Archive for July, 2009

The 6 rights of medication administration, comment

July 17, 2009

Coming across this post, l recognised the device (scanner) which the writer says her facility uses. On the face value, JAHCO will applaud this device because it acted as if the cases of med errors have been eliminated. Yet as the writer said, it still goes back to knowing your patients and knowing your medications. Nurses are the final check point in the health team providers list. We are in between the ordering physicians and the releasing pharmacists. Nurses have to see that the parameters for which the drug is being administered is not in violation. For instance, nurses know by common sense that once the med is due, the scanner will scan and does not tell if the parameter for using a betablocker is checked for not. It is up to the nurse to make sure that the blood pressure is stable and the heart rate is within normal range. Despite these technologies, we are still required to do our checks before trusting the device.

Original Post:
June 30, 2009
Title: The 6 rights of drug administration
The 6 rights of drug administration did not prevent the cause of death in one particular case. The problem lies with the incorrect labeling of medication. The key is to trace what happened, review for any outlying causes or "what happened" and correct that as soon as possible. While the nurse I am sure will have to live with that the rest of her life, and that’s not easy, I feel that she has comfort in knowing she did not cause this. Many hospitals are using the computerized medical dispenser where you scan the patients ID bracelets then you scan the drug that is being administered which is on a time schedule also. The thinking is this will correct and help make sure the 6 rights of drug administration are followed, while this looks good for JACHO, the bottom line is a human is still keying in the information and we all make mistakes. I am not so sure the technology we have today in practice is as good as the old fashion, "know your patient and the medications being administered".

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Documentation of bedsores, comment

July 17, 2009

As a wound care champion at my place of work, l got excited reading the original post on bedsore docs. Most hospitals are anal about Hospital Acquired Pressure Ulcer, (HAPU). In dealing with hapu, nurses have to do a thorough investigation on assessment once we get new admits. In the past, patients who are triaged in the emerg room are often not properly assessed leaving room for errors while the floor nurses have to pick up the slack. Once at a meeting, most nurses were amazed at a case where a patient had about 10mm open sore which was never documented. The hospital lost their reimbursement because it was treated as HAPU rather than CAPU (community acquired pressure ulcer.) In quality management, our hospital decided to collect nursing volunteers who will meet monthly to act as buddies to other nurses while doing initial assessment. This has paid off because for the past year, we did not record any HAPUs .

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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Internet Education and a changing belief among traditional nurse educators, comment

July 13, 2009

Finally! nursing has almost entered the 21st century but still lags behind in becoming united in recognition of what the gold standard should be for entry-level nurses. For years, nurses were told they had to have a BSN in order to advance their careers. For as long as I can remember working full time, raising a family, and attending classes at night was just too much pressure for a majority of nurses to endure. Therefore, many nurses accepted that they would never be able to advance their education level above the ADN or Diploma Degrees. Thankfully, the Internet has allowed a large number of nurses and other professionals to advance their educational level while still working full time and managing a household. I must admit that at first I did not think degrees obtained online was as good as or equal to the ones earned at traditional brick and mortar institutions. Since having to personally balance work, education, and family my attitude has taken a 360-degree turn. The online degree is just as or more challenging than the traditional route because individuals must manage their time more efficiently, stay focused, and self motivated. The class work is just as challenging if not more and demands sacrifices to be made in order to succeed. For all those who still think online degrees are less important and easier to obtain than traditional ones should try taking an online class to evaluate for themselves whether or not this degree should be weighed the same as the traditional degree.

Original Post:
June 29, 2009
Title: Internet Education and a changing belief among traditional nurse educators
I can’t help but be amazed how far nursing has come in accepting Internet based BSN programs. I spent the past week at a top university meeting with the director for their nurse anesthesia program. In the past I recall nurse educators that held a belief that if one didn’t get their BSN in a traditional university it was something less that a "real" degree. But these same educators hurt themselves when they view that a BSN is the gold standard as opposed to ADN/Diploma nurses. The problem became when those of us with life responsibilities could not drop everything and attend traditional classes so we didn’t try to obtain our BSN. To maintain the BSN as the gold standard for registered nurses the traditional nurse educators had to accept non-traditional programs. The director I met with not only embraces a BSN earned via the Internet but voiced belief that a BSN learned through independent learning is more challenging due to the discipline it takes to complete such programs. Finally, nursing is entering the twenty-first century. I’m grateful it did during my career; it makes my ability to achieve my goals more realistic.

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Nursing Education – Stress and Workload, comment

July 7, 2009

I thought it was appropriate to discuss stress because that is exactly what I am feeling about my degree program. It does feature online interaction and computer use. The purpose of my degree program was to prepare myself on how to be a better Community Health Nurse; I did not think it was to spend time on academic work. I went to bed last night feeling very stressed. My workday is already 9 hours long and by the time I get to my computer at night I am already tired and stressed. What am I going to do about it? I do not know. I am sure I am not the only one feeling this way. Many Nurses are already feeling the strain of work, family, education etc. I graduated from Nursing in 1982 at the ripe age of 19; it was a 3-year diploma program. Now it is all about the degree and it is becoming increasingly difficult for diploma nurses to move forward in their career. With the national nursing shortage, one would think the government would concentrate on more effective ways for diploma nurses to bridge over to their degree. I cannot afford to take 2 years off to go back to school and taking a course at a time I will be ready to retire by the time I get my degree. To the poster of July 3, 2009 first of all I feel your frustration, but the fact is that it is the nursing organizations that are at blame for this need for additional education not the government. As I am sure that you have found by now, taking classes online require a great deal of discipline and initiative. As with anything else in your life you deem important, time has to be made for it. I know making time in an already full life is going to be very difficult, but you have to weigh what’s more important to you right now, family and work or school. Once that question is answered, you will find a way to make it work.

