NTI
Registration
Opens
Reducing
‘Never
Events’
Page 5
Page 10
Nurse Voice:
Jorge Murillo
Pages 12-13
Sedation
for Patients
With PTSD
Tips for
New Graduate
Nurses
Things
to Do in
NOLA
Page 15
Page 19
Page 20
Vol. 8, No. 2 | FEBRUARY 2016
®
High Acuity & Critical Care Nurses Make Their Optimal Contribution
Bold_Voices_February_2016_Pages.indd 1
1/12/16 6:41 PM
Removing
Barriers to
Practice
Another Angle
Read more in my note on page 22.
Karen McQuillan
AACN President
And so with a literal keyboard and a figurative paintbrush, I scratch tooth
and nail to honor my resolutions every single day. Because as a nurse
in the intensive care unit, I’ve learned — while I’m relatively young, I
possess an old soul — that nothing in this life is promised. We have no
guarantee. We cannot push off what we crave today unto tomorrow,
because there is no certainty that tomorrow may come. Our painting —
our masterpiece — it may live and die within us, never to be shared. The
intensive care unit is my momento mori: a constant reminder that the
world shall turn, time shall pass, and us, too, along with it.
The barriers are not erected which
can say to aspiring talents and
industry, “Thus far and no farther.”
—Ludwig van Beethoven
3
AACN BOLD VOICES FEBRUARY 2016
I
t’s not that others don’t
recognize the importance
of cherishing every day.
Resolutions and bucket lists are created by people across the globe,
hopeful to allow the dawn of a new year to represent a new self. From
hemisphere to hemisphere, as the world turns, we focus on a literal
timeline. Men and women paint the new year with broad strokes — a
personalized rendering of new beginnings. Yet before the paint has even
dried, we so quickly forget to admire the picture of our own goals and
dreams, cutting off progress on a personal masterpiece for the sake of
shadowy obligations and sooty responsibilities. And so our potential sits
on canvas, abandoned and incomplete, because our resolve was taken
over by our worries, doubts, and distractions.
The other day I ran into the dry
cleaners wearing my pink scrubs
and jacket that proudly displays
my name followed by RN.
The young woman behind the
counter asked if I was a nurse.
After confirming I was, she
responded like so many others,
“I don’t know how you do it!
That job must be very difficult.
Thank you for being there for us.”
Although this can feel grim and pessimistic to those on the outside,
in fact, it’s quite the opposite. While so many await January 1st to
make a change, make an impact, make a difference — as a nurse I feel
compelled to do so every single day. While few can understand just
how ridiculous it is to incessantly plan the future without pursuing your
dreams today, the patients charged with my care each shift have inspired
me to open up to the universe; paint my passions tirelessly; and quite
frankly, give a damn where once was none. I feel compelled to gather
my rosebuds, so to speak, while I still may. I feel the need to create my
masterpiece while I’m here today.
—Sonja Mitrevska-Schwartzbach
REFERENCE: Mitrevska-Schwartzbach S. A nurse and a new year. The Blog: Huffington Post. 2015 Dec
28. http://www.huffingtonpost.com/sonja-mitrevskaschwartzbach-bsn-rn-ccrn/a-nurse-and-a-newyear_b_8879610.html. Accessed January 5, 2016.
Bold_Voices_February_2016_Pages.indd 3
1/12/16 6:41 PM
®
The American Association of Critical-Care
Nurses is the world’s largest specialty nursing
organization. AACN is committed to a healthcare
system driven by the needs of patients and
families where high acuity and critical care nurses
make their optimal contribution.
Board of Directors
President
Karen McQuillan,
RN, MS, CNS-BC, CCRN, CNRN, FAAN
Clinical Nurse Specialist
R Adams Cowley Shock Trauma Center
University of Maryland Medical Center
Baltimore, MD
President-elect
Clareen Wiencek, RN, PhD, ACHPN, ACNP
Associate Professor
ACNP Program Coordinator
University of Virginia School of Nursing
Charlottesville, VA
Secretary
Deborah Klein,
RN, MSN, ACNS-BC, CCRN, CHFN, FAHA
Clinical Nurse Specialist
Coronary ICU, Heart Failure ICU,
Cardiac Short Stay/PACU/CARU
Cleveland Clinic
Cleveland, OH
Treasurer
Paula S. McCauley, DNP, APRN, ACNP-BC, CNE
Associate Dean for Academic Affairs,
Associate Professor
University of Connecticut School of Nursing
Storrs, CT
www.aacnboldvoicesonline.org
4
Directors
Megan E. Brunson, RN, MSN, CNL, CCRN-CSC
CVICU Night RN Supervisor
Medical City Dallas Hospital
Dallas, TX
Kimberly Curtin,
DNP, APRN, ACNS-BC, CCRN, CEN, CNL
Associate Director, Clinical Nurse Leader Program
University of Texas, MD Anderson Cancer Center
Houston, TX
Nancy Freeland, RN, MS, CCRN
Senior Nurse Educator for Critical Care
University of Rochester Medical Center
Strong Memorial Hospital
Rochester, NY
Wendi Froedge, RN-BC, MSN, CCRN
RN IV, Critical Care Services
Houston Methodist Willowbrook Hospital
Houston, TX
Karen L. Johnson, RN, PhD
Director of Nursing Research
Banner Healthcare System
Phoenix, AZ
Editorial Office
AACN Communications
101 Columbia, Aliso Viejo, CA 92656
800-394-5995 ext. 512
949-448-7335
[email protected]
www.aacn.org
AACN Certification Corporation, the credentialing
arm of the American Association of Critical-Care
Nurses, maintains professional practice excellence
through certification and certification renewal of
nurses who care for acutely and critically ill
patients and their families. AACN Certification
Corporation develops and administers the CCRN,
PCCN, CCRN-E, CCRN-K, CCNS, ACCNS-AG,
ACCNS-P, ACCNS-N, ACNPC and ACNPC-AG
specialty exams in acute, progressive and critical
care; CMC and CSC subspecialty exams in cardiac
medicine and surgery; and, in partnership with
the AONE Credentialing Center, the CNML exam
for nurse managers and leaders.
Board of Directors
Chair
Mary Frances Pate, PhD, RN, CNS
Assistant Professor
East Carolina University College of Nursing
Greenville, NC
Chair-Elect
Karen S. Kesten,
RN, DNP, APRN, CCRN-K, CCNS, CNE
Director of Educational Innovations
American Association of Colleges of Nursing
Washington, DC
Secretary/Treasurer
Lisa A. Falcón, RN, MSN, NE-BC
Director, Trauma and Injury Prevention
Robert Wood Johnson University Hospital
New Brunswick, NJ
Directors
Sonia Astle, RN, MS, CCRN, CNRN, CCNS
Clinical Nurse Specialist
Inova Fairfax Hospital
Falls Church, VA
Denise Buonocore,
RN, MSN, ACNPC, CCNS, CCRN, CHFN
Acute Care Nurse Practitioner,
Heart Failure Services
St. Vincent’s Multispecialty Group
Bridgeport, CT
Michelle Kidd, RN, MS, ACNS-BC, CCRN-K
Clinical Nurse Specialist for Critical Care
Indiana University Health Ball Memorial Hospital
Muncie, IN
Nancy Freeland, RN, MS, CCRN
Senior Nurse Educator for Critical Care
University of Rochester Medical Center
Strong Memorial Hospital
Rochester, NY
Lisa Riggs, MSN, APRN-BC, CCRN-K
System Director, Regulatory Readiness
Saint Luke’s Health System
Kansas City, MO
Milisa Manojlovich, RN, PhD, CCRN
Associate Professor
University of Michigan School of Nursing
Ann Arbor, MI
Louise Saladino, RN, DNP, MHA, CCRN
Director of Nursing
Ochsner Medical Center
New Orleans, LA
Lisa Riggs, MSN, APRN-BC, CCRN-K
System Director, Regulatory Readiness
Saint Luke’s Health System
Kansas City, MO
Christine S. Schulman, RN, MS, CNS, CCRN
Critical Care Clinical Nurse Specialist
Legacy Health System
Portland, OR
Editor: Marty Trujillo; Managing
Editor: Judy Wilkin; Contributing
Editor: Connie Barden; Clinical
Adviser: Julie Miller, RN, BSN, CCRN ;
Contributing Writers: Marijke
Vroomen Durning, Jim Kerr, Neal
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Hinton; Design: Brian Burton Design
Inc., Matthew Edens; Web Editor: Paul
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AACN BOLD VOICES (print ISSN 1948-7088,
online ISSN 1948-7096) is published monthly by
the American Association of Critical-Care Nurses
(AACN), 101 Columbia, Aliso Viejo, CA 92656.
