How medical errors occur
It’s only on rare occasion that medical errors occur due to carelessness or caregiver misconduct. Some are due to technical problems or laboratory errors, but the bulk of medical errors are caused by simple human failing, most often resulting from:

• Poor communication between staff
• Indecipherable handwriting on charts or prescriptions
• Lookalike drug names
• Fatigue due to long shift hours
• Heavy caseloads that pressure medical personnel to minimize the time spent with each patient
• Inadequate staff training in facility procedures and lack of procedural standardization across regional facilities

But while all of these factors increase the chance of a medical error occurring, a surprising number of medical mistakes are caused by thinking errors.

“About 15 percent of all patients are misdiagnosed, and half of those face serious harm, even death, because of the error,” says noted Physician, researcher, and Harvard Medical School professor Dr. Jerome Groopman in the September/October 2008 issue of AARP magazine.

About 80 percent of all misdiagnoses are due to cognitive errors. “Contrary to the general impression that most misdiagnoses result from a technical foul-up, such as mislabeling someone’s X-ray or mixing up a blood specimen in the laboratory, most cases are due to mistakes in the mind of the doctor,” asserts Groopman.

When making a diagnosis, doctors look for evidence of patterns in physical examination results, symptoms, and laboratory tests, then search their cranial catalog of diseases for matching patterns. Groopman believes that, too often, doctors base their diagnosis on incomplete or misleading information, or jump to an incorrect conclusion.

Studies show that both the patient and doctor contribute to the problem. Patients may be uncomfortable discussing certain symptoms and fail to mention a critical indicator. Under the stress of visiting the doctor, patients often fail to remember all symptoms or recognize the possible connection to a past event. Overscheduled doctors may jump to a ready conclusion and cut off a patient’s recital before differentiating symptoms are mentioned.

The unique experience of each individual patient and atypical cases can further complicate the pattern recognition process. “Most significant is how the doctor selects the clinical elements, weighs their importance, and arranges them in his or her mind, a process that can result in several different patterns, leading to quite different diagnoses,” explains Groopman.

Three major cognitive mistakes are at the root of most medical misdiagnoses:

• Anchoring: the tendency to focus on the first definitive symptom. While such “snap judgments” are often accurate, they can cause medical personnel to ignore other possibilities.
• Availability: the use of recently remembered experience to explain the current case. Because the brain focuses most easily on recent events, similarities between recent and current cases can lead medical personnel to erroneous assumptions.
• Attribution: the human inclination to stereotype people – often seniors — and mentally assign a diagnosis based on behavior. Dismissing patients as “hypochondriacs” or “complainers” can result in medical personnel overlooking signs of illness or disease.

The phenomenon isn’t limited to Physicians. Nurses and nursing assistants, who make up 54 percent of U.S. healthcare workers, are just as prone to making the same mistakes. In a growing number of healthcare settings, including home healthcare, hospice, college infirmaries, urgent care centers, and pharmacy clinics, nurses are becoming the principal providers of primary healthcare. Increasingly, nurses and nurse assistants are responsible for making immediate decisions about a patient’s care.

To prevent cognitive thinking errors, Groopman suggests medical personnel ask themselves three important questions:

• What else could it be?
• Could two things be going on to explain the patient’s symptoms?
• Is there anything in the patient’s history, physical exam, lab findings or other tests that doesn’t support the working diagnosis?

The answers to these questions can help medical personnel to either confirm or re-evaluate their working diagnosis. Nurses are in a unique position to guard patients against cognitive thinking errors. They collect the vital data that helps determine a diagnosis: medical history, symptoms, behavior, drug list, etc. They chat with and observe patients who are often more comfortable confiding in a nurse. They check and administer doctors’ orders, go over instructions and prescriptions with patients, answer questions, demonstrate care procedures, and educate. Nurses are a patient’s first, and last, line of defense against medical errors.

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

Pass it on
More than a billion colds besiege Americans every year, with an estimated five to 20 percent of the U.S. population contracting the flu virus annually. While some years may be milder or more severe than others, more than 200,000 people are hospitalized with flu complications each year, 10 percent of which are children younger than five years of age. Additionally, nearly 36,000 people die annually from complications caused by the flu, with seniors constituting the majority of those cases.

Both the cold and flu virus are spread through droplets in the air, when someone who is infected coughs, sneezes, or talks. But it also spreads through hand-to-hand contact with someone who has the virus, or by coming into contact with shared objects such as towels, utensils, toys or telephones. Touch your eyes, nose, or mouth after such contact or exposure to an infected individual, and you’re likely to contract the virus. Colds and flu share similar symptoms, with some notable differences:

• Colds. The virus settles in the back of the nose in the adenoid area where it multiplies. Symptoms begin within 10 to 12 hours, with infected individuals at their most contagious two to three days after symptoms appear. The coughing, sneezing and copious quantities of mucous released signal the body’s efforts to defend itself. Wet, phlegmy coughs, dripping noses, and sore throats are typical. Most cold symptoms get worse over the first 48 hours, and then begin to subside. The average cold lasts a week to 10 days.

