...the Power of the Pump In April 2013, The Joint Commission published a Sentinel Event Alert describing a patient death that occurred secondary to a delayed response to a device alarm. This same article describes two of the most common contributing factors reported are alarm fatigue and alarm settings that are not customized to the individual patient or patient population. Recommendations made by both the Association for the Advancement of Medical Instrumentation (AAMI) and ECRI Institute included the need to “establish guidelines for tailoring alarm settings and limits for individual patients. The guidelines should address situations when limits can be modified to minimize alarm signals and the extent to which alarms can be modified to minimize alarm signals.” Additional recommendations included to define a process for continual improvement and constant optimizing of alarm systems policies and configurations. Intermountain Healthcare is a nonprofit healthcare system of 22 hospitals with a Medical Group of more than 185 physician clinics covering patients in Utah and southeastern Idaho. In July 2013, the quality and safety teams of Intermountain Healthcare followed the recommendations from the AAMI and ECRI organizations and convened a task force to evaluate the many devices in use within our facilities and analyze the alerts and alarms that correspond to those devices. One of these devices, the infusion pump, has allowed for a very accurate analysis of infusion related alerts and...
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...Real-Time Location System- Awarepoint IS535ON Curtis Austin Saturday August 13, 2011 Professor Raymond Bell Abstract The purpose of this report is to show how important the use of a Real time location system (RTLS) can be to hospitals. Knowing the location, status and movement of equipment and people in hospitals provides valuable information used to reduce equipment expenses and increase staff productivity. RTLS enables hospital managers the ability to increase oversight of millions of dollars’ worth of hospital-owned equipment and provides financial returns on increasing hospital-owned equipment utilization, reducing the need for excessive equipment rentals, and impacting lost, stolen or misplaced equipment. These asset tracking and management business drivers often provide the financial catalyst for getting an RTLS project approved. Real Time Location System- Awarepoint I. Definition To briefly explain the technology, RTLS wirelessly tracks the location of tagged assets or individuals in real-time wherever the facility has installed coverage. While RTLS is a complex technology, it can be simplified into three basic components: 1) the T2A asset tags (figure 2) that are affixed to the piece of equipment the hospital wants to be tracked; 2) the platform, which is the infrastructure consisting of sensors that creates a zigbee mesh grid (figure 3) and network...
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...that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of drugs and doses prescribed, evaluation of treatment responses and review of treatment regimens were also areas of concern. Guidelines for the use of syringe drivers in non-specialist hospitals are put forward. Therapeutic regimens Diamorphine and hydromorphine as analgesics for opioid-responsive pain are the opioids of choice for continuous subcutaneous infusion simply on the grounds of...
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...Annual number (in thousands) of new cases of diagnosed diabetes among adults aged 18-79 years, United States, 1980-2014. (2015, December 01). Retrieved June 11, 2017, from https://www.cdc.gov/diabetes/statistics/incidence/fig1.htm Aronson, R., Reznik, Y., Conget, I., Castañeda, J. A., Runzis, S., Lee, S. W., the OpT2mise Study Group. (2016). Sustained efficacy of insulin pump therapy compared with multiple daily injections in type 2 diabetes: 12‐month data from the OpT2mise randomized trial. Diabetes, Obesity & Metabolism, 18(5), 500–507. http://doi.org/10.1111/dom.12642 Bolderman, K. M. (2013). Putting your patients on the pump. Alexandria, VA: American Diabetes Association. DeVries J.H., Snock F.J., Kostense P. J., Masurel N., Heine R. J.(2002). A randomized trial of continuous subcutaneous insulin infusion and intensive injection therapy in type 1 diabetics for patients with...
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...Product Liability and Legal Ramifications Christopher M. Branch MBA 5861 New Product Marketing 08/13/2013 Christopher Branch MBA 5861 Term 1A Dr. David Castle 08/13/2013 Product Liability and Legal Ramifications The next time you walk into a retail store like Wal-Mart, Target, Home Depot, Office Depot, Babies R’ Us/Toy R’ Us, you will see a board, typically in plain sight of the viewing public, with sheets of papers titled “Product Recall” or Safety Recall or something of the like. Recalled items run the gamut of consumers good and are generally recalled because of a safety or health concerns. The Food and Drug Administration regularly issues recalls or public safety notices for Medical Products, Pharmaceuticals, Tobacco, and contaminated food items. Product Liability is the responsibility of manufacturers, distributors and sellers, they are expected to act in the best interest of the public; to deliver a product free of defects which can harm an individual or persons; and to make good on that responsibility if their products are defective. These can include faulty auto brakes, contaminated baby food, exploding bottles of beer, flammable children's pajamas, or lack of label warnings. The key element in products liability law is that a person who suffers harm from a product need not prove negligence, since the negligence is "presumed" and the result is "strict liability" (absolute responsibility) on the seller, distributor and manufacturer. An injured person...