Telephone: 949-362-2000. Fax: 949-362-2049.
Copyright 2016 by AACN. All rights reserved.
AACN BOLD VOICES is an official publication
of AACN. No part of this publication or its
digital edition may be reproduced or transmitted
in any form or by any means, electronic or
mechanical, including photocopying, recording
or by any information storage retrieval system,
without permission of AACN. For all permission
requests, please contact Sam Marsella, AACN,
101 Columbia, Aliso Viejo, CA 92656. Telephone:
800-899-1712. Email: [email protected].
Prices on bulk reprints of articles available on
request from AACN at 800-899-1712. AACN
BOLD VOICES is indexed in the Cumulative
Index to Nursing and Allied Health Literature
(CINAHL).
The statements and opinions contained in AACN
BOLD VOICES do not necessarily represent the
views or policies of the American Association
of Critical-Care Nurses, except where explicitly
stated. Advertisements in this publication or its
digital edition are not a warranty, endorsement
or approval of the products or services by AACN
or the editors and content contributors of AACN
BOLD VOICES, who disclaim all responsibility
for any injury to persons or property resulting
from any ideas or products referred to in the
articles or advertisements.
Individual subscriptions by request. Institutional
subscriptions: $200.  
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Chief Executive Officer
Dana Woods
Bold_Voices_February_2016_Pages.indd 4
1/12/16 6:41 PM
AACN
NTI 2016: Registration Opens Feb. 1 —
Make Your Case for Attending
These five to-do’s will help you
jump-start your NTI planning.
AACN’s National Teaching Institute &
Critical Care Exposition (NTI) is May
16-19, with preconferences May 15.
At the premier conference for high
acuity and critical care nurses, earn
more than 34 hours of continuing
education (CE) contact hours via live
sessions, plus additional hours of self-study during and for
60 days after the conference.
As we welcome the first months of 2016, five to-do’s
will help you jump-start your NTI planning:
 Register now at www.aacn.org/ntino16 if you are
planning to attend.
NTI with your manager to request professional
development funds and to schedule time off. Visit
our ROI toolkit for a template request letter and
planning worksheets. Focus on what you will
specifically bring back to your unit or hospital in
return for the opportunity to attend.
 Search the NTI educational program online, and
personalize your program with a combination of
sessions tied to your unit’s or hospital’s strategic
initiatives and your professional development
goals.
Engage, Connect,
Participate at
NTI 2016’s LDW
The Chapter Leadership
Development Workshop
features techniques and
competencies for successful
chapter management.
Bold_Voices_February_2016_Pages.indd 5
 Book your hotel early for the best selection and
discounted rates, since reservations are assigned
on a first-come, first-served basis. Visit www.aacn.
org/nti > Hotel and Travel for a list of hotels and
rates, and to book your hotel reservation.
5
AACN BOLD VOICES FEBRUARY 2016
 If you are deciding, discuss the value of attending
 Experience the magic of NTI and the rich history
and culture of New Orleans. The vibrant culinary
and music scene adds to the atmosphere as we
welcome our community of exceptional nurses to
the Big Easy. Visit www.neworleanscvb.com/aacn
to learn more about New Orleans.
T
he 2016 Chapter Leadership Development Workshop (LDW), at the National
Teaching Institute & Critical Care Exposition (NTI) in New Orleans, is an
excellent learning opportunity for current and future chapter leaders. Be
a part of this preconference, featuring techniques and competencies for
successful chapter management.
LDW will take place Sunday, May 15, from 8 a.m. to 5 p.m. at the Sheraton
Hotel, Grand Ballroom, class code PC125. Sign up when you register for NTI. To
add LDW after you register for NTI, call Customer Care at 800-899-2226. Each
AACN chapter that sends one person to LDW automatically receives a one-time
$435 grant to help defray attendance costs.
Discuss the workshop at your next chapter meeting to ensure your chapter
is represented. There is no limit to the number of additional chapter leaders or
members who may participate for $85 each. Contact your chapter advisor or
email [email protected] with your questions.
1/12/16 6:41 PM
CERTIFICATION CORNER
Consensus Model Continues to
Unite Nursing Community
T
he Consensus Model for APRN
Regulation is a broad-based model
for regulation of advanced practice
registered nurses (APRNs), providing
guidance throughout the U.S. for states
to adopt uniformity in regulating APRN
roles. The target date to complete that
work was 2015. We spoke with Carol
Hartigan, AACN certification and policy
strategist, for an update.
www.aacnboldvoicesonline.org
6
What’s significant about
what has happened with the
Consensus Model?
This is the first time the nursing
community worked collaboratively
and for a sustained period with
such a diverse group of stakeholders on a potentially divisive
issue without breaking apart. What
could have become the “Contentious
Model” emerged as the Consensus
Model — but not without negotiation, compromise and crucial
conversations, all with the goal of
patient safety. What emerged is a
comprehensive understanding of,
and respect for, the foundational
underpinnings of each role and
stakeholder group that participated.
Because of the strength of
the process, we won support
from important allies, such as
the Institute of Medicine, which
printed the model as an appendix
to its landmark 2010 report, “The
Future of Nursing: Leading Change,
Advancing Health.” AARP is now
advocating for full scope of practice for APRNs in order to increase
patient access to care, and the
Citizen Advocacy Center developed
resources for removing unjustified
scope-of-practice restrictions.
What was AACN’s role in
making this happen?
AACN Certification Corporation
was involved from the beginning
of the 11-year process of developing
the model. We are proud of bringing
Bold_Voices_February_2016_Pages.indd 6
together a coalition of members of
the APRN Consensus Work Group to
keep acute care within the licensure
section. Throughout the process,
there was a strong undercurrent
to keep the model primary care, to
essentially ignore acute care and
place critical care on the specialty or
unlicensed level. AACN believes that
APRNs who care for patients along
the acute to critical care continuum
must be educated at the graduate
level according to national competencies and standards. If acute care/
critical care had been placed on the
specialty level of the Consensus
Model — which is the non-licensure
level — these requirements would
not have been in place, and our
patients would not have been guaranteed their APRNs would have
these competencies.
What has improved because of
the model?
Since each state is governed by
an individual Nurse Practice Act,
there are 51 variations on how
APRNs are defined, regulated and
what their scope of practice may be.
This results in situations like the
one in Kansas City, where a nurse
practitioner may have one scope of
practice on the Missouri side of the
street and a totally different scope
of practice on the
Kansas side. Same
person, same qualifications, different
law. Once states
accomplish the
required legislative
changes under the
Consensus Model,
boards of nursing
will license APRNs
as independent
practitioners with
full scope of practice
and no regulatory requirements
for collaboration, direction or
supervision.
What still needs to be done?
It is very difficult for states to
achieve changes in their statutes;
more so in some states than in others.
In many states, the board of nursing
is not allowed to lobby for changes
in legislation, so that work must be
done by professional associations
and others. There can be tremendous opposition by groups such as
state medical associations, which
often view full scope of practice by
APRNs as the practice of medicine. It
is particularly effective when other
healthcare groups such as pharmacists and psychologists help lobby
for nursing scope-of-practice legislation and vice versa. This changes the
perspective of these bills from being
viewed as nurse-physician “turf
battles” to a patient-access-to-care
issue and can be quite successful.
To check the status on how your board
of nursing is implementing the Consensus
Model, view the state maps at www.ncsbn.
org/5397.htm. Look for a link in AACN
CriticalCare eNewsline to participate
in the upcoming Study of Practice survey,
specifically for APRNs practicing within
the spectrum of wellness through acute
care.
