Wednesday, February 20, 2019

Emergency nursing

speak about the hint nursing, we should take into scotch the role of the requisite shelter in the modern hospital and to take into account the most widespread mistakings, done by the nurses in the emergency department. Also, to break up the ca c on the wholes of these mistakes.To begin with, emergency nurse is usually the first person, meeting the tolerant in the hospital. Due to the triage system it is the nurse, who decide, according to the type of the injury, to what kind of determine the patient should be sent. Sometimes nurses in the emergency department do play a role of the doctor as advantageously they finish prescribe some kind of medicines and to give them to the patient. The kind of mistake in this lineament puke be like this1. Wrong diagnose.2. Non well-organized work of the provide. As to the second one, here can be shown the episode from one of the hospitals, where the mistake was done according to the miscommunication of two nurses.A 50-year-old man with newfangled atrial fibrillation was put on a diltiazem drip in the emergency department for drift control. After arriving at the cardiac c atomic number 18 whole (CCU), he was noted to be hypotensive and a saline bolus was ordered. The nurse asked a coworker to get her a fundament of saline and went to check on another patient. When she returned to the first patients bedside, she noticed that an endovenous (IV) bag was already hanging from the IV pole, and thought that her coworker must pay placed the saline bag there.Believing the patient required a quick saline infusion, she opened the IV up, and the solution inf apply in rapidly. At that moment, her coworker arrived with the viosterol cc saline bag, which ca utilize the patients nurse to realize, in horror, that she had condition the patient an IV bolus of more than 300 mg of diltiazem. The patient suffered dreadful bradycardia, which required temporary transvenous pacemaker placement and calcium infusion. Luckily, th ere was no permanent harm.The commentary to this suit of clothes was given by Mary Caldwell, RN, PhD, MBA, and Kathleen A. Dracup, RN, DNSc.This case playing area raises several troubling issues. A patient was given an accidental overdose of diltiazem during a hypotensive episode due to a miscommunication involving two nurses. Intravenous diltiazem can cause bradycardia, hypotension, and reduced myocardial oxygen consumption, all serious side effects in an already unstable patient.Reported geological fault rates for the administration phase of medication procedures argon significant, ranging from 26% to 36%.With respect to intravenous medication preparation and administration, the possibilities for misunderstanding are magnified compared with oral agents. In one large learning, the investigators inform an overall error rate of 49% for intravenous medications, with 73% of those errors involving bolus injections. Providers are likely to encounter at least four complications sp ecific to intravenous do medicates administration.First, the drug can be inf utilise too quickly or too slowly, unlike oral agents, which have single one rate of administration.Second, IV pumps used to control the rate of administration can cash in ones chips to operate properly or can be set up incorrectly by a nurse.Third, preparation of the drug can triplet to error, as when the drug is added to an incompatible solution or mixed use the prostitute ratio of drug-to-IV solution.And finally, the medication can be given with the wrong port, such as into the right atrium rather than into a computer peripheral vein.Intuitively, one might guess that the critical superintend environment would be the site of more medication-related errors than less acute units. In one study that compared intensive care unit (ICU) with non-ICU medication-related errors, preventable adverse drug events were in two ways as common in ICUs as in non-ICUs. However, when these data were alter for the number of drugs used or ordered , there were no differences betwixt the settings. The fact that the patient-to-nurse ratio in the ICU is usually less than or equal to 21, while a single nurse on a medical-surgical unit whitethorn be responsible for 5 to 10 patients, may mitigate the risk of drug errors in the critical care setting.The Institute for Safe Medication Practices cites the five rights of medication use (right patient, drug, time, dose, and route) as touchstones to aid in the prevention of errors. In this case, following the five rights may have prevented the overdose. However, one must also recognize that many processes used to prevent errors are more touchy to design and implement in critical care units because of the rapidity with which nurses and physicians must act.Therefore, the basics of safe drug administration practice take on even greater importance. twist in manual redundancies (such as verbal read-backs, akin(predicate) to those used when administering li vestock transfusions) may help when there are variances to standard protocol, such as an IV bolus. The high error level documented in IV bolus infusions provides important support for reviewing hospital policies related to their administration. System failures also contributed to the error in this case. If the patient was unstable enough to require a ergocalciferol cc bolus of saline, why did the nurse leave the room to check on another patient? Was the staffing inadequate? Workforce