• Flu. Flu is more serious than a cold, with the danger lying in the virus’ invasion of the bronchial tubes and lungs. Flu can be spread one day before symptoms occur and up to five days after their onset. While flu usually lasts only four to five days, symptoms begin more suddenly and are more violent than a cold. Body aches, extreme fatigue, high fevers, severe headache, chills, and a dry, hacking cough are typical. Cough and fatigue may persist for a few weeks.

If your symptoms haven’t improved or have become worse after 10 to 14 days, contact your doctor. You may have developed a sinus infection or bacterial bronchitis that requires antibiotics. If your symptoms seem to disappear and then return, or if you experience shortness of breath, wheezing, chest pain, or a severe cough that produces blood or phlegm, contact your doctor. This may be a sign of bacterial pneumonia, which also requires antibiotics and can be dangerous, particularly to older adults, people with compromised immune systems, or those with chronic heart or lung conditions.

Fighting back
The best defense against a cold or flu is rest, fluids, and time. Over-the-counter medications, herbal teas, lozenges, and juice can be used to treat your symptoms and may make you feel better, but they won’t cure you sooner. You just have to wait it out. So stay home, make yourself comfortable, and listen to your body, advises Dr. Eric Westerman, an infectious-disease specialist at Houston’s Methodist Hospital. “If your body says you need to sleep, then that’s what you should do. Ignore it and it could take you longer to recover.”

It’s also important to stay hydrated. You need at least three to four extra glasses of fluid a day to replace moisture lost by coughing and sneezing. Fluids also help to thin mucous secretions and reduce coughing. Your grandmother’s favorite remedy, chicken noodle soup, helps reduce inflammation. Use anti-viral tissues to avoid spreading germs. Gargle with warm salt water or sip warm liquids to soothe a sore throat. For an irritated throat, skip the cough drops (they don’t work) and suck on sugar-free hard candy. Decongestants can ease a stuffy nose, but stay away from nasal decongestant sprays. Overuse can cause a rebound effect and serve to worsen congestion. Saline spray (each person should have his/her own), vaporizers and steamy showers help keep nasal passages moisten.

What you can do to protect yourself from colds and flu:
• Wash your hands to prevent the spread of infection, scrubbing for at least 20 seconds in warm soapy water.
• Get plenty of rest. Lack of sleep and prolonged stress weaken the body’s immune system, making you more susceptible to illness.
• Eat a balanced diet.
• Exercise regularly.
• Cover your mouth with a tissue when you cough or sneeze, then throw it away.
• To prevent spreading germs, avoid touching your eyes, nose, or mouth.
• To prevent flu, get vaccinated.

Flu shots significantly reduce risk of death and hospitalization in adults 50 and older, according to a study just published in the New England Journal of Medicine. An analysis of 10 years of medical data found that seniors who received flu shots were 27 percent less likely to be hospitalized with flu or pneumonia and 48 percent less likely to die from flu-related complications.

Seniors are among the highest risk groups for influenza, which also include adults and children with weakened immune systems, those with chronic health conditions like asthma, diabetes, and heart or lung disease, pregnant women, and young children.

Children are the prime carriers of flu virus, which led the U.S. Centers for Disease Control and Prevention (CDC) to issue new guidelines this year recommending that all children from six months to 18 years of age be vaccinated. The CDC specifically targeted children six months to five years old as being at greatest risk of serious complications from flu viruses. “Our current thinking is that to control influenza, we really have to vaccinate all children,” said Dr. Robert Belshe, a vaccine specialist at St. Louis University.

Maxim Health Systems is a community-driven organization that is committed to educating the public about the benefits of flu and pneumonia immunization and ensuring that the vaccine is widely accessible to:
• Corporations and their employees
• Physicians and their patients
• Retail locations and their customers
• Senior Living Facilities and their residents
• Public Access Facilities and their community members
• Schools and Colleges/Universities
• General public

Each year, Maxim offers on-site flu clinics at easily accessible locations throughout the country. Flu clinics in your area can be located on our website.

Maxim Health Systems is always looking for motivated nurses and medical personnel to work in our flu clinics. Contact us to explore employment opportunities with Maxim.

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

A national survey performed last year by the U.S. Centers for Disease Control and Prevention (CDC) showed that less than 70 percent of older Americans had received flu and pneumonia shots. Only 2 percent of eligible Americans had received a whooping cough booster shot, and only 10 percent of eligible women and girls had received the HPV (Human Papillomavirus) vaccine. Many Americans didn’t even know these vaccines were available.

Most medical experts agree that the benefits of vaccines outweigh the risks. While there are some risks, most adverse reactions are mild, such as soreness or swelling at the injection site. Severe allergic reactions are extremely rare; generally less than 1 in a million doses, and present a much lower risk to health than the diseases they prevent.