1/12/16 6:41 PM
AACN
Invest in Your Future With an AACN Scholarship
A
s an AACN member, you seek
lifelong learning, and AACN
offers many benefits to help you
reach your goals, including professional
development scholarships.
AACN scholarships enhance the value
of your membership. Whether you seek
learning at a national conference or a
AACN Updates Popular,
Best-Selling Pocket
Reference Cards
AACN has updated the design and content of its
popular evidence-based pocket reference cards. The 13
cards are designed to place expert knowledge at nurses’
fingertips in a handy and simple format, offering quick
and convenient information.
A popular tool with nurses, these best-selling cards
address conditions across the continuum, from neurological assessment to cardiac medications. They provide
nurses with at-a-glance information that addresses
their patients’ conditions, helping them take quick
action in crucial moments.
“I use these at least twice a week,” says Patricia A.
Baker, critical care clinical nurse specialist, Winchester
Medical Center, Winchester, Virginia, “assisting the
bedside nurse in developing their research question, or
perhaps assisting with a school project.
“They’re compact for the pocket with the right
amount of key information,” she says. “They help me
when I need to refocus a topic — or to refresh the
memory from research courses.”
AACN offers a Pocket Reference Card Bundle at 20
percent off the regular price. The bundle contains all
13 of AACN’s pocket reference cards, including the
following best-sellers:
class for your RN to BSN, AACN supports your quest to expand
your knowledge and skills.
When you apply for a scholarship, you develop a learning
plan that links a knowledge gap to your requested activity. Your
plan should answer several questions, including:
• How will the opportunity help you achieve your learning
goals?
• Specifically, how will you apply your new knowledge to
your nursing practice?
Start your journey at www.aacn.org/scholarships, where
you can read about the many opportunities AACN scholarships
have funded, from health policy, evidence-based practice and
leadership development to personal growth and communications. Then read Information and Instructions for Scholarship
Applicants before you start your application.
Apply for an AACN scholarship online, and please submit
it three or four months before the activity, so we have sufficient time to process your request. If you aren’t a member yet,
consider all the benefits of joining the world’s largest specialty
nursing organization, now more than 106,000 members strong.
Please email [email protected] with your questions on
scholarships or [email protected] about membership.
7
AACN BOLD VOICES FEBRUARY 2016
Apply
your new
knowledge to
your nursing
practice.
• AACN Hemodynamic Management Pocket
Reference Card (#400751)
• AACN Cardiovascular Assessment Pocket
Reference Card (#400855)
• AACN Cardiac Medications Pocket Reference Card
(#400801)
• AACN Dysrhythmia Recognition Pocket
Reference Card (#400758)
• AACN Pulmonary Management Pocket Reference
Card (#400857)
To place an order for the bundle or to purchase
individual, single-topic cards, visit the AACN Online
Bookstore; www.aacn.org/bookstore.
Bold_Voices_February_2016_Pages.indd 7
1/13/16 9:42 AM
AT THE BEDSIDE
Early Noninvasive Ventilation No Better
for Immunocompromised Patients
Further studies are needed to compare high-flow nasal
oxygen vs. standard oxygen and noninvasive ventilation
for critically ill immunocompromised patients.
E
www.aacnboldvoicesonline.org
8
arly noninvasive ventilation proved no more effective
than oxygen therapy alone in
reducing mortality in a European
clinical trial of immune-compromised intensive care patients with
hypoxemic acute respiratory failure.
“Effect of Noninvasive Ventilation
vs. Oxygen Therapy on Mortality
Among Immunocompromised
Patients With Acute Respiratory
Failure: A Randomized Clinical
Trial,” in JAMA: The Journal of
the American Medical Association,
reports that 24.1 percent of patients
receiving noninvasive ventilation
died within 28 days, compared to
27.3 percent of those in the oxygen
group. A total of 374 patients
at 28 hospital units in France
and Belgium participated in the
study from 2013 to 2015, with 191
randomly assigned to the noninvasive ventilation group and 183 to the
oxygen group.
Composed largely of patients
with acute leukemia, aggressive
lymphoma, lung cancer or kidney
transplantation, the two randomized
groups had no significant differences
in length of hospital or ICU stay,
time spent on mechanical ventilation
or infections acquired in the ICU.
Oxygenation failure occurred in 38.2
percent (73 of 191) of the noninvasive
group, compared to 44.8 percent (82
of 183) in the oxygen group. “The
median oxygen flow was 9 L/min at
randomization in both groups,” adds
a related article in Physician’s Briefing.
One area of difference was the
need for high-flow nasal oxygen
in 44.3 percent of patients in the
oxygen group but only 31.4 percent
in the noninvasive ventilation group.
“Studies comparing use of high-flow
nasal oxygen vs. standard oxygen and
noninvasive ventilation for critically
ill immunocompromised patients are
needed,” the study adds in suggesting
follow-up actions.
The hypothesis that early noninvasive ventilation would improve
survival rates did not prove correct,
so the study theorizes the result “is
probably ascribable to the greater
than 50% decrease in the rates of
intubation and mortality compared
with earlier work.” The study also
notes that the findings might fail
to exclude a clinically important
effect that might account for similar
outcomes in both groups.
REFERENCE: Lemiale V, Mokart D, Resche-Rigon M, et
al. Effect of noninvasive ventilation vs oxygen therapy
on mortality among immunocompromised patients with
acute respiratory failure: a randomized clinical trial.
JAMA. 2015;314(16):1711-1719.
New Eye-Tracking Devices Help Ventilated ICU Patients Communicate
By the end of the
pilot project, all
patients were able to
communicate using
the devices, and
their psychosocial
status improved.
ICU patients who could not communicate verbally were able to use eye-tracking devices
to communicate, reveals a pilot study in Surgery.
“A Pilot Study of Eye-Tracking Devices in Intensive Care” gave eye-trackers to 12 ICU
patients at Johns Hopkins Hospital in Baltimore in 2013 and 2014. Although ventilated, the
patients created sentences by staring at words and images on a computer monitor. Small
cameras followed their eye movements.
Speech pathology therapists provided five days of training to teach patients how to
convey basic hospital needs, such as spelling out “nurse,” “hungry,” “thirsty” and “pain.”
Patients also learned to use picture sets and play memory games to help the learning
process, adds a related article in Reuters.
By the end of the pilot project, all patients could communicate using the devices, and
their psychosocial status improved. Patients reported being happier and less anxious, although further studies
are needed to prove if the devices are directly responsible. Some patients were even able to use the eye-tracker
to communicate on social media.
Although not involved in the study, Daniel Howes, an emergency medicine specialist at Queens University in
Ontario, adds in the article: “Ideal patients are those who are mentally intact, can go through the training and
who can’t communicate by other means.”
The article adds that further study is needed to determine the benefits and limitations of eye-trackers for a
broader ICU population.
REFERENCE: Garry J, Casey K, Cole TK, et al. A pilot study of eye-tracking devices in intensive care. Surgery. 2015 Sep 7.
Bold_Voices_February_2016_Pages.indd 8
1/12/16 6:41 PM
AT THE BEDSIDE
Middle-Aged White Americans
Dying at Higher Rates
Less-educated white Americans between
the ages of 45 and 54 experienced a
particularly dramatic spike in mortality
from 1999 to 2013.
9
AACN BOLD VOICES FEBRUARY 2016
A
commentary on health and mortality reveals that
middle-aged white non-Hispanic Americans are the only
group with rising death rates, driven by suicides and the
effects of substance abuse.
“Rising Morbidity and Mortality in Midlife Among White
Non-Hispanic Americans in the 21st Century,” in Proceedings
of the National Academy of Sciences of the United States of
America, shows that less-educated white Americans between
the ages of 45 and 54 experienced a particularly dramatic spike
in mortality from 1999 to 2013. All other age groups and ethnic
groups, as well as parallel groups from other wealthy countries,
showed reduced mortality in that time period.
The death rate for white non-Hispanics ages 45-54 with a
high school education or less rose 134.4 per 100,000, enough
to counteract small improvements among better-educated
groups. In that age range, overall mortality among white
Americans rose 33.9 per 100,000, while mortality for blacks
dropped 214.8 and Hispanics 63.6.