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...notable events that triggered recent interest in this topic are the heparin overdoses that occurred in California, associated with actor Dennis Quaid’s newborn twins, and those affecting neonates in an Indiana hospital. The Failure Mode Effect Analysis (FMEA) is a proactive approach to error prevention. Implementation of an FMEA system would serve as a crucial method that will help to recognize potential failures of a product or process before adverse events occur. FMEA can help identify where the use of technology can be implemented to facilitate the reduction of medication errors, especially pertaining to heparin as in this case. Studies have shown how technology, such as computerized heparin nomagram system (HepCare), smart pump infusion technology, computerized physician order entry (CPOE), and the bar coding system, can reduce medication errors. Expanding nationwide awareness of these methods should result in a significant decline of medication errors. Introduction Errors are unavoidable in today highly complex and technologically advanced medical treatment facilities and hospital. Recent studies have shown that over 1.3 million people suffer from unintended injuries in United States hospitals as a result of medical errors. As hospital medicine becomes more complex, the frequency of medical errors is increasing. For instance,...
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...Tub bath taken. Patient able to bathe self, but needed assistance getting in and out of tub. Skin on both legs dry and flaking; patient reports severe itching. Emollient lotion applied after bath. Patient states itching is less now. (Tub Bath or shower) After complete bed bath, provided back massage using pétrissage and friction. Patient reported muscle tension and rated pain a 4 before back massage; reported muscle relaxation and rated pain a 2 after back massage. Skin is moist, pink, and intact with no bruises, swelling, or redness. After back massage, patient’s respirations decreased from 20 to 16 per minute and pulse decreased from 78 to 70 beats per minute. (Back Massage) Complete bed bath given. Patient unable to assist but cooperative with turning. Skin on both legs dry and flaking, complains of severe itching. Bath oil added to bath water. Emollient lotion applied after bath. States itching is less after bath. (Complete or Partial Bed Bath) Perineal care given. Patient unable to assist but cooperative with positioning. No redness, drainage, or open areas noted. Patient complained of mild itching before perineal care. Patient reports reduced itching after perineal care. (Perineal care for Female Pt) Perineal care given. Patient unable to assist but cooperative with positioning. External genitalia show no signs of redness, swelling, or drainage. Indwelling catheter is intact and draining clear amber urine. Patient denies pain but states that he feels...
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...Today’s healthcare institutions and providers strive to be safe places for patients to receive care, but past data indicates it has not always been so. The Institute of Medicine determined in the late 1990’s that 44,000 to 98,000 patients die from medical mistakes each year (Wachter, 2008). This tremendous number of deaths places medical care mishaps between the fifth and eighth leading causes of deaths in the United States (Kizer, 2001). In 2002, The Joint Commission established National Patient Safety Goals (NPSG) to help accredited organizations with patient safety in specific areas. An advisory group comprised of nurses, physicians, pharmacists, risk managers, clinical engineers, and others with appropriate experience advises The Joint Commission on how to address emerging patient safety issues. This group also periodically develops and updates the goals. The goals are grouped into broad categories and for 2011-2012, cover such categories as patient identification, health care-associated infections, improving communication, medication safety, reducing falls, and risk assessment. A discussion of selected elements underlying the current NPSG such as hand washing techniques, training, and lack of communication between healthcare personnel that can lead to medication errors, to falls, and even death, plus other related factors such as staffing shortages, problems with using outdated equipment, considerations in using the electronic medical records, and compliance with statutes...
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...Sweet Poison- Epidemic of the 21st Century! TEAM RISKY BUSINESS DEEPAK JOSHY JOBIN RAJ NEERAJA S RAVI TEJA POLINENI VIGNESH SANKAR J CONTENTS 1.0 INTRODUCTION ................................................................................................................................1 2.0 OBJECTIVES .......................................................................................................................................2 2.1 Decision Maker’s Problem: ....................................................................................................2 2.2 Market Research Problem: ....................................................................................................2 3.0 DESK RESEARCH .............................................................................................................................3 3.1 Purpose.....................................................................................................................................3 3.2 Procedure ................................................................................................................................5 3.3 Summary .................................................................................................................................5 4.0 RESEARCH DESIGN: ......................................................................................................................6 4.1 Exploratory Research ...............................................
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...around the clock for the benefit of all citizens in the country. In many cases, nurses work double or triple shifts, to provide holistic nursing care. Nurses contribute major roles in the healthcare systems and as competent health care providers. Nursing is a dynamic profession and forever striving to meet the challenging needs due to constant change occurring in the profession. Nowadays, nurses generally became accountable for their own practices and they have been at the vanguard of new role development. However, nursing at times, will cross their boundaries in providing care, as an individual or teamwork to save patient lives. This may result overlapping of roles. Nurses adapting the changing environment and continually develops new skills (Chaboyer et.al., 2001). Doyal (1998) argues on nurses and others medical practitioner is doing physician’s work, which has involved the creation of new roles. As described by Nancarow & Borthwick (2005), the nurses have an opportunity to identify a new role in getting change within their expertise boundary. This paper will explore, discuss and critically analyze on the impact on professional roles on crossing professional boundary that often occur in my practice performs task which is suppose done by anesthetic physicians. The issues that I am going to debates here is on my daily activities, cross professional boundary of preparing, diluting and administering the intrathecal opiate drugs. Occasionally, most of the time, the boundaries...