Original Post:
June 15, 2009
Title; Stress and Workload
I thought it was appropriate to discuss stress because that’s exactly what I am feeling about my degree program. It does feature online interaction and computer use. The purpose of my degree program was to prepare myself on how to be a better Community Health Nurse; I did not think it was to send time on academic work. I went to bed last night feeling very stressed. My workday is already 9 hours long and by the time I get to my computer at night I am already tired and stressed. What am I going to do about it? I don’t know. I am sure I am not the only one feeling this way. Many Nurses are already feeling the strain of work, family, education etc. I graduated from Nursing in 1982 at the ripe age of 19; it was a 3-year diploma program. Now it’s all about the degree and it is becoming increasingly difficult for diploma nurses to move forward in their career. With the national nursing shortage one would think the government would concentrate on more effective ways for diploma nurses to bridge over to their degree. I can’t afford to take 2 years off to go back to school and taking a course at a time I will be ready to retire by the time I get my degree.

Tags: Healthcare Informatics, Healthcare Informatics Resources, Nursing Education, Health Care Informatics Eduction, Community Public Health Nursing Education

Nursing Education and the Computer, comment

July 7, 2009

The computer is such a vast magnitude of information and when used appropriately can be a wonderful education tool. I wouldn’t know what to do if I had to attend class because I have taken Internet courses for so long. I love it for the convenience. The only downfall that I see to education via the computer is that the individual must be disciplined and take initiative. In other words, I have learned that I must still schedule my school time. The other thing is, that it is my responsibility to look for clinical education. I use my current employment to get clinical experience to assist in the studies I am currently doing. I think nurses and anyone really can benefit from computer education if used the right way. I do believe we must be cognizant of the fact that not all information on the Internet is accurate and we must utilize information from reputable sites. July 3, 2009 I have also taken courses on line and completed a masters in psychology. Now I am enrolled in classes where I actually have to appear in person. Since it is a nurse practitioners program I guess being there is more important. It was quite an adjustment to sit and listen to someone lecture for hours at a time and then be quizzed on the information. You right on point about the fact that one has to maintain a great deal of discipline and initiative to be successful in an online program. I too have to find my own clinical experiences, but we were provided with a list of providers who already had contracts with the school for preceptorship, therefore the hunt was not as difficult as going out totally on your own. You are also correct that not all the information online is reliable or even creditable, one needs to find trusted and well established literature from organizations that are well known and established in the area that you are researching otherwise your research won’t be evidence based nor have any validity.

Module One of this program helps nurses to use the computer in your education. Click here.

Original Post:
April 28, 2009
Title; Nursing Education and the Computer, comment
The computer is such a vast magnitude of information and when used appropriately can be a wonderful education tool. I wouldn’t know what to do if I had to attend class because I have taken Internet courses for so long. I love it for the convenience. The only downfall that I see to education via the computer is that the individual must be disciplined and take initiative. In other words, I have learned that I must still schedule my school time. The other thing is that is is my responsibility to look for clinical education. I use my current employment to get clinical experience to assist in the studies I am currently doing. I think nurses and anyone really can benefit from computer education if used the right way. I do believe we must be cognizant of the fact that not all information on the Internet is accurate and we must utilize information from reputable sites.

Original Post:
April 22, 2009
The information that we can gain to utilize in our nursing career is
significant.  I currently work with the Director of the Child Abuse team.
She is a remarkable physician and is constantly working to keep the nursing
staff up to date in assessing for child abuse.  A few years ago she showed a
video of a daycare provider’s boyfriend physical abusing an infant on a
nanny cam.  The day care provider was suspicious of her boyfriend and hid a
video camera when she left the children alone with him.  After seeing the
vicious beating on tape she immediately called the parent and had the child
brought to the local ER.  The child had not one bruise and not one broken
bone.  To see this video is to assume the child would be barley breathing.
The doctor’s intent of the video is to show us recent information about an
ongoing child abuse case and to re-enforce a child victim of abuse does not
necessarily have the marks to show it.  The current and readiness of the
Internet to help educate has kept our clinic up to date on what to look for
with child abuse.

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Not sure what happened to this one

July 3, 2009

The wonders of technology. I looked at my completed tasks and noticed that the one of my assignments is not listed as completed. Looking back through me emails from Dr Johnson I found where it was graded. Technology is a wonderful thing and I know it has greatly enhanced every day life. There are times though when I think we take for granted that it is working so well that we need not pay attention to the old ways of doing things, like entering on a calendar when an assignment is completed. I remember as a young nurse when computer documentation first came into the hospitals and we were told it would make our lives easier, there would be no paper. At my current job we are getting ready to "go live" on a new anesthesia documentation system and they will be taking away our paper charts……. I will really miss my paper trail.

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Glascow Coma Scale

July 1, 2009

Anatomy and Physiology of the human body can differ from individual to individual. Computerized notations do not always allow for these variances. The example I would like to expand upon is neurological exams. The Glascow Coma Scale can be depicted in a computerized screen very well. However, it does not allow you to expand on the neuro state that happens to fall in between the number scale. I always have to go to a narrative note to explain orientation or insert patient sentences to explain their orientation level. While computer charting is easy to read than the human hand written notes, it can only chart a definite range. There are no in between allowances.

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