Vaccines provide immunity to disease by causing the body to produce proteins, called antibodies, to a specific disease. These antibodies neutralize toxins and destroy disease-carrying organisms, providing protection against the specific disease. Once the body develops antibodies to a disease, future contact with the disease organism causes the immune system to immediately produce antibodies to fight it, thus protecting the individual from subsequent attack. A vaccine may provide either active or passive immunity:

• Active immunity occurs when the body produces antibodies in response to exposure to the disease organism. Exposure can occur by infection through contraction of the actual disease or by vaccination with a killed or weakened form of the organism. Active immunity generally takes several weeks to develop but is long-lasting and often, as in the case of vaccinations against many childhood diseases, lifelong.

• Passive immunity occurs when antibodies to a disease are given to an individual as opposed to being produced by his or her immune system. For example, the immunity a newborn receives from the mother’s placenta. Antibody-carrying blood products such as immune globulin are sometimes used to provide passive immunity when immediate protection is required. While passive immunity lasts only a few weeks or months, its protection is immediate.

The CDC website provides a comprehensive list of common vaccines for children and adults, their possible complications, and recommended vaccination schedules. Additionally, with flu season just around the corner, the CDC recommends that you receive a flu shot if you meet one or more of the following criteria:

• All persons who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others
• All children aged 6 months to 18 years old
• All persons aged 50 years and older
• Children and adolescents (aged 6 months to18 years) receiving long-term aspirin therapy
• Women who will be pregnant during the influenza season
• Adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus)
• Adults and children who are immunosuppressed
• Residents of nursing homes and other chronic-care facilities
• Health-care personnel
• Healthy household contacts (including children) and caregivers of children aged less than 5 years and adults aged 50 years and older
• Healthy household contacts (including children) and caregivers of persons with medical conditions that put them at higher risk for severe complications from influenza

Some medical experts are concerned that the failure of last year’s flu shot to correctly target the most prolific strains of influenza and the resulting upsurge in flu cases last winter could discourage people from getting a flu shot this year. But as CDC influenza epidemiologist Joseph Bresee points out, last year was somewhat of an anomaly.

“Most years, the prediction is very good,” said Bresee. “In 16 of the last 19 years, we have had a well-matched vaccine.”

Because of the rapid mutation of the influenza virus, a new vaccine must be formulated each year based on researchers’ best estimates of the influenza strains that may become most prolific. Flu vaccines contain elements of the three families of flu virus: influenza A, types H1N1 and H3N2, and influenza B. In the average year, the vaccine has one or two strains updated.  In response to last year’s strain mismatch, the 2008 vaccine received a complete overhaul with all three strains being new to this year’s vaccine.

Periodically throughout history, influenza viruses cause global epidemics called pandemics. The great influenza pandemic of 1918-19 is estimated to have killed 675,000 Americans and between 30 and 50 million people worldwide, putting pressure on scientists to find a cure. The influenza A virus, which causes most endemic and pandemic influenza, was isolated in 1933, followed by isolation of the influenza B virus in 1940. By 1944 the first influenza vaccine was introduced in the U.S. Influenza pandemics in 1957-58 and 1968-69 killed 70,000 and 33,000 Americans, respectively, far fewer than in 1918-19.

Consider this: on average, every year influenza:

- Infects 60 million people
- Kills almost as many Americans as breast cancer
- Kills two to three times more Americans than HIV/AIDS
- Kills the equivalent to a major league stadium full of people

Annual flu vaccines are our greatest tool for avoiding another pandemic. Influenza poses the greatest risk to the very young and the elderly. Every year, Maxim Health Systems hosts thousands of on-site public flu shot clinics across the country to provide preventive care for a wide range of individuals. Flu shot clinics begin October 1 and continue through the end of the flu season.

Visit Maxim Health Systems’ website, http://www.findaflushot.com, and use our online Flu Shot Locator to find a flu clinic near you. Protect yourself and those you love. 

You can also apply to become a nurse at one of Maxim’s flu clinics by visiting www.maximnurses.com/apply.

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

The tenth annual survey of America’s 100 Most Wired Hospitals and Health Systems published in the July 2008 issue of Hospitals & Health Networks found a direct relationship between information technology (IT) and, not only the quality of patient care, but, surprisingly, patient perception of that care. Medical facilities that employed IT techniques such as patient portals and personal health records to promote strong customer relationships were rewarded with higher-than-anticipated overall patient satisfaction ratings.

“Any action that an organization takes to improve communication, such as IT, is going to have an effect on patient perspectives,” said Dennis Kaldenberg, senior vice president of research, knowledge management, and strategic planning for Press Ganey Associates, Inc., which performed the satisfaction analysis for the Most Wired survey.

“Patients perceive this as technology protecting them,” affirmed R.N. Merrie Wallace, vice president and solution line manager of McKesson Corp.

Whether Health Information Technology (HIT) raises the quality of care or the pursuit of greater quality drives the investment in technology is like asking, “Which came first, the chicken or the egg?”

“Facilities that are more progressive with regard to IT are also those that are more progressive with regard to changes that improve the processes of care,” noted Kaldenberg.