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...Advanced Information Management Western Governors University February 21, 2016 Regulation placed upon the healthcare system only seek to improve safety and security of the patients we care for. The enactment of the Health Insurance Portability and Accountability Act (HIPPA) and the enactment of Meaningful Use Act the United States government has set strict regulations on the security of health information and has allotted for stricter penalties for non-compliance. The advancement of electronic health record (EHR) systems has brought greater fluidity and compliance with healthcare but has also brought greater security risk of protected information. In order to ensure compliance with government standards organizations must adapt technologies such as CPOE and EHR. The use of such technologies also require organizations to develop policies and safeguards to protect both themselves but the community they serve. Team Members and Responsibilities To ensure success in the merger of the health care system, a team of highly trained and competent members will be needed. An implementation manager would be the leader of the team, responsible for keeping the project on schedule, keeping a list of practice issues that need to be resolved, scheduling go live dates, and also be responsible to delegate task to other members of the implementation team. A physician lead is another valuable member of the implementation team. Acting as a liaison between physicians and the implementation...
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...still placed on paper charting. Difficulties I encountered first hand included tracking down the chart while other staff members had possession of it. It made charting in a timely fashion almost impossible, and I often found myself charting late entries. Today I am a Certified Emergency Nurse in the Emergency Department of LVHN. In the grand scheme of things, 15 years is relatively a short time, yet the advances in technology I have been witness to are sometimes overwhelming. “Informatics is a field that’s evolving every day, and there’s much to learn” (Abbott, 2002 p. 14). Today, the majority of charting is done electronically. “Modern systems go beyond merely computerizing paper records. These new systems gain control over the generation of information and develop new techniques for using it creatively (Catalano, 2009 p. 367). Even the technology with the equipment we used on our patient’s 15 years ago would be considered antiquated in today’s...
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...Nurse Practitioners, 20(4), 172-180. doi:10.1111/j.17457599.2008.00305.x Introduction Authors of this investigative review wanted to research the predisposing factors in peripheral intravenous (IV) catheters causing phlebitis. Millions of patients hospitalized in the U.S. each year have had an IV or IVs’. The patients in this study received a variety of IV drugs and IV infusion solutions. Review of Literature Phlebitis rates from previous studies range from 41.8% to 68.8%. These studies also looked into consideration of predisposing factors such as age, gender, immunosuppression, aseptic techniques, medications and high osmolality solutions. The authors found conflicting correlations with age, gender and infusion rates being a cause for phlebitis. Catheter size, length of time it was in place, location (site) and the drugs infused had not been studied. Discussion of Methodology This is a descriptive comparative study. Standard protocol for this hospital: Sites are assessed and cared for with povidone iodine 10% every 24 h. PIVs are changed routinely every 72 hrs. A new IV is inserted when symptoms such as tenderness or pain develop. The data was collected by, developing a questionnaire and direct observation using the Scale of Phlebitis to diagnose phlebitis. 91% of the data collected was by the author, Esin Uslusoy, BSN, MS. The remaining 9% of data was reported by the nurses taking care of the patients....
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...Right spastic hemiparesis-chronic: paralysis of one side of the body usually resulting from damage to the corticospinal tracts of the central nervous system. Most common cause of hemiplegia is a stroke cause by thrombosis brain hemorrhage or cerebral embolism Patient is unable to perform normal daily hygiene requirements, ranging from bathing, eating, oral care, medication administration, dressing, cleaning due to Right spastic hemiparesis (chronic). Patient does not have control over muscles (LeMone, 2015, p.1403). Improper positioning and support to minimize tissue pressure should be provided for all patients, including those with pressure ulcers. The development of any new ulcers should prompt review of the method and intensity of preventive...
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...Discussion This experiment was based on data that oxygenated perfusion of NHBD livers will promote cellular recovery from warm ischaemic injury. (Schon, 1994: S159-62) Without perfusion, cold storage exacerbates the injury by subjecting the organ to additional (cold) ischaemia; then, during surgical anastomosis in the recipient, another period of warm ischaemia. These consecutive ischaemic periods facilitate the progression of cellular injury to a state that is not compatible with recovery upon reperfusion. (Endoh, 1996: 110-15) It is therefore essential to restore cellular energy levels between retrieval and reimplantation for NHBD livers. Previous studies have shown that perfusion prior to harvesting of the NHBD liver can restore cellular energy levels before cold storage. Total body reperfusion with cardiopulmonary bypass (CPB) using autologous blood after 30 min without ventilation was shown to revive total adenosine 5' -triphosphate (ATP) content in porcine livers and kidneys", Conditioning the liver with 30 min of normothermic isolated perfusion in vivo, using whole blood, has been shown to increase mitochondrial ATP content after 10 min of circulatory arrest in the porcine model7. CPB for only 10 min after 30 min of arrest, at 37°C, provided functional recovery of the heart, liver and kidney in the canine models. In the porcine transplant model, CPB for systemic perfusion with cold, oxygenated Eurocollins solution restored tissue energy charge after 10 min ofarrest9....
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