The commentary observes that drug and alcohol poisoning,
suicide and liver disease/cirrhosis were the causes of death most
responsible for the spike, even while deaths due to lung cancer
decreased and diabetes remained similar. The commentary
also finds parallel declines in overall health in the same group,
including chronic pain, difficulty moving and alcohol abuse.
Co-authors Anne Case and Angus Deaton discuss potential explanations, such as the increase in opioid prescriptions
and heroin use during the time period, the documented rise
in misuse and abuse of such drugs, the potential effect of the
financial slowdown, reduced economic security and quality of
life, and a significant rise in Americans on disability.
AACN Bo
2/1/2016
8233916UNMHO
3.375” x 1
Tracy O’N
REFERENCE: Case A, Deaton A. Rising morbidity and mortality in midlife among white
non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA. 2015 Nov 2.
pii:201518393.
Bold_Voices_February_2016_Pages.indd 9
1/12/16 6:41 PM
AT THE BEDSIDE
Reducing ‘Never Events,’ Measuring
Progress in Patient Safety
Any incident at Mayo Clinic involving
serious harm is examined to determine
whether it resulted from a deviation in
standards of care.
©www.ghshospital.org
T
racking the frequency of preventable harmful events
— so-called “never events” — is important, but it’s
not sufficient to measure progress in patient safety
over time, two Mayo Clinic executives write.
“Getting Rid of ‘Never Events’ in Hospitals,” in Harvard
Business Review, notes that several factors have combined
to distort measurements in patient safety, suggesting that
little progress in reducing never events has occurred in the
past decade, write Timothy Morgenthaler, chief patient
safety officer at Mayo Clinic, and Charles M. Harper, executive dean for practice. Not only has the definition of the
term changed over time, the average patient’s condition
is more complex than ever, and many of today’s common
procedures were not performed a decade ago.
www.aacnboldvoicesonline.org
10
National Patient Safety Goals
Focus on Solving Safety Problems
AACN Resources on Patient Safety
“AACN Alarm Management” — www.aacn.org/
practicealerts
“AACN Standards for Establishing and Sustaining Healthy
Work Environments” — www.aacn.org/hwe
“Live Q&A: Alarm Management Implementation
Revisited” — www.aacn.org/webinars
“Managing Alarm Fatigue: New Approaches and Best
Practices” — www.aacn.org/webinars
The Joint Commission’s 2016 National Patient Safety Goals
include steps to prevent medical mistakes and hospitalacquired infections.
“Establishing a Culture of Safety” in American Journal of
Critical Care — www.ajcconline.org
Some of the goals:
Silent Treatment: How Silence Still Kills — www.aacn.org/
silenttreatment
• Identify patients correctly — Identify patients in at
least two ways, such as name and birthdate.
• Improve staff communication — Ensure test results
are delivered on time.
• Use medicines safely — Before procedures, make sure
all medicines are labeled. Record medicines and pass
along correct information.
• Use alarms safely — Ensure alarms are heard and
responded to promptly.
• Prevent infection — Improve hand cleaning. Use
proven guidelines against infections from central lines,
catheters and post-surgery.
• Identify patient safety risks — Determine which
patients are most likely to attempt suicide.
• Prevent mistakes in surgery — Make sure the correct
surgery is performed on the correct patient and at the
correct place on the body.
Bold_Voices_February_2016_Pages.indd 10
A related article in FierceHealthcare notes that while
patient safety is an ongoing concern, the Mayo executives suggest that for meaningful reform to take place, the
healthcare industry must reassess the way it measures
medical mistakes.
For instance, rather than focusing solely on rates of
never events, Mayo Clinic monitors safety in additional
ways. It analyzes each step of care for patients who die
in the facility, producing quarterly metrics and looking
for trends that lead to opportunities for improvement.
Additionally, any incident involving serious harm is examined to determine whether it resulted from a deviation in
standards of care.
“This is a meaningful way to measure progress in
patient safety, because it measures something we feel we
can influence i.e., how reliably we follow our best practices
to prevent harm,” the writers explain.
1/12/16 6:41 PM
AT THE BEDSIDE
Stereotyping in Healthcare May Affect Outcomes
W
hen healthcare providers stereotype patients, poorer outcomes may
result, according to an article in American Journal of Preventive
Medicine.
“Healthcare Stereotype Threat in Older Adults in the Health and Retirement
Study” says that healthcare stereotypes can result in patients being judged
prematurely, with negative effects on their health, including increased hypertension and depression. However, cultural competency training could help healthcare
providers.
The study, which involved data from the 2012 Health and Retirement Study, included a sample subset of 1,479 participants with a healthcare stereotype threat. Seventeen percent of participants reported being subjected to healthcare
stereotypes, with associated higher levels of distrust in their physician and the healthcare system and being less likely to
use preventive care. Stereotyping may involve judgements related to age, weight, race, gender, ethnicity and more.
“Some healthcare stereotyping can be an inadvertent side effect of health awareness campaigns,” lead study
author Cleopatra Abdou, assistant professor, USC Davis School of Gerontology, Los Angeles, notes in a related article in
FierceHealthcare. “An unintended byproduct of public health campaigns is that they often communicate and reinforce
negative stereotypes about certain groups of people.”
While these campaigns are necessary, they may be seen as supporting some preconceptions, such as those showing
older people with memory problems and women with depression.
“Hospitals and other health care institutions with inclusive policies which welcome diversity and celebrate tolerance,
both symbolically and explicitly, hold great promise for reducing health care stereotype threat and the short- and longterm health disparities that we are now learning result from it,” Abdou adds in the article.
Healthcare institutions with
inclusive policies that welcome
diversity and celebrate tolerance
hold great promise to reduce the
healthcare stereotype threat.
REFERENCE: Abdou CM, Fingerhut AW, Jackson JS, Wheaton F. Healthcare stereotype threat in older adults in the Health and Retirement Study. Am J Prev Med. 2015 Oct 13.
doi:10.1016/j.amepre.2015.07.034.
AACN BOLD VOICES FEBRUARY 2016
11
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NURSE VOICES
Traveling a Circuitous Path
That Led to Nursing
An Interview With Jorge Murillo
www.aacnboldvoicesonline.org
12
Bold_Voices_February_2016_Pages.indd 12
1/12/16 6:41 PM
NURSE VOICES
S
ome people know as children they were born to be a nurse.
Jorge Murillo is not one of them. Murillo is an RN working
in the CCU at Lakeland Regional Medical Center, St. Joseph,
Michigan, but the route he took to his true calling was a bit more
circuitous than others’. First, the entertainment industry called him.
Then a successful turn as a bartender, before life events opened his
eyes, his mind and his compassionate spirit to nursing. Turns out, it’s
where he’s always wanted to be.
How did you get started in nursing?
Well, I got my BA in media communications in 1993. I
always felt like I wanted to be involved in the entertainment
industry at some level, so I figured that was a good course to
take. At the same time I used to work in the food industry as
a bartender. I landed a freelance job in video editing, but the
bartending job was more profitable, so I decided to stay in the
food industry. I was 23 years old, and at that point money
seemed to matter more for me.
So it played a big role in your wanting to be a nurse?
Because of my father’s experience, this choice seemed so
appropriate. I wished I could have provided the same kind of
care and compassion those two did for my father, but I knew
I could for others. I made the decision of changing careers,
going back to school, and that is how I started to engage in
this amazing and rewarding profession.
Have the skills you learned in your previous professions helped you as a nurse?
In these few years practicing nursing, I have come to realize
there are two kinds of nurses: those that only work for the
money, since it is a stable industry, and those, who, like
myself, find nursing fulfilling and see it as a profession where
you have to invest yourself with all your heart, mind and
soul, leaving behind prejudices and
and science, but taboos to become part of the healing
process of a human being.
Nursing is art
furthermore, it is compassion
and empathy. It is treating
your patients as if they were
your family members.
My old job helped teach me to listen and not to judge; it gave
me the opportunity to learn more about the whole spectrum
of the human being: mental, physical, spiritual and religious
aspects. It taught me that every person’s life is important,
no matter race, gender, age, economic or cultural status. The
experiences I accumulated over those years prepared me for
my present career, giving me the maturity needed — at least
for me — to become competent in my present career.