Despite increased use of HIT in certain areas – admissions, testing, patient-centric care – the Most Wired survey concluded: “Industry-wide progress in adopting clinical IT remains elusive. Overall gains in the use of information technology appear remarkably slow.”

The medical community, particularly at the Physician level, has been reluctant to replace paper records with electronic records. “Despite its potential to improve quality and reduce errors, use of information technology in the health sector lags behind other sectors of the economy in the U.S.,” concluded the 2001-03 National Ambulatory Medical Care Survey (NAMCS) conducted by the Centers for Disease Control and Prevention (CDC) and National Center for Health Statistics (NCHS).

Hospital emergency rooms were the first to embrace computerized patient records. According to the 2003 NAMCS, from 2001 to 2003, 31 percent of hospital emergency rooms and 29 percent of outpatient departments used electronic medical records (EMRs), compared to only 17 percent of Physicians participating in the survey. However, 73 percent of Physicians did use computerized billing systems.

By 2005 (the latest data currently available), NAMCS results showed a 31 percent increase in the use of EMRs by Physicians with nearly one-quarter (23.9 percent) of those surveyed reporting at least partial use. However, only 1-in-10 Physicians surveyed satisfied the survey’s minimum requirements for full EMRs: computerization of prescription orders, test orders, test results reporting and Physician notes.

The 2005 survey found that use of EMRs was more likely in multi-Physician practices in large metropolitan areas. Solo practitioners were the least likely to use EMRs. Neither specialty, age, gender of the Physician, nor ethnic makeup of the patient population had any statistical bearing on EMR use. While progress has been made toward universal electronic health records, the medical community is still years away from realizing the enrollment of every U.S. citizen in a nationwide EMR system.

Experts agree on the potential value of implementing a comprehensive nationwide EMR system that would store patient medical history, patient demographics, nurse and doctor notes, prescription information, diagnostic test orders and results, and other clinical and medical support tools, such as nutritional and genetic data, in a universal data base. The ability to access a patient’s complete and accurate medical record 24-hours a day, 7 days a week from anywhere in the country or the world would revolutionize patient care. There would be significant advantages to both patients and the medical community, including:

• ability to instantly update a patient’s medical record
• records viewable by multiple Physicians concurrently
• improved communication between primary and specialty care providers
• improved Physician communication during referrals
• improved communication between doctors, nurses and other staff
• legibility of orders, notes and prescriptions
• reduction of medical errors, duplicate testing and redundant treatments
• reduced cost of dictation and chart pulls
• improved test scheduling and results reporting
• automatic transfer of patient information captured from discrete systems, decreasing documentation time and handoff errors
• reduction of pharmaceutical errors through electronic Physician order entry and bedside medication matching
• improved efficiency in identifying the least expensive drugs and those covered by the patient’s insurance
• identification of allergies and drug interactions
• automated reminders and alerts
• prevention guidelines for chronic conditions
• billing efficiency
• expansion of medical research and faster disclosure of results
• public health disease surveillance
• homeland security surveillance

So why all the foot-dragging? The cost of implementation, record transfer and staff training is a major prohibitive, especially for sole practitioners. A 2005 study by the non-profit Rand Corporation estimated that implementation of a national EMR system could cost $8 billion per year over 15 years, but would save $81 billion over the same period – a net cost of $39 billion. In 2007, the U.S. Department of Health & Human Services projected that wide-scale adoption of EMRs could reduce health spending by 7.5 percent to 30 percent, with additional cuts in administrative costs which comprise one-third of total healthcare expenses.

The other major stumbling block is security. Maintaining patient privacy and confidentiality, authorizing access, and preventing identity theft are just some of the legal liability issues to be solved. The fear is not merely that hackers could gain access to patients’ personal information, but that they might tamper with medical information or co-opt electronic signatures. If allergy, drug interaction, or blood type data was changed, the consequences could be deadly.

Some hospitals and health systems have already implemented EMR measures of their own. A consortium of drug companies and care providers has launched the Health Information Trust Alliance (HITRUST) in an attempt to create universal security measures for the creation, access, storage and exchange of personal health information.

Implementation of HITRUST is expected to improve workflow efficiency and free more nursing time for direct patient care.

“Nurses should care, generally, about information technology in hospitals, because it drives quality, it drives efficiency and it drives safety,” said Aldeh Solovy, executive editor of Hospitals & Health Networks.

Nurses now spend only 30 percent of their time on direct patient care, according to Linda Burnes Bolton, vice president of nursing at Cedars-Sinai Medical Center in Los Angeles. By freeing nurses from manual record keeping and other time-consuming chores, HIT can increase nurse-patient interaction, improve the quality of care and increase patient safety.

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

Today, a patient’s medical care team may include the primary care physician, one or more physician specialists, physician assistants, the supervising nurse, specialist nurses, shift nurses, practical nurses, health aides, a whole host of lab technicians, med techs, physical therapists, psychologists and social workers, pharmacists, equipment purveyors and on and on. Healthcare delivery can also be profoundly affected by federal and state regulations, insurance companies, hospital systems and the pharmaceutical industry. Without professional collaboration and expert coordination, conflicts, oversights, and redundancies can occur, sometimes placing the patient at risk, and at the very least wasting valuable medical resources.

