts of the body.

Visit article link above and the CDC pages on HPV and the HPV vaccines here. The CDC has a host of resources for both medical professionals and patients.  These links are important references for nurses in the field as well as nursing students and educators.

A recent article at WebMD reviews the reported success of the Rotavirus vaccine, RotaTeq.  Rotavirus is a GI virus that causes diarrhea and is responsible for serious complications, hospitalizations, and death in infants throughout the world.

A recent joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America presented the findings of several studies that pointed to a significant reduction in the number of infant deaths related to the Rotavirus since the vaccine became available for regular use.

Reported reductions in deaths and major complications range from 66% to 100%.  Prior to the production of the vaccine the studies reported some of the following statistics on the the effects of the Rotavirus:

• No. 1 cause of diarrhea-related hospitalizations and deaths in babies and young children
• Responsible for about 400,000 physician visits, more than 200,000 emergency room visits, up to 70,000 hospital admissions, and 60 deaths every year in the U.S. alone
• Causes 2 million hospitalizations worldwide annually
• Blamed for nearly half a million deaths annually in children under 5 years.

If you are involved in infant or pediatric care, review the availability of this vaccine and be prepared to educate parents and caregivers about the benefits of protecting their children from serious child illnesses.

Nurses and nursing students are always looking for good resources for themselves and their patients about medication safety and risks.  Lisa Booze from the Maryland Poison Center has this resource for us.

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MotherRisk.org info for pregnancy and breastfeeding

The Motherisk program at the Hospital for Sick Children in Toronto provides information on the safety of medications, illicit drugs, chemicals, personal products and more during pregnancy and breastfeeding. There is a wealth of information, resources and references for health professionals and the public on their website, www.motherisk.org.

Motherisk also operates telephone helplines to answer questions. New information such as a recent Motherisk advisory on the risks of using codeine during breastfeeding can also be found on the website.

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Maryland Poison Center Links

You can get email notification about the Maryland Poison Center’s ToxTidbits and ToxAlert newsletters.  Sign up for free here (you don’t have to live in Maryland to get these).

also -

Hear more of Lisa Booze here on the Nursing Show each month with a featured segment on toxicology and medication overdoses just for Nursing Show listeners.

Check out past episodes below:

Poison Control Nursing

Insecticide Poisonings

Household Cleaner Poisonings

Dextromethorphan OD

Snakebites and Venom (pt 1)

Snakebites (pt 2)

Buprenorphine OD

Phenytoin OD (Dilantin)

Poison Control Centers

The Florida Institute of Technology conducted a survey of 1,000 randomly selected adults to find out their attitudes towards autism and to the safety of vaccines for child illnesses.  The study found that nearly 1 in 4 (24%) of the adults surveyed believed that because of links to autism, it was safer not to vaccinate children.

The article on this survey is posted here at MedicalNewsToday.com.

Clearly, medical professionals are not doing enough to combat this knowledge deficit.  As study after study releases results that there is not clear link to autism for child vaccines, you would think that parents would begin to get the point but this internet myth has become so pervasive that it has taken on a life of its own.  Part of the problem is the way that scientists and researchers speak when they are interviewed.

Understanding Scientist Speak - What is “Unlikely?”

Many scientists are reluctant to use the words impossible when referring to something that can’t happen under normal circumstances.  They will instead use words like “unlikely” or “not very probable” when referring to something they are studying.  This is because in science there are very few absolutes.  What they really mean is that the odds are too long for me to even bother to calculate — in other words, as close to impossible as I’m willing to admit.

Ask a scientist if the earth is going to explode tomorrow and you will get the same answer, “its unlikely.” What they really mean is “you are being ridiculous,” and “stop wasting my time by making me calculate something with so little chance of happening.”

Of course, we can’t call our patients ridiculous.  Insult them and they’ll stop listening to what we say.