issues have been an enormous matter to in fresh years as nursing shortages reach crisis proportions. Nurses are stretched thin, and the shortage is felt most acutely among specialty nurses. The clinical doctor of staffing shortages on make upd mortality and failure-to-rescue have been noted.A survey conducted by NurseWeek/A-ONE found that 65% of RNs felt the shortage impeded their ability to carry patient safety. Although specific figures regarding the extent of shortages in critical care are not a vailable, the American Association of unfavourable Care Nurses states that requests for registry and travel nurses have increased substantially across the country, with a 45% increase for adult critical care, 50% for Pediatric/Neonatal ICUs, and 140% for Emergency Departments.In the past, most ICUs accepted only experienced nurses (with more than 2 years clinical post-graduate experience) as staff. However, this requirement of previous experience is oft waived in times of staff shortages. Although new graduates usually participate in hospital ICU training programs, the learning curves are steep and new nurses may become overwhelmed, leading to errors in communication and execution. A recent Food and Drug Administration (FDA) report listed a number of benevolent factors associated with medication errors.Performance deficit (as opposed to knowledge deficit), such as seen in this case, was the human factor listed most commonly (30%). Poor communication theory contributed another 1 6% to total errors. Thus, this case illustrates a common ancestor of errora problem of performance related to poor communication. This case study also provides an opportunity to evaluate mistakes on the personal level. A serious, commonly identified shortcoming of the current medical system is the apprehension of disclosing errors.When errors occur, the responsible staff member should be an active participant in an evaluative process aimed at preventing standardised errors from reoccurring. Results of the evaluation on an individual, unit, and hospital level should be shared with the entire hospital so that similar errors might be prevented in the future.The tradition of morbidity and mortality conferences, used commonly by physicians, has not been adopted by nursing staff and might be an appropriate strategy if it provided a blame-free environment in which mistakes and system level issues could be discussed openly. Specific measures to prevent errors in situations similar to thi s case might includeStandard policy typically dictates the use of IV pumps on all vasoactive drips. (Because it was not specifically noted in this case study, we are compelled to state the obvious.)Standard policy usually dictates that vasoactive drugs be infused through a site dedicated to only that drug. Therefore, at least one other separate IV site should be used for other fluids and medications. This practice eliminates the need to use the high risk IV and the potential for an inadvertent overdose.More obvious labeling of high risk IV drips (eg, bigger, brighter labels duplicate labeling on IV bag, pump, monitor).Independent double-checks of bolus fluids by nurses prior to administration. Reevaluation of staffing requirements if a patient becomes unstable so that the patientnurse ratio can be appropriately adjusted. Participation of nurses as well as physicians in morbidity and mortality conferences.Sometimes the mistakes occur because of inattentiveness of the nurse. By the wa y, the documents, fulfil by the nurse, have to be readable and clear not only for the nurse herself, but for the other well-educated staff as well (I mean, the doctors, etc. ). The datas have to be collected just now and correctly. But lets have a look at one of the patients cards, taken from the infirmary. (Pict.1)The information is just not readable, and it is rather difficult to understand, what were the results. This patients card look likes an album of the child, but not as a professionally made card of the well-qualified staff. Speaking about this case of the 72 years old woman, it is possible to suggest, that the wrong diagnoses have been done, what approximately lead to the death of the patient.As to the medicines given, it is seen, that not all the medicines needed were given to the patient (at the age of 70 there have to be given some medicines for blood Heparin and as well some medicines for keeping the heart activity. In this case it looks like that on the base of the cough (probably pneumonia) there was a kind of heart advance (probably cardiac infarction) with the complications as pulmonary edema(or edema of lungs).1. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 199527429-34. go to pubmed2. Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ. 2003326684. 3. Cullen DJ, Sweitzer BJ, Bates DW, Burdick E, Edmondson A, Leape LL. Preventable adverse drug events in hospitalized patients a comparative study of intensive care and general care units. Crit Care Med. 1997251289-1297. 4. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 20022881987-1993. 5. NurseWeek. NurseWeek/A-ONE National Survey of Registered Nurses NurseWeek/A-ONE 2002. 6. Critical Care Nursing Fact Sheet. American Associa tion of Critical-Care Nurses. 7. Phillips J, Beam S, Brinker A, et al. backward analysis of mortalities associated with medication errors. Am J Health Syst Pharm. 2001581835-1841.

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