Maximizing nurse-physician collaboration specifically, as well as collaboration within the entire medical team, improves patient care and leads to greater job satisfaction for medical professionals. Productive collaboration requires intentional sharing of knowledge and communal acceptance of responsibility. Collaboration often develops naturally between professionals of long association. However, the specialization of healthcare providers, the increasing volume of patients, and growing reliance on fast-paced electronic communication demand that today’s healthcare professionals strive to implement effective collaborative techniques immediately at every contact.

“Collaboration is multidimensional. It can occur in both face-to-face encounters and electronically via fast-paced interactions such as voice mail and email,” stated RNs Linda Lindeke and Ann Sieckert in Nurse-Physician Workplace Collaboration, published in the January 2005 edition of The Online Journal of Issues in Nursing. “In whatever place or form, collaboration involves an exchange of views and ideas that considers the perspectives of all the collaborators, whether or not agreement is reached in the interaction.”

Mutual respect, trust and tenacity are the qualities that Lindeke and Sieckert believe best define successful professional collaboration. Such qualities not only impact professional relationships, but carry over into patient care. Research conducted by the American Nurses Credentialing Center at 14 hospitals in 2003 showed a positive direct correlation between successful physician-nurse collaboration and the quality of patient care.

Collaborative professional relationships enhance job satisfaction for every member of the medical team. “Professionalism is strengthened when all members take credit for group successes,” emphasize Lindeke and Sieckert. When responsibility for patient well-being is shared and the contributions of each team member are recognized, a more supportive work environment is created. Collaborative environments promote safe communication, creative problem solving, respectful negotiation and positive conflict management. Individual recognition increases, negative behaviors decrease, and job satisfaction improves.

Collaboration is the essential ingredient in the development of an effective medical care team, but it requires intentional team-building efforts. To create a collaborative team environment, use these team-building strategies:

1. Arrive at common definitions for patient care and well-being. The knowledge of diverse disciplines must be melded into a universal language that allows the team to communicate effectively and work from common ground.

2. Negotiate responsibilities respectfully. Team members must define individual and group tasks. Expectations should be clearly defined. Operating within hierarchical structures and respect for the chain of command will achieve results more effectively and more quickly than bypassing authority for expediency.

3. Encourage healthy conflict, but do not let it destroy group cohesiveness. Healthy conflict promotes creative problem solving and allows for the consideration of diverse ideas, often resulting in multiple solutions. Focusing on facts rather than opinions can preserve group unity when ideas differ.

4. Discourage negative behavior. The negative behavior of a single individual can derail collaborative efforts. Avoid the blame game. Discourage unproductive dialogue. Defuse individual dominance with group consensus. Respectful, unemotional language and strong team leadership that values consensus can defuse negativity and foster a positive team environment.

5. Communicate effectively. Whether communicating face-to-face or electronically, respond promptly and be efficient in your communications. Leave out peripheral data, provide current information, and avoid unnecessary jargon. Stick to the facts; avoid emotionalizing issues. If you receive an unclear message, ask for clarification before responding. Always critique the message, not the sender. Strive to remain open-minded and respectful in communicating with other members of the team.

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

Doctors, nurses, and healthcare workers are in the business of saving lives, but our medical system is complex. Humans are not infallible and errors occur. Errors can be caused by changes in treatment standards, drug names that sound alike, bad handwriting on a chart or prescription, a missed or missing decimal point, an identity mix-up, poor communication, or healthcare worker fatigue, often caused by increased workloads resulting from inadequate staffing levels.

“Medical errors most often result from a complex interplay of multiple factors,” explains Dr. Lucian Leape of the Harvard School of Public Health, who is recognized as the father of the patient safety movement in the U.S. “Only rarely are they due to the carelessness or misconduct of single individuals.”

Most healthcare organizations are working to create cultures of safety to prevent medical errors and improve patient safety. The old “blame and train” mentality that punishes individuals for errors is being replaced by a more effective management model that recognizes that errors usually occur as the result of ineffective, improperly designed, or flawed systems. Creating a culture of safety recognizes the necessity of redesigning medical systems to promote a safe patient environment.

Nurses and other healthcare workers intimately involved in the daily care of patients will always carry the burden of safeguarding patient safety. America’s 2.8 million licensed nurses and 2.3 million nursing assistants represent 54 percent of all U.S. healthcare workers. In caring for patients and interacting with their families, nurses acquire a depth of knowledge about their patients that is unavailable to other providers on the medical team. Their repeated interaction with patients uniquely places them in a position to provide the constant surveillance necessary to identify and prevent potential medical errors.

University of Pennsylvania nursing expert Linda Aiken called nurses “the early warning and early intervention system” in hospitals and other healthcare institutions. Through their vigilance, nurses “are responsible for intercepting 86 percent of all errors made by physicians, pharmacists, and others involved in providing medications prior to the medication being administered.”

Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality, stated at a 2006 conference of the Nurse Alliance of Service Employees International Union that “nurses are the best advocates that a patient can have in a hospital,” adding that nurse advocacy is critical to improving the safety and quality of patient care.

Tips for preventing medical errors
Nurses and other healthcare workers must serve as advocates for their patients, particularly for those too ill to advocate for themselves. Nurses are the front line of defense in the battle to prevent medical errors. Follow these tips for preventing medical errors:

• Accept accountability for your actions. If you make an error, report it. If you suspect an error on the part of another person, speak up. If you feel fatigue or stress is at any time impairing your ability to safely perform your job, seek immediate help from your supervisor. Silence can have disastrous results for your patient.
• Practice prevention. Do not rely on memory; always check the chart for care instructions and updates. If you are unclear on care instructions or medications, or if you can’t clearly read a chart or prescription, obtain clarification before taking action.
• Medical care is a team experience. Share your knowledge and insights with the team. Learn from the successes and mistakes of others.
• Take time to be safe. Each year two million Americans contract infections during hospital stays and nearly 100,000 die, making hospital infections the sixth leading cause of death in the U.S. Be scrupulous in your practice of hygiene – particularly hand hygiene – and follow all safety procedures.
• Encourage self-advocacy. Encourage your patients to create and maintain a personal health record and share it with their medical providers. Recommend that they carry a Universal Medication Card that lists all of the medications they take. Invite patients to ask questions about their health and care and provide answers and resources.

What will the future bring?
Efforts to create a culture of patient safety have resulted in several initiatives to improve the safety, quality, efficiency, and effectiveness of healthcare in America. Health Information Technology (HIT) is slowly revolutionizing U.S. healthcare. In 2004, President Bush announced a federal plan to digitize and connect most Americans’ medical records by 2014, saying, “By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”

Concerns about patient privacy rights and sensitive information getting into the wrong hands have been raised in Congress, but the medical community is gradually embracing the idea. “HIT has huge potential, and in the next several years it will become much more universal than it is now,” prophesized Harvard Medical School professor Dr. Don Goldmann, Vice President of the nonprofit Institute for Healthcare Improvement. “But we shouldn’t underestimate the complexity and cost.”

HIT envisions fully-computerized, integrated medical records that would allow doctors, pharmacists, and medical staff to instantly access and search complete records from any location at any time, day or night. A complex trigger system would alert providers to potential drug interactions, allergies, dosing errors, even the latest medical research. Computerized medical records might not prevent every medical error, but they can provide an extra layer of protection against mistakes. Some hospitals have already taken a step toward this goal. Boston’s Brigham and Women’s Hospital initiated an advanced electronic records system in 1993, reporting an 88 percent drop in serious medication errors in first two years of use. Some hospitals have implemented barcode systems that link provider ID badges, patient bracelets, and medications. The systems use computers to track medications and alert staff to potential errors, hazardous drug interactions, and overdoses.

Sources:
1 Centers for Disease Control, National Practitioner Bank, National Academy of Sciences’ Institute of Medicine

2 The Commonwealth Fund Study, 2002; corroborative figures from the Agency for Healthcare Research and Quality,  2008

3Agency for Healthcare Research and Quality, 2008

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

Some healthcare staffing companies provide a more satisfactory work experience and better benefits than others. If you’re considering working with a staffing company, look for the following:

• A variety of job options, including occasional and permanent positions, short- and long-term assignments, and flexible scheduling. You want a company that can provide work that fits your schedule.
• A company that takes a personal interest in helping you meet your goals. You want a company that values your preferences when matching you to a job. Is 24-hour support provided should you have a question, problem, or concern?
• Most staffing companies today offer employment benefits, including medical, dental, vision, life insurance, and 401(k) plans to employees who work a certain number of hours.
• Free continuing education programs to meet re-licensing, re-certification, and professional development goals. Does the company offer assistance if you need to update your license?
• Travel opportunities, usually short-term assignments, allow you to explore new cities and facilities without relocating. Does the company arrange travel and accommodations?
• If you’re considering relocating, choose a staffing company with a nationwide reach. 

The following appeared in an issue of Maxim’s nursing eNewsletter, Nursing Now. To receive news in your e-mail inbox each month, sign up today.

America is headed for a one-two punch that has the potential to deal the nation’s healthcare system a knockout blow – and just when it will be most in demand. Post-war “Baby Boomers,” the most numerous generation in American history, are reaching retirement age. According to the U.S. Census Bureau, 75 million Boomers will reach age 65 and be eligible for Medicare by 2011. Over the next decade, the growing need for medical, and particularly nursing, care is expected to reach crisis levels. Unfortunately, peaking demand is occurring at a time when our nation’s supply of doctors, nurses, and healthcare workers is in critically short supply.

