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February 02 2017

Medication Error by Covering Nurse

I was recently speaking to a nurse about an incident that occurred at her hospital. A nurse that was changing shifts asked another nurse to do her discharge teaching and administer a medication for her as she was busy. This is a frequent thing that is seen amongst many different facilities. The covering nurse administered a medication to the patient and he had an adverse reaction to it, because it was the incorrect dose. It is a scary thought to think that this could happen to any of our families staying in a hospital or as a healthcare professional that it could happen to us.

In speaking with the nurse she proceeded to tell me that the nurse at her hospital was too busy to attend to her own patient to do the discharge planning. She could have taken the patient herself and done a proper discharge planning and allow the new nurse coming on to take care of another patient, but instead she gave the nurse coming on shift her discharge. I would hope that in this day and age a nurse would not administer a medication or explain a medication that she is not familiar with. In talking with the nurse, I felt that the covering nurse should have verified the medication if she had a doubt about it as that is her license on the line.

The covering nurse needed to be more information seeking and applying standards of care. Regardless if the other nurse was busy, it is up to the covering nurse if she accepted the assignment to fulfill it correctly. This means she needs to be able to follow the standards of care in that unit (Rubenfeld & Schaeffer, 2014).

References

Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. http://dx.doi.org/

February 02 2017

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations. In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic. If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance are they coming in when a shot is not needed?

After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area). I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.

Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse. The structure is the routine immunizations that they provide to the parents at the clinic. The process is based on the age of the infant and that will determine when they come in for their routine immunizations. The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live. Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system. The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church. Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

Another alternative, is working with the resources available in the community. Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day. If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.

When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations. If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming. Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener. If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay. The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.

References

Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571

February 02 2017

Implementing Changes in the Emergency Room

An emergency room nurse asks how can he make changes in his emergency room to better serve the patients?

My response to the ER nurse was to acknowledge that I understood his enthusiasm in wanting to make the changes in his emergency department. In such a fast paced department where it is a matter of life and death, it is hard to implement changes because the nurses may feel they do not have the time to learn but as managers we know that a change must take place (Stevens & Caldwell, 2012). The emergency department is one of those places where there is never a happy medium making it difficult to staff and do trainings. But as the website for the American Academy of Healthcare Communication noted “communication is the key to exceptional patient care” (http://www.health.gov/communication/resources/Default.asp).

In order for the nurse to feel that there needs to be a change, there has to be an explanation to them impressing that remaining in the same pattern is not helping the patients. As managers though, we need to be careful on how this is communicated to the staff, because people are sensitive and if they feel that the work they are doing at the moment is not good enough, they will not accept new changes favorably.

One way to implement change is by communication in a narrative format; doing a synopsis of what has been happening in the emergency department. For example, how many patients have had complications as a result of starting an IV on patients with difficult vascular access because too much time was spent on trying to get an IV line in or calling someone else when attempts have failed? Without laying blame on anyone, if this study is brought as a statistic and narrative then it may help the nurses see the importance of a quick ultrasound to see the access.

Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that the hospital has. Once the plan is implemented for training, being able to have the educators follow-up with each nurse on how they are doing, will show the staff that the management genuinely cares. It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped.

Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care rises to a new level, they will be more receptive.

References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse Leader Resistance Perceived as a Barrier to High-Quality, Evidence-Based Patient Care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp

February 02 2017

Communication Resources

As a nurse leader, one has to be able to communicate with the staff and the patients as well. Nurses are influential in informing people about changes that will affect their health (http://www.health.gov/communication/resources/Default.asp). Patients do not like change, much like we do not like change. In order for you to make an impact on someone to change, the person has to be able to feel that remaining the same will be more painful physically or emotionally than making the change itself. For example, the patient that is a diabetic but insists on eating the wrong foods because they like cookies, cake, ice cream and soda, has to be willing to want to make a change. The obvious change that we want to see is that the patient follows a diet and exercise routine to maintain his diabetes so that he can avoid elevated blood sugars and all the other complications to the body that come from elevated blood sugars.

Sometimes the assistance of oral agents to control the blood sugar is necessary. The painful alternative to not stopping the inappropriate diet would be, monitoring blood sugar four times a day and administering insulin on a sliding scale. The pain of needle sticks and frequent trips to the doctor to manage the diabetes may be an incentive to the patient to follow his diet.

Now on the management side of things, just as communication is going to be the key to our patient accepting change, this is also true for employees. In a previous position, change was always happening. We were dictated and told that the change was here and it was happening effective yesterday as the expression goes. As managers we were to accept it, implement it and move on to the next thing (Stevens & Caldwell, 2012). The employees were kept in the dark and not given much information except to say that the change was here and it had to be done to perfection. An example was a company department goal that was added to the staff evaluation was to have zero mistakes on any reports based on the staff doing their work one hundred percent perfect with no margin of error. It was an unattainable goal as no one in this planet is perfect. The staff was never made aware of this goal and how it would be tied to the financial aspect of the company. If the employee had one mistake this would affect whether they obtained a bonus or a raise.

When I was in a leadership position, my leadership with my team has to be such that I could be and influence to them in a positive way and be able to help them grow and embrace new changes. This was not an easy process for me as I always try to be there for my staff, but there is no one there for me. I opted not to be a transactional leader to my team. I opted to be a transformational leader that will help their team grow in the long run.

References

January 01 2017

Implementing Changes

Many nurses ask themselves, how can we as nurses implement changes in our units and departments? One way to implement change is by communicating in a narrative format; doing a synopsis of what has been happening on our unit or department. For example, how many patients have had complications as a result of coming in with an ulcer to the unit vs. the ones that may develop them in the hospital? Without laying blame on anyone, if this study is brought as a statistic and narrative then it may help the nurses see the importance of proper documentation on initial admission.

Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that a hospital or facility has. Once the plan is implemented for training, being able to have the educators follow up with how each nurse is doing, will show the staff that the management genuinely cares. It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped. Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care will be raised to a new level, they will be more receptive.

References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse leader resistance perceived as a barrier to high-quality, evidence-based patient care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp

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Years of experience in Work Comp, Case Management, Disease Management, Utilization Review and Prior Authorization.

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Medication Error by Covering Nurse

Quality and Safety at Well Baby Clinics

Implementing Changes in the Emergency Room

Communication Resources

Implementing Changes