Why did you change your career path?
I was happy with my old job, but I felt like I was missing
something in my professional life, so I decided it was time to
leave. I tried to go back to work in the marketing industry,
but all I found were sales jobs, which is what I’d been doing
before. So I started to look into other options and started to
contemplate nursing.
Then my father became very ill, and later died, but I noticed
something while visiting him. There were two nurses that
were really nice to him. I know my father was really going
through a hard time, and they were so good at showing
compassion and empathy to him.
Nursing is art and science, but furthermore, it is compassion and empathy.
It is treating your patients as if they
were your family members. For me,
it is seeing my father in each of my
patients, and caring for them as I would care for my father.
Back then, I did not have the knowledge that I have now, and
I so wish I could have given him much more.
You attended your first NTI in 2015. What was that
like?
I was blown away. It was incredible. Seeing so many nurses
dealing with the same types of problems on a daily basis, and
then having access to so many resources and tools. It was so
cool because, to me, meeting so many peers and colleagues
with similar desires to do good — it was just amazing! I will
absolutely go again.
13
AACN BOLD VOICES FEBRUARY 2016
Do you think that helped you
prepare for your current career?
I do. Back then, I lived in Chicago,
and I worked for several restaurants
until 2010. The service industry gave
me more than money; it taught me
the concept of customer satisfaction
and increased my empathy for all
kinds of people.
him, such as a back massage, a caring touch, playing music
that he liked, scratching his itching back and empathizing
with him.
What do you call a good day at work?
Our patients depend on us, and we have to be careful and
concentrate effectively in our care and give the best care
possible. But, if at the end of my shift, I accomplish my job,
which entails transitioning my patients to a better condition,
or if they are alert, I got a smile out of them, then nursing
fulfills my life, and no money in the world would give me
that satisfaction.
Interview by Paul Taylor ([email protected])
That experience showed you a lot about nursing?
It did. Nursing is remembering how those amazing nurses
took care of my father and showed him compassion. I learned
that bringing a smile to my suffering father was as important
as the treatment. Those little moments made him forget, for
a few seconds, his illness. Those little actions meant a lot to
Bold_Voices_February_2016_Pages.indd 13
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AT THE BEDSIDE
Full Use of EHRs Associated With Differences
in Clinical Outcomes for Non-STEMI Patients
Patients treated at hospitals
with fully implemented
EHRs had fewer heparin
overdoses and other adverse
outcomes than patients in
hospitals without EHRs.
N
ational legislation promoting the
adoption of electronic health
records (EHRs) in U.S. hospitals has resulted in fewer incidents of
heparin overdoses.
“Modest Associations Between
Electronic Health Record Use and
Acute Myocardial Infarction Quality of
www.aacnboldvoicesonline.org
14
Care and Outcomes,” in Circulation:
Cardiovascular Quality and Outcomes,
explains that overall EHR use increased
from 82.1 percent in 2007 to 99.3
percent in 2010.
The article adds that patients who
were treated at hospitals with fully
implemented EHRs had fewer heparin
overdoses than patients in hospitals
without EHRs (45.7 percent vs. 72.8
percent). The study included data from
43,527 patients treated at hospitals
with fully implemented EHRs, 72,029
patients at hospitals with partially implemented EHRs and 9,270 patients at
hospitals without EHRs.
There was also a difference in other
measures among patients with non-ST-
Pediatric Syringes May
Reduce Blood Loss in
Adult ICU Patients
U
sing pediatric syringes to obtain blood gas
samples in adult ICU patients may be preferable,
according to study results presented at the American
Society for Clinical Pathology 2015 Annual Meeting
in Long Beach, California.
“Safely Reducing Blood Specimen Volume in the
Blood Gas Laboratory,” on www.planion.com, notes
that by replacing standard 3 mL adult syringes with
1 mL pediatric syringes, the total amount of blood
removed per draw decreases, while still providing
accurate blood gas test results.
A related article in Medscape Medical News notes
that patients undergoing daily phlebotomy could
lose a mean of 40 mL to 70 mL of blood. Blood loss
from phlebotomy could be responsible for an estimated one-third of blood transfusions in critical
care. In addition, “more than 95 percent of patients
in the ICU are anemic after their first week of care.”
“We changed from using a 3cc syringe to a 1cc
syringe, and in the last year, we saved patients in
our cardiovascular intensive care unit alone about
25,000 mL of blood,” adds study author Phill Jensen,
laboratory manager, University of Utah Health
Sciences Center, Salt Lake City.
Bold_Voices_February_2016_Pages.indd 14
segment-elevation myocardial infarction
(STEMI). Fully implemented EHR use
was associated with a slightly lower
risk of major bleeding and mortality for
these patients, the study adds.
“EHR use has risen to high levels
among hospitals in the National
Cardiovascular Data Registry.” This
increased use resulted in patients experiencing fewer heparin overdoses, and,
although the improvement was modest,
they were more likely to receive guideline-recommended MI therapies.
REFERENCE: Enriquez JR, de Lemos JA, Parikh SV, et al.
Modest associations between electronic health record
use and acute myocardial infarction quality of care and
outcomes: results from the National Cardiovascular
Data Registry. Circ Cardiovasc Qual Outcomes.
2015;8(6):576-585.
FDA Approves Praxbind
The U.S. Food and Drug Administration (FDA)
recently gave accelerated approval to Praxbind (idarucizumab) to reverse the blood-thinning effects of the
anticoagulant Pradaxa (dabigatran).
“FDA Approves Praxbind, the First Reversal Agent
for the Anticoagulant Pradaxa,” on www.fda.gov,
announces that Praxbind, an intravenous solution,
“works by binding to the drug compound to neutralize
its effect.” Richard Pazdur, director of the FDA’s Office of
Hematology and Oncology Products, notes that it would
be used in cases where bleeding can’t be controlled and
for emergency surgery. Praxbind is the “first reversal
agent approved specifically for Pradaxa,” the release adds.
Safety and effectiveness were studied with 283
healthy volunteers (they did not require an anticoagulant), and there was a quick reduction in Pradaxa in the
blood when the patients were given Praxbind. The most
common adverse effect was headache.
Another trial using Praxbind to reverse Pradaxa
involved 123 injured patients who had uncontrolled
bleeding or required emergency surgery. Pradaxa was
fully reversed in 89 percent of those patients within four
hours of receiving Praxbind. The most common adverse
effects were “low potassium (hypokalemia), confusion,
constipation, fever and pneumonia.”
Because reversing the effects of Pradaxa may increase
the risk of blood clots and stroke from underlying
diseases, “Praxbind labeling recommends patients resume
their anticoagulant therapy as soon as medically appropriate, as determined by their health care provider.”
1/12/16 6:41 PM
AT THE BEDSIDE
Cleveland Clinic Announces
Medical Innovations
A
n academic medical center that integrates clinical
and hospital care with research and education
released “Cleveland Clinic Unveils Top 10 Medical
Innovations for 2016,” for the 10th year.
The breakthrough therapies, medical devices and
health initiatives were chosen by a panel of 75 of the
clinic’s physicians and scientists; following are summaries
of four of these innovations:
• “Rapid Development of Epidemic-Battling Vaccines”
is rated number one by the panel, which notes that
the most promising Ebola vaccine was developed in
only 12 months. It should be available for human
use this year.
“The rapid scientific response to recent epidemics
indicates that we’ve achieved a new level of sophis-
tication in the area of vaccine development,” says
Steven Gordon, chair of the Department of Infectious
Disease at Cleveland Clinic.
• “Naturally Controlled Artificial Limbs” is seventh.
Sensors implanted in the brain can control prosthetic
arms, wheelchairs and full-body exoskeletons. Brainmachine interfaces are being developed that will be
safer and less expensive.
• “Frictionless Remote Monitoring” is number nine.
Biosensors on the skin that measure insulin and
report the results could mean patients with diabetes
won’t need to use needles. “Other frictionless remote
monitoring devices in development include a bandage
that reads sweat molecules to diagnose pregnancy,
hypertension or hydration.”