5 Tips for Nurses on Patient Communication and Education

What can we do about helping people understand the dangers in not vaccinating their children? I’ve made a list below of some of my tips for this issue:

1. Become Knowledgable - use resources at sites like CDC.gov and the National Institutes of Health.  They have many good articles about this issue.  Use them to educate yourself about what has been studied and how the research has arrived at their conclusions.
2. Become a Patient Advocate - show how much you care and they will care how much you know. Educate them so that they can make an informed decision about their child’s health.
3. Treat Them With Respect - these parents are not making these decisions because they want to hurt their children.  The parents are afraid of making a decision that will hurt them.
4. Communication Skills Rule - take the time to find out what they know and don’t know.  Find out their arguments for and against vaccination.  Use open ended questions to help them flesh out their concerns and to direct them to resources they can trust.  Review communication skills and listen to this episode of the Nursing Show.
5. Community Outreach - write your local newspaper, radio, and TV stations. Offer to talk to community groups.  Publish a newsletter from your facility to your community.

Medication errors are one of the horrors that can haunt a nurse’s career. Many nurses believe it’s not a case of if you will make a medication error but when will you make a medication error.

Tools from the content experts at Lexi-Comp will help reduce your risk of making a medication error.

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Nursing Show features Lexi-Comp Med Minutes

Pharmacist Liz Tomsik from Lexi-Comp has recorded 11 segments on different medication concerns for nurses.  As one of the content specialists behind Lexi-Comp’s innovative nursing suite of applications for PDA’s and smart phones, Liz is responsible for providing up to date information on medications for subscribers to Lexi-Comp’s pocket informatics tools.

You can hear Liz’s Lexi-Comp Med Minute segments in each Nursing Show episode through the end of November.  Check out Lexi-Comp’s excellent products and save 10% as a listener to the Nursing Show by visiting this special landing page for the Nursing Show at www.Lexi.com/NursingShow.

Our friend, Lisa Booze over at Maryland poison center (mdpoison.com), recently released this toxicology update surrounding medication errors using Acetylcysteine, the antidote for acetaminophen overdoses.  Check out what she has to say below:

Maryland Poison Center Toxtidbit -Acetylcysteine Medication Errors

Acetylcysteine is a commonly used antidote to prevent or limit the hepatotoxicity associated with acetaminophen overdoses. It was first approved in 1985 by the FDA to be administered orally.  An intravenous preparation of acetylcysteine was approved in 2004 and is currently sold as Acetadote®. The intravenous dosing regimen is somewhat complex in that a loading dose followed by 2 maintenance doses are all given at different infusion rates:

• 150 mg/kg in 200 mL D5W over 1 hour
• 50 mg/kg in 500 mL D5W over 4 hours
• 100 mg/kg in 1000 mL D5W over 16 hours

In order to assess the frequency of errors in the administration of IV acetylcysteine, a retrospective chart review of Maryland Poison Center records of patients treated with IV acetylcysteine from August 1, 2006 to August 31, 2007 was performed.  The results of this study were recently published:

Hayes BD, Klein Schwartz W, Doyon S. Frequency of medication errors with intravenous acetylcysteine for acetaminophen overdose. Ann Pharmacother 2008;42:766-70.

There were 84 medication errors identified in 74 (33%) of 221 patients. Errors occurred more frequently in emergency departments (54% of cases) as compared to medical floors, ICU’s and during patient transfers, and occurred more commonly on third shift. The types and frequency of errors included:

• More than one hour of interruption between doses (especially between the 2nd and 3rd dose)—18.6%
• Unnecessary administration—13.1%
• Incorrect infusion rate (including 5 cases of administering the loading dose over 15 minutes instead of 1 hour, as was recommended until 2006)—5.0%
• Incorrect dose—1.4%

Hospital staff should be aware of the potential for IV acetylcysteine administration errors and take steps to prevent these errors. When consulted, the Maryland Poison Center works closely with physicians, nurses and pharmacists to ensure that acetylcysteine is administered correctly.

DID YOU KNOW THAT… anaphylactoid reactions to intravenous acetylcysteine sometimes occur?

Adverse effects including rash, pruritus, angioedema, bronchospasm, tachycardia, and hypotension have occurred in a small number of patients.  The frequency of adverse effects reported in the literature ranges from 0.2% to 20%, but is generally accepted to be less than 10%. In most cases, adverse effects are mild and do not require discontinuing treatment with IV acetylcysteine. Call the Maryland Poison Center for assistance in assessing and managing adverse effects with IV acetylcysteine.