According to the U.S. Department of Health and Human Services, the U.S. faces a current shortage of 120,000 nurses. An average nurse vacancy rate of 8.5 percent plagues hospitals nationwide, placing additional strain on often overworked medical professionals. Health and Human Services projections estimate that the national shortage of nurses will double over the next two years, top 500,000 by 2015 and reach one million by 2020. The U.S. Centers for Disease Control and Prevention (CDC) projects that 110,000 new nurses per year will be needed through 2012 to meet growing demand. While nursing applicants have increased in recent years, faculty and teaching facilities have been unable to keep up with demand. In 2007, four-year nursing programs were forced to turn away 30,000 qualified applicants, according to the American Association of Colleges of Nursing.

While the sheer numbers of the Boomer generation are expected to strain America’s healthcare system, the growing crisis is compounded by advances in medical science and technology. Not only are people living longer, but older people utilize medical services at a significantly higher rate than younger people. The National Ambulatory Medical Care Survey conducted by the CDC revealed that adults 66 and older averaged six doctor visits per year, compared to 2.2 annual visits for adults aged 25 to 35. In addition, each year medical advances enable us to treat an increasing array of health problems and improve life expectancy for many chronic conditions like heart disease and diabetes. As life expectancy from previously incurable conditions like breast and uterine cancers increases, so does the continued need for medical care. Our increased emphasis on preventive care places another burden on our country’s healthcare system.

In a September 2007 Gallup Poll, Americans chose healthcare as the most important domestic policy issue facing our country today. Presidential candidates are stumping for healthcare reform and increased healthcare for all citizens; however, many plans fail to address the growing shortage of doctors, nurses, and healthcare workers. The success of any plan to expand access to healthcare services will hinge on the ability to significantly increase the nation’s supply of doctors and nurses. Highly-trained and skilled physicians and nurses form the foundation upon which our system of medical care is built.

Nurses and other healthcare professionals serve as first responders in matters of patient advocacy. Patient advocacy is speaking on behalf of a patient to protect his or her rights, to ensure he or she receives quality care, and to help him or her obtain necessary information and services. Social workers, physicians, lawyers, and others may serve as patient advocates, but it is their professional knowledge and skill combined with their intimate involvement in a patient’s daily care that places healthcare professionals in the position to serve as a patient’s primary advocate.

In providing daily care for a patient, nurses are the first to discover new symptoms, notice physical or mental changes, and understand a patient’s emotional needs. Through observation and participation, they are aware of the care and services a patient receives and are in a unique position to recognize unmet needs. While important in every care environment, advocacy can be critical in homecare situations where family interaction, stresses, and resources can have considerable impact on patient care. The healthcare provider may be the patient’s only link to the outside world and the family’s only source of information and support.

Patient Advocacy Week, April 13-19, recognizes the essential role each medical professional plays in protecting the rights of patients. Patient advocacy is so fundamental to nursing that it is included in the American Nurses Association (ANA) definition of nursing: “. . . the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.”

Today, most hospitals and residential care facilities staff an on-site advocate to serve patients and their families. Often a social worker, the advocate’s role may include answering questions, providing information, facilitating problem-solving, and coordinating communication between the patient or family and appropriate staff. However, staff advocates may be unaware of events and issues that impact the patient’s health and well-being. Nurses and other healthcare professionals will always carry the primary responsibility of advocating for their patients. It is through these individuals that doctors, managers, and other staff are generally apprised of a patient’s difficulties or needs.

As emphasized in the ANA Code of Ethics for Nurses, nurses have an ethical duty to safeguard the rights of their patients:

• The nurse’s primary commitment is to the patient, whether an individual, family, group, or community.
• The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

In today’s increasingly complex medical environment, it is easy for patients and their families to feel overwhelmed, particularly when faced with a serious illness. As patient advocates, nurses and other healthcare professionals provide vital support, information, and assistance in obtaining access to treatment. They can assist families in understanding a patient’s illness, making informed medical decisions, and coping with the requirements of treatment and care. They can recommend support groups where patients and their families can find much-needed comfort and encouragement in the company of others facing the same struggle. Advocates may be able to direct patients to resources for assistance with legal, financial or employment issues related to their illness.

In advocating for their patients, nurses and other healthcare professionals should turn first to the resources available through the hospital or care facility at which they work, or to their staffing company. Excellent information and statistical data on most major diseases and medical conditions, as well as general health information can be found on the federal government’s Centers for Disease Control and Prevention (CDC) Web site (http://www.cdc.gov/). Most disease-specific organizations such as the American Cancer Society, American Diabetes Association, and others host Web sites that provide clinical information, notices of clinical trials, access to research findings, prevention information, and support group networks. These additional Web sites can be helpful to patient advocates:

• The Agency for Healthcare Research and Quality (http://www.ahrq.gov/) provides downloadable guides and information on a wide variety of diseases and medical conditions, as well as information on health plans, prescriptions, prevention and wellness, and quality of care issues. Up-to-date research findings are also posted. Sponsored by the U.S. Department of Health & Human Services, AHRQ is a federal government Web site that provides information for both patients and medical professionals. Considerable information and press releases are also available in Spanish.
• The Patient Advocate Foundation (http://www.patientadvocate.org/index.php) offers free case management services to patients and a wealth of useful information on financial resources, clinical trails, disease information, job retention, Medicare help, and senior services. PAF is a private, non-profit group dedicated to ensuring universal access to quality medical care. Basic information and resources are available in Spanish.
• A useful list of links to advocacy Web sites for specific diseases and medical conditions is provided on the Enduring Health Web site (http://www.healthier-harvest.com/news_articles/medical_information/advocacy_list.htm#PATIENT%20ADVOCACY%20GROUP%20INFORMATION). Scroll past the product advertisements to find a brief description of each organization and a summary of information provided on its Web site with a link. Web sites are listed alphabetically by disease from Alopecia Areata to Urologic Disease.
• Patient-Centered Guides (http://www.patientcenters.com/) provide disorder-specific information with a primary focus on cancer. A number of helpful books are reviewed and available for purchase. The Life on Wheels Center (http://www.patientcenters.com/wheels/) provides information and a comprehensive list of advocacy groups, organizations and resources for wheelchair-bound patients.

As we shake off the winter’s chill and see the first signs of spring upon us, what do we think of as healthcare providers? Cold and flu season, of course! With the warmer weather, we usually notice a surge in upper respiratory issues, not only in ourselves and our colleagues, but also in our homes and the population we serve. Old wives’ tales attribute the increase in illness to the change in the seasons, but as healthcare workers, we know that we must look to the source of the illness. It’s not the season, but the accompanying bacteria, viruses, and germs that are the culprit. There are many ways that we can protect ourselves, our co-workers, our families, and our clients from these outbreaks.

Hand washing. Practice what you preach. Routine hand washing for 20 seconds with soap and running water has the potential to stop a multitude of germs in their tracks, as does the use of alcohol gel. Remember to emphasize to your clients the effectiveness of hand washing on a routine basis.

Cleaning and disinfecting surfaces. Cleaning and disinfecting are not synonymous. Cleaning removes germs from surfaces, whereas disinfecting kills them. For the most part, cleaning surfaces will remove dirt and most germs and is usually enough. But there are times when you may want to disinfect for that extra level of protection. Remember that a surface may look clean, but germs can live for hours or even days on a surface. In the kitchen, clean and disinfect surfaces prior to food preparation. Follow label directions and let the disinfectant stand for a few minutes to accentuate its effectiveness. Use paper towels when cleaning and dispose of them so you don’t have any germs hanging around. If you prefer to use cloths to clean, wash them in hot water to destroy any germs that may linger. In the bathroom, routinely clean and disinfect all surfaces. This is especially important if a member of the family has a cold or the flu.

Separate foods in the kitchen. Don’t cross-contaminate one food to another. This occurs when bacteria spread from a food to a surface and from a surface to another food or from one food to another. To help prevent cross-contamination, you should separate raw meat, poultry seafood and eggs from other foods; not only in your grocery cart, but in your grocery bags and in your refrigerator. Use different cutting boards for fresh produce, raw meat, poultry, and seafood, and clearly mark these so everyone in the family knows which cutting board is used for which food. Use a thermometer to ensure your food is cooked to the proper temperature to eliminate bacteria. Meat and fish should reach 145°F; pork, ground meat, and eggs should reach 160°F; and poultry should reach 180°F to be considered safe.

Get immunized. Getting immunizations is easy, inexpensive, and most importantly, it saves lives. The CDC has recommendations available on their Web site for childhood immunization schedules, as does your pediatrician. Adults need tetanus and diphtheria boosters every 10 years. Last but not least, get a yearly flu vaccination; this is the single best way to prevent the flu.

Use antibiotics appropriately. Overuse and underuse of antibiotics causes more problems than the wonder drug can handle. Overuse can lead to “super strains” of bacteria and under-use can lead to ineffective eradication of the bacteria, leading to further therapy. Antibiotics are not the “magic bullet” to cure everything, so it’s important to teach our clients that viruses like the cold and flu do not respond to them. Simple solutions like over-the-counter cold and flu medications will help alleviate the symptoms.

Be careful with pets. While pets provide many benefits to their owners, including comfort and companionship, even domesticated animals can pass diseases to humans. Keep these simple tips in mind to help make sure your pet relationship is a happy and healthy one:

• Adopt an animal from a shelter or a reputable pet store or breeder.
• Schedule your pet for routine immunizations and check ups.
• Obey leash laws.
• Clean litter boxes daily. NOTE: Pregnant women should not clean litter boxes.
• Do not allow children to play in a yard where animals defecate and keep your child’s sandbox covered.
• Babies and children under the age of five are more likely to get diseases from animals, so do not allow young children to kiss pets or put their hands in their mouths after touching a pet. Wash the child’s hands with soap and water after contact with a pet.

Staying healthy is important to everyone. These simple everyday practices can help keep you, your loved ones, and the population you serve happy and healthy for many years to come.