• “Neurovascular Stent Retrievers” is ranked 10th.
Patients with stroke whose clots were removed with
a stent retriever had quicker recoveries and better
outcomes. The tiny, wire-caged device — which
should be available later this year — is inserted
through a catheter into the bloodstream and removes
the clot.
15
Patients With PTSD May Require
Special Sedation When Ventilated
Sedation regimens tailored to
patients with PTSD could reduce
sedative requirements and improve
their ICU experience and outcome.
P
atients with pre-existing post-traumatic stress disorder (PTSD) had a
more difficult time in the ICU when mechanically ventilated, finds a
poster abstract in CHEST.
According to “Effects on PTSD on Patient Outcomes in the Intensive Care
Unit,” the ICU environment can be jarring to patients who are ventilated and
may feel helplessly constrained and dependent. Alarm and monitor sounds,
endotracheal tubes, positive pressure ventilation and unfamiliar faces can
awaken traumatic experiences, resulting in agitation, delirium, and physical and psychological distress. As a result, longer
regimens and higher doses of sedatives — or other psychoactive drugs — were required in many of the observed cases.
Although the study focused on veterans with combat-related PTSD, the invasive nature of the ICU could have a
similar impact on non-combat-related patients with PTSD, says study author Philippe Jaoude, State University of New
York at Buffalo, in a related article in Medscape Medical News. Jaoude points out that sedation regimens tailored to
patients with PTSD “could reduce their sedative requirements and improve their ICU experience and outcome.”
The retrospective cohort study included 174 ICU patients receiving mechanical
ventilation. Approximately 87 had pre-existing PTSD. The abstract notes no
difference in the number of ventilator-free days at 28 days between the groups,
but the length of sedation was longer in the PTSD group than in the non-PTSD
group. There was also an increased, although not significant, trend toward ICU
mortality in the PTSD group.
AACN BOLD VOICES FEBRUARY 2016
The breakthrough therapies, medical
devices and health initiatives were
chosen by a panel of 75 physicians and
scientists from the clinic.
REFERENCE: Kebbe J, Lal A, El-Solh A, Jaoude P. Effects of PTSD on patient outcomes in the intensive care unit. Chest. 2015;148(4MeetingAbstracts):220A.
Bold_Voices_February_2016_Pages.indd 15
1/12/16 6:41 PM
AT THE BEDSIDE
Guide Assesses PICC Use
Avoid PICC use for inappropriate
indications, ensure necessary
consultations, outline instances
where PICCs should be removed
and consider alternative devices.
A
www.aacnboldvoicesonline.org
16
team of specialists created a guide for
intravenous catheter use, focusing on the
appropriateness of peripherally inserted
central catheters (PICCs).
“The Michigan Appropriateness Guide for
Intravenous Catheters (MAGIC): Results From
a Multispecialty Panel Using the RAND/UCLA
Appropriateness Method,” in Annals of Internal
Medicine, reviewed 665 patient scenarios and
rated 253 (38 percent) appropriate for PICC use
in adults, 124 (19 percent) neutral or uncertain,
and 288 (43 percent) inappropriate. “Avoiding PICC use for
inappropriate indications, considering alternative devices,
ensuring appropriate consultations, and outlining instances
where PICC removal is appropriate are but a few examples
of how these recommendations may be implemented to
improve practice.”
The article describes the following scenarios:
• For hospitalized patients, PICC use is inappropriate for
durations less than five days but preferred for 15 days
or more, with more invasive devices only for longer
durations when PICC use is not feasible.
• Midline catheters and ultrasonography-guided PICCs
are preferred for six to 14 days.
• For parenteral nutrition or vesicant/irritant chemotherapy, PICCs are appropriate for all durations.
• Patients with cancer need evaluation of expected duration and frequency of treatment as well as the type of
therapies.
• Critically ill patients require assessment of hemodynamic stability, risk of infection and thrombosis, and
the availability of intensivists to insert central venous
catheters.
• In patients who are hemodynamically unstable,
central venous catheter insertion is preferred, and
urgent requests for PICC placement are deemed
inappropriate.
• Patients with chronic kidney disease require evaluation
of severity and potential access needs to determine the
best device.
“PICCs are associated with important complications,
including thrombosis and infection. Moreover, some PICCs
may not be placed for clinically valid reasons. Defining
Bold_Voices_February_2016_Pages.indd 16
©www.vygon.com
appropriate indications for insertion, maintenance, and care
of PICCs is thus important for patient safety,” notes study
author Vineet Chopra, assistant professor, University of
Michigan, in a related article in Healio.
The article offers future research recommendations,
including a focus on neonatal and pediatric patients, smartphone applications, testing the criteria in a large health system
and randomizing clinical trials to test the approaches.
REFERENCE: Chopra V, Flanders SA, Saint S, et al. The Michigan appropriateness guide
for intravenous catheters (MAGIC): results from a multispecialty panel using the RAND/
UCLA appropriateness method. Ann Intern Med. 2015;163(6 Suppl):S1-S40.
No Bloodstream Infections With
Antimicrobial-Impregnated
Catheters
Two types of antimicrobial-impregnated catheters did not
produce any cases of catheter-related bloodstream infections, while 7.3 percent of intensive-care patients with
standard catheters contracted such infections.
The retrospective study, in American Journal of Infection
Control, involved 641 patients with femoral venous catheters and found 18 infection cases among 245 patients
(2,061 ICU days) with standard catheters. There were no
infections among patients given catheters impregnated
with second-generation chlorhexidine-silver sulfadiazine
(169 patients, 1,489 ICU days) or rifampicin-miconazole
(227 patients, 2,009 ICU days).
REFERENCE: Lorente L, Lecuona M, Jiménez A, et al. Chlorhexidine-silver
sulfadiazine- or rifampicin-miconazole-impregnated venous catheters decrease the
risk of catheter-related bloodstream infection similarly. Am J Infect Control. 2015
Sep 24.
1/12/16 6:41 PM
AT THE BEDSIDE
Wearable Artificial Kidney Being Tested
Although daily functions are
automated, the user must
replace the catheter and
filter once a week and add
chemicals daily.
A
n experimental wearable artificial kidney (WAK), currently
in trials, could eventually
liberate patients from frequent visits
to a hospital or clinic to use a dialysis
machine.
“Could Wearable ‘Artificial Kidney’
Free Patients of Big Dialysis Machines?”
on CNN, explains that the portable
device is worn on a belt and connects
to the body through a large vein via a
catheter. The WAK reportedly filters
water, salts and minerals from the blood
at the same rate as healthy kidneys. It
filters blood continuously versus two or
three times a week with conventional
dialysis machines.
Victor Gura, associate clinical
professor of medicine, David Geffen
School of Medicine, UCLA, and his
team are developing the device.
Although daily functions are automated, the user must replace the
catheter and filter once a week and add
chemicals daily. Currently, the prototypes are powered by 9-volt batteries
and weigh 10 pounds, but Gura and his
team hope to reduce the weight to 5
pounds.
A small trial involved seven patients
in Seattle with end-stage kidney disease
who wore the WAK for 24 hours. They
were able to sleep wearing the device
and should be able to take showers and
participate in other normal activities.
The patients also were encouraged
to eat off-limit foods such as bananas,
mashed potatoes, orange juice and ice
cream, which typically cause potassium and phosphorus buildup. They
did not express discomfort or experience any adverse effects. Although the
device stopped working properly for
two patients, Gura and his team fixed
the problem.
“Getting the machine to be reliable
and consistent is going to be (Gura’s)
greatest challenge,” Leslie Spry, medical
director for the Dialysis Center of
Lincoln, Nebraska, and spokeswoman
for the National Kidney Foundation,
says in the article.
The research should be considered
preliminary until it is published in a
peer-reviewed journal. The Food and
Drug Administration says it will expedite approval after studies have deemed
the device safe and effective, the article
adds.
AACN BOLD VOICES FEBRUARY 2016
17
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1/12/16 6:41 PM
AT THE BEDSIDE
Improving the Outcomes of
Urgent Weekend Surgeries
Focusing on five
tactics to improve
patient outcomes
can help hospitals
overcome the
weekend effect.