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You can get email notification of new versions of the Maryland Poison Center’s ToxTidbits and ToxAlert newsletters.  Sign up for free here (you don’t have to live in Maryland to get these).

Hear more of Lisa Booze here on the Nursing Show each month with a featured segment on toxicology and medication overdoses just for Nursing Show listeners.

Check out past episodes below:

Poison Control Nursing

Insecticide Poisonings

Household Cleaner Poisonings

Dextromethorphan OD

Snakebites and Venom (pt 1)

Snakebites (pt 2)

Buprenorphine OD

Phenytoin OD (Dilantin)

Poison Control Centers

It must be pain management week here at the Nursing Show. After last week’s episode of the Nursing Show, I found this press release from a new resource for nurses and other health professionals.

The results of the survey in the article underlines the need to improve our communication skills, learn to ignore our own preconceptions about pain, and focus not just on hearing the words spoken by our patients but truly listening to the context and meaning.

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Nashville, TN (Sept 8, 2008) - A nationwide survey found a sizable gap exists between patients and healthcare professionals when it comes to understanding and discussing pain. To address this discrepancy, a new coalition of leading pain management organizations has formed to improve how patients and healthcare professionals communicate with each other.

The Let’s Talk Pain Coalition is the first of its kind to unite the perspectives of patients, caregivers, and healthcare professionals to encourage people to talk more about pain, listen actively, and act in ways that improve care for the millions of people who live with pain. The organizations behind Let’s Talk Pain have created a new interactive Web site, www.letstalkpain.org, to provide visitors with comprehensive information and tools to help enhance the dialogue between those affected by pain and healthcare professionals.

“Pain is one of the nation’s leading public health problems, and it often goes under-treated. It is difficult to diagnose and challenging to talk about,” said Dr. Scott Fishman, Chair and President of the American Pain Foundation and Chief of the Division of Pain Medicine and Professor of Anesthesiology at the University of California at Davis. “Open lines of communication and strong patient-professional relationships are what healthcare professionals strive for, and in pain management this is absolutely vital. This Coalition is exciting because it aims to help professionals and patients communicate better in order to help improve pain management.”

The Let’s Talk Pain Coalition debuts this week at the American Academy of Pain Management (the Academy) annual meeting in Nashville, TN. The Academy is one of the founding members of the Coalition along with the American Society for Pain Management Nursing (ASPMN) and the Coalition’s lead organization, the American Pain Foundation (APF). PriCara™, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. is the sponsor of the Coalition.

One of the Coalition’s first activities was a national online survey of pain patients and physicians. It revealed the need for an increase in open and direct conversations about pain and highlighted the impact pain has on patients’ quality of life. The findings also underscored a disconnect between how patients and physicians are communicating with each other. Additional barriers such as lack of trust and not enough time for office visits can affect communications, and ultimately may influence pain management. According to the survey:

• Sixty percent of patients strongly agreed that they can be open and honest about their pain with their physician. Yet, the same survey found that less than 10 percent of physicians strongly agreed that their patients tell them the truth about their pain.
• While the majority of physicians, 97 percent, strongly agreed that there is enough time to discuss pain with their patients, less than half of patients surveyed, 46 percent, felt the same way.
• Pain has a substantial impact on the lives of patients and interferes with their ability to work outside the home and to exercise.
• Treatment-related side effects can have a negative impact on the management of pain, causing some patients and physicians to discontinue using pain medicine.

“Having pain is challenging and has significantly affected my daily life, to the point where I have had to stop working,” said Andrea Cooper, a Maryland-based artist who suffers from chronic pain and is featured in a video on the Let’s Talk Pain Web site. “Pain is an invisible condition. I have learned that the best way to improve my health and my treatment outcome is through engaging in an open and personal dialogue with my healthcare professional and connecting with others to talk about pain.”

Andrea’s story and the Let’s Talk Pain Web site were previewed during the ASPMN annual conference in Tucson, AZ, for pain management nurses this past weekend. Several Web features were highlighted, including:

• Talk: an interactive section where visitors-pain patients and healthcare professionals alike-can learn strategies for opening up the lines of communication about pain. Housed here are video success stories from real patients and healthcare professionals as well as an interactive Q&A with pain experts.
• Listen: a clearinghouse of essential, credible information about pain. Here people with pain, healthcare professionals, caregivers, and family members can become familiar with pain terms and conditions as well as learn more about how pain is assessed so that it is easier to start an informed dialogue.
• Act: a section with up-to-date information on how the Coalition is improving communication within the pain community.