Supplements Lead to More
Than 23,000 Annual ED Visits
H
ospitals can improve the
outcomes of weekend
surgeries by focusing
on five factors: fewer beds per
nurse, full adoption of electronic
health records, inpatient physical
rehabilitation, a home health
program and a pain management
program.
These five tactics can reduce
the higher rate of complications, mortalities and readmissions
for surgical patients who have emergency procedures on the
weekend, concludes “Components of Hospital Perioperative
The issue is of concern, because
nutritional products, which continue
to grow in popularity, remain largely
unregulated.
www.aacnboldvoicesonline.org
18
D
espite being available over the counter, multivitamins, diet pills and herbal supplements may have
unexpected health risks and lead to an emergency
department (ED) visit, finds a study in The New England
Journal of Medicine.
Based on 3,667 reviewed cases, “Emergency
Department Visits for Adverse Events Related to Dietary
Supplements” estimates that more than 23,000 annual ED
visits can be attributed to adverse events related to dietary
supplements — 2,154 of which resulted in hospitalization.
The study, which was conducted by the Centers for
Disease Control and Prevention (CDC) and the Food
and Drug Administration, used nationally representative surveillance data in 63 EDs from 2004 to 2013. Data
was analyzed for U.S. hospital cases related to dietary
supplements.
Many cases with young adults (20 to 34 years old)
involved cardiovascular manifestations that were attributed to weight-loss or energy products, while older adults
(over 65 years old) had serious swallowing issues and
choking associated with micronutrients. Unsupervised children often ingested supplements they were not supposed
to touch.
While the trend accounts for only 5 percent of ED visits,
the issue is of concern, because nutritional products, which
continue to grow in popularity, remain largely unregulated,
adds a related article in The Washington Post. According
to the CDC, more than half of U.S. adults took at least one
dietary supplement in the previous month.
REFERENCE: Geller AI, Shehab N, Weidle NJ, et al. Emergency department visits for
adverse events related to dietary supplements. N Engl J Med. 2015 Oct 15.
Bold_Voices_February_2016_Pages.indd 18
©www.spotmatikphoto-fotolia.com
Infrastructure Can Overcome the Weekend Effect in Urgent
General Surgery Procedures,” in Annals of Surgery. The
weekend effect can be described as differences in staffing and
resources, compared to weekdays, and the resultant variation
in surgical care.
The study involved data on 126,666 patients at 166 Florida
hospitals from 2007 to 2011. It focused on 17 hospitals that
overcame the weekend effect during the research period,
“studying 21 separate hospital resources and analyzing how
these factors worked together to improve outcomes,” adds a
related article in FierceHealthcare.
Among the findings: Hospitals with fewer beds per nurse
were “1.44 times more likely to overcome the weekend
effect,” and those with electronic health records were “4.74
times more likely” to overcome this effect.
Improved staffing ratios and resources for patients “can
play an important role in ensuring patients are not disadvantaged by being admitted to the hospital on the weekend,”
study co-author Paul Kuo adds in the article.
REFERENCE: Kothari AN, Zapf MA, Blackwell RH, et al. Components of hospital perioperative
infrastructure can overcome the weekend effect in urgent general surgery procedures. Ann
Surg. 2015;262(4):683-691.
1/12/16 6:41 PM
AT THE BEDSIDE
Patient Satisfaction Surveys May
Compromise Healthcare Quality
While patient satisfaction is
a valuable element of good
healthcare, some uses and
consequences of surveys
may be problematic.
T
he institutional focus on patient satisfaction and surveys to assess it could
compromise the quality of healthcare and raise costs, according to an article
published by The Hastings Center, a bioethics research firm in Garrison, New
York.
“Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or
Leading It Astray?” provides an overview of the concept of patient satisfaction,
then traces the evolution of patient satisfaction surveys and their effects on the
healthcare community.
The article considers three factors:
• Provision of medically necessary care that improves outcomes
• Interventions that patients or families request that may negatively affect outcomes
• Factors that are less likely to affect outcomes but may contribute to a sense of dignity and well-being
While patient satisfaction is a valuable element of good healthcare, some uses and consequences of surveys
may be problematic, the article states. “The pursuit of high patient-satisfaction scores may actually lead health
professionals and institutions to practice bad medicine by honoring patient requests for unnecessary and even
harmful treatments.”
A related article in Modern Healthcare adds, “The current metrics used to rate, rank and evaluate hospital
quality continue to undergo scrutiny as the field of quality measurement advances in healthcare.”
REFERENCE: Junewicz A, Youngner SJ. Patient-satisfaction surveys on a scale of 0 to 10: improving health care, or leading it astray? Hastings Cent Rep. 2015;45(3):43-51.
N
ew graduate nurses can
overcome the sometimes
overwhelming challenges
at work if they have a plan and
set priorities, according to “For
the Overwhelmed New Graduate
Nurse,” by Katie Kleber, on her blog:
NurseEyeRoll.com.
new tasks with the ones that you
know you must perform (assessments
and charting for example). Typically,
while you’re working on completing
new tasks, you can combine them
with others.”
What Are MY Priorities?
“Many people will act like absolutely everything is a priority right
this very second (from therapy, to
management, to the doctor, to the
PA, to radiology tech, to the family
member), but you as the nurse must
look at your task list and prioritize
everyone’s priorities. ‘Everything is a
priority to everyone. I need to decide
what is a priority for me right now. I
am the nurse, the common denominator. I see the big picture.’”
Take Your Thoughts Captive
“When you are already overwhelmed and discouraged before
you’ve even clocked in, it’s important to stop those thoughts before
they take over. And they can take
over your mind pretty quickly. So,
before you clock in, before you drive
to work, before you get your coffee
ready, before you put your scrubs
on, remind yourself that you can
do this. Continue to tell yourself
this during your entire commute,”
Kleber says.
Tackle Your Tasks With a Plan
“OK, What is the most important
thing to do? What fires can I put out
immediately? Remind yourself that
Bold_Voices_February_2016_Pages.indd 19
you can tackle everything appropriately, just do so in chunks. Don’t
think, ‘Oh man there’s 5 new things
I need to do and I haven’t assessed
my patients yet!’ While yes, that’s
true, but you can combine these
19
AACN BOLD VOICES FEBRUARY 2016
How New Graduate Nurses Can Overcome Challenges
Kleber is a bedside critical care nurse
who is also an AACN ambassador and
was featured in an interview, “A Bold
Voice: Rolling Our Eyes at Nurse Eye
Roll,” in the August 2015 issue of AACN
Bold Voices.
1/12/16 6:41 PM
AACN
Things to Do in New Orleans During NTI 2016
The Crescent City offers a vast array of fun,
interesting and entertaining things to do.
Last issue, our wide-ranging
correspondent offered you a
list of great things to eat in
the Crescent City. Now
that your stomach’s full,
let’s find some fun things to
do in this historic town.
www.aacnboldvoicesonline.org
20
Party (or Don’t) in the French Quarter.
The French Quarter — or Vieux Carré — is
for many people the embodiment of the
Crescent City. Site of the original French
colony in 1718, the French Quarter is
a national historic landmark that overflows with life. Its unmistakable draw is
Bourbon Street — New Orleans’ infamous
party hub, teeming with tourists, street
performers, bars and a kaleidoscope of
local color. Even if the colorful characters
and noisy nights on Bourbon aren’t for
you, you should still explore the Quarter.
Wander the narrow cobblestone streets,
and view the historic buildings etched with
baroque ironwork and majestic balconies
— perhaps during an early-morning jaunt for beignets!
www.neworleansonline.com/neworleans/fq
Stroll Down Frenchmen Street. If you want an authentic
NOLA experience, distinct from the touristy French
Quarter, walk along Frenchmen Street, a four-block
stretch of restaurants, nightclubs, bars, galleries and the
finest CD shop in the world, the Louisiana Music Factory.
Despite its close proximity to the Quarter, Frenchmen
Street maintains a hip neighborhood vibe, as well as an
aura of authenticity.
Peruse the Exhibits at the National WWII Museum.
Located in the Warehouse District, the National WWII
Museum houses an impressive collection of artifacts and
educational films documenting the war, from D-Day to
the Holocaust to the war in the Pacific. Formerly known as
the D-Day Museum, the National WWII Museum is open
daily from 9 a.m. to 5 p.m. and offers a unique experience
(although some exhibits may be too intense for children).
www.nationalww2museum.org
Ride the Streetcars All Over Town. NOLA is blessed with
a delightful, historic streetcar system. Its three lines originate downtown but take you to different parts of the city.
Few experiences in the city rival settling back into one of
the classic mahogany bench seats, gazing through the
Bold_Voices_February_2016_Pages.indd 20
©bbslawnsidebbq.com
open windows at the oak trees lining St. Charles Avenue
and listening to locals describe their favorite things about
the city (and they will!). Just remember that when you
ride the streetcars, you are riding in a bit of history — and
that can take time. So, make sure you allow plenty of time
to reach your destination. Fares are $1.25 and can be paid
with exact change when you board. One-, three- and
31-day unlimited-ride passes are also available. www.
norta.com
Explore the Garden District. Although the Garden District
is less than 3 miles from the French Quarter, it may as well
be a continent away. As its name suggests, the historic
neighborhood is laden with stunning residential architecture, magnificent buildings, mighty trees and, yes, the
splendid gardens that give this district its name. A day
in the Garden District is a perfect antidote to the noisy
crowds in other areas.
Hear Some Live Music. Music is the lifeblood of the
Crescent City. A delicious gumbo of jazz, brass band,
Creole, country, Cajun, zydeco and rhythm and blues
music can be enjoyed at any time in nearly any place
echoing throughout the streets. Stop and listen!
1/12/16 6:41 PM
AACN
Hot topics from this
month’s AACN journal
In an observational study conducted in
a pediatric ICU, Owen et al offer further
insight on the instillation of normal saline
during endotracheal tube suctioning. The
authors provided unit personnel with a
decision tool for applying this intervention
and then observed nearly 2,000 episodes
of suctioning in which the tool was
applied. They found an increase in adverse
events, including hemodynamic instability and bronchospasm in the episodes in
which normal saline was used. This study
adds to the existing body of literature indicating that routine use of saline should be
avoided. (Owen et al, CCN, February 2016)
www.ccnonline.org
Few critical access hospitals in rural
areas have palliative care programs, but
older adults in these remote areas facing
serious, life-limiting illnesses need access to
palliative care consultation. The authors offer a
description of the “expert
generalist” role of nurses
in critical access settings
and the fit of palliative
care domains with fundamental aspects of quality
nursing care. A case study
illustrates the role of
critical access hospitals in
providing palliative care
and emphasizes the value
of such services in the
patient’s home community. (Mayer, Winters,
CCN, February 2016)
www.ccnonline.org
To see the table of contents for this issue
of CCN, visit www.ccnonline.org.
www.ccnonline.org
Transitions
Events in the Lives of Members and
Friends in the AACN Community
Michael Ackerman, nurse practitioner, prolific writer
and keynote speaker, becomes associate director of Niagara
University School of Nursing, New York. He has been an
AACN member since 2000 and is a past recipient of the
Circle of Excellence award.
Katherine Smith Long, RN, in the critical and progressive care units, Carteret General Hospital, Morehead
City, North Carolina, receives the 2015 Barton College
Outstanding Recent Graduate Award.
Linda Martinez, manager of advanced illness for
the Home and Transition Service line of Presbyterian
Healthcare Services, Albuquerque — an AACN member
since 1979, president of AACN’s Albuquerque Chapter
and a past AACN board member — is one of 60 alumnae
of University of New Mexico College of Nursing,
Albuquerque, to receive an award in honor of the college’s
60th anniversary.
21
The American Heart Association names Barbara Riegel,
professor of nursing, Penn Nursing, a 2015 Distinguished
Scientist in honor of her efforts to fight cardiovascular
disease and stroke.
The New Jersey State Nurses Association (NJSNA),
Trenton, names Judith Schmidt — nurse educator for
the night shift staff at Community Medical Center, Toms
River, New Jersey — its new CEO. NJSNA represents the
interests of 125,000 RNs and advanced practice nurses as
an advocate for the nursing profession in New Jersey.
AACN BOLD VOICES FEBRUARY 2016
In Our
Journals
Alcohol withdrawal syndrome (AWS) is
difficult to manage in ICU patients, because
many tools rely on patient self-report of
symptoms, and objective signs of AWS are
difficult to differentiate
from signs of existing
or progressing critical
illness. The authors offer
a thorough review of
the current literature
on AWS in critically ill
patients and provide
evidence for the use of
screening tools, standardized assessments and
specific pharmacologic
agents in managing this
high-risk population. The
nurse’s role in assessing
patients’ history of
alcohol use and areas
for further research are
emphasized. (Sutton, Jutel, CCN, February
2016) www.ccnonline.org
Joan Vitello, AACN past president and a member since
1977, with 30 years of nursing experience, receives
an alumni achievement award from the University of
Massachusetts Dartmouth.
Christine Westphal, director and nurse practitioner for palliative care services, Beaumont Health,
Dearborn, Michigan, and an AACN member since 1988,
co-presented the webinar “Straight From the Heart:
Palliative Care for Advanced Cardiac Disease.”
Send new entries to [email protected].
You may also honor or remember a colleague by making a gift to AACN at www.aacn.org/gifts.
Bold_Voices_February_2016_Pages.indd 21
1/12/16 6:41 PM
FROM THE PRESIDENT
T
Karen McQuillan
he other day I ran into the dry cleaners wearing my pink scrubs and
jacket that proudly displays my name followed by RN. The young woman
behind the counter asked if I was a nurse. After confirming I was, she
responded like so many others, “I don’t know how you do it! That job must
be very difficult. Thank you for being there for us.”
Her comment brought a smile to my face. It’s rewarding to think others
are grateful for my work — but it gave me pause to think of challenges that
often go along with doing that work and providing high-quality patient- and
family-centered care.
In fact, I immediately thought of the nurse who expressed his frustration
with the time it was taking to master the new electronic health record on his
unit, the nurse who complained her patient’s meds were delayed again in arriving on the unit,
and the nurse who wished she had more time to spend with her tetraplegic patient. All these
nurses had to overcome numerous obstacles to provide courageous care.
www.aacnboldvoicesonline.org
22 The barriers are not
erected which can
say to aspiring talents
and industry, “Thus
far and no farther.”
—Ludwig van Beethoven
Bold_Voices_February_2016_Pages.indd 22
Removing Barriers to Practice
The process of removing these obstacles can be very frustrating. And when they’re left
unresolved, these obstacles can contribute to job dissatisfaction and hinder our ability to
provide optimal care.
So, in an effort to identify and understand what barriers to practice exist in your work environments, this past fall AACN gathered your input during forums at chapter conferences and
through an online survey. Once this data is compiled, we will start to consider initiatives we
can all undertake that may help overcome these obstacles.
In my travels, I have had the privilege to speak with many nurses who shared barriers to
providing patient- and family-centered care. Interestingly, the obstacles described by nurses
in both large academic medical centers and small community hospitals were similar across
the country. Topping the list are staffing issues, abusive behavior from patients and families,
bullying by peers and struggles with documenting in the electronic health record.
We also focused our November 2015 AACN webinar on identifying and removing barriers
to nursing practice. In that presentation, Mary Bylone did a stellar job describing common
barriers to practice and why our healthcare environment seems to foster their existence. She
also provided invaluable practical tips to overcome barriers, emphasizing the need to be courageous in asking questions to unearth root causes of barriers and educating ourselves on the
problems we are trying to resolve.
Of course, we can’t be content with just knowing the causes of the roadblocks. We need to
seek opportunities to sit with key healthcare leaders, where we can share information about
barriers and partner to remove them.
Nurses — because we are at the patient’s bedside 24/7 — are the most knowledgeable about
barriers to practice, and we have the most expertise on how best to resolve them. I know it takes
courage, but using our bold voices to call out barriers, help create solutions and permanently
remove these barriers is critical to providing the best possible care to patients and their families.
Have you overcome a barrier to providing patient- and family-centered care? Please share
your experience with me at [email protected].
1/12/16 6:41 PM