“Let’s Talk Pain offers the first pain resource that will effectively equip people to improve how they discuss pain so that the actions taken improve pain outcomes,” said Nancy Eksterowicz, MSN, RN-BC, Department of Anesthesiology Acute Pain Service, University of Virginia Health System, and President-Elect of ASPMN. “The pain community has never had one online location for credible information, nor have we had a place where patients and healthcare professionals can connect to learn from each others’ experiences.”

About the Survey
The Let’s Talk Pain Coalition commissioned a national, Internet-based survey of 500 pain patients and 275 physicians treating pain, including primary care physicians, oncologists, pain specialists, neurologists, rheumatologists, surgeons, and psychiatrists. Analytica International, a research firm based in New York, NY, conducted the survey from April 3 to 11, 2008.

American Pain Foundation
Founded in 1997, the American Pain Foundation (APF) is an independent nonprofit 501(c)3 organization serving people with pain through information, advocacy, and support. APF’s mission is to improve the quality of life of people with pain by raising public awareness, providing practical information, promoting research, and advocating to remove barriers and to increase access to effective pain management. For more information, visit www.painfoundation.org.

American Academy of Pain Management
The American Academy of Pain Management (the Academy) is a nonprofit organization serving a broad range of clinicians who treat people with pain through education, information, and advocacy. Founded in 1988, the Academy has approximately 5,300 members and is the largest interdisciplinary/integrative pain organization in the United States. Visit www.aapainmanage.org for more info.

American Society for Pain Management Nursing
American Society for Pain Management Nursing’s mission is to advance and promote optimal nursing care for people affected by pain by promoting best nursing practice. This is accomplished through education, standards, advocacy, and research. Visit www.aspmn.org.

PriCara™, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc.
PriCara™, Division of Ortho-McNeil-Janssen Pharmaceuticals, Inc., is a major health care company in the United States dedicated to the needs of primary care providers who serve a vital role on the frontline of medicine. For more information about the company, please visit www.PriCara.com.

The Nursing Show, the number one nursing and nursing student podcast, is proud to announce a new sponsorship agreement with Lexi-Comp and their innovative suite of electronic nursing tools. Lexi-Comp is the perfect partnership for us here at the Nursing Show.

As innovators in the marketplace, Lexi-Comp’s Nursing Suite offers a unique package of frequently updated drug and patient care information.  Available for PDAs, smart phones, and via wireless interfaces, the Lexi-Comp suite for nurses and nursing students offers a wide array valuable services to subscribers.

We have been using these nursing tools for almost 6 months and have been very pleased with the quality, thoroughness, and innovative nature of the products. We also found the Lexi-Comp PDA connection and sync tools to be much easier and smoother to use with our palm devices than other nursing suites we have used in the past. This exciting partnership will provide an opportunity for the Nursing Show listeners to find out more about Lexi-Comp’s line of products and where they can go to listen to special listener-only expert advice from Lexi-Comp’s professionals.

Plus, visitors who visit via the Lexi.com/NursingShow link will be able to use a coupon for 10% of their purchase!

Over at this week’s MedicCast podcast for EMS providers, we take a look as some of the special considerations in the treatment of geriatric patients. First, a look at geriatric trauma considerations and why special care is needed to ensure that the elderly trauma patient is taken to the most appropriate facility just like younger patients. A recent study by the State of Maryland found that geriatric trauma patients were not being taken to trauma centers as much as younger patients with similar injuries.

The show also includes a look at polypharmacy and how it affects the geriatric population. Polypharmacy is the presence of at least 5 to 7 prescribed medications for a patient.  Each additional med increases the risk for adverse drug interactions, compounded side effects and endangers the patient.  Encourage patients to review their medications at least annually with their physicians.

Any person may experience problems with polypharmacy, but an elderly person will have more issues due to decreased metabolism, reduced renal and hepatic function, and slowed GI clearance and absorption.

Visit the MedicCast Episode show notes pages here.