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Incredibly Easy blog
The Incredibly Easy blog will expand on selected topics presented in the print journal.
Monday, July 28, 2014

From the beginning, nursing has had a rich history of utilizing research to develop its practice as a profession. Today, we call this evidence-based practice (EBP). There are many published models that you can use when implementing EBP, and the best implementation comes at the point of care where practice meets the patient.

There are naysayers who declare this to be cookie cutter medicine, but following protocols and guidelines, along with monitoring outcomes, is the key to quality patient care. To the naysayers, we say that EBP is the conscientious joining of research, clinical trials, clinical expertise, and patient values. How can that be considered anything but quality?

I encourage you to become engaged in your practice. Why do you do what you do? Read articles, follow research, obtain continuing education credits (even if they aren’t required by the state in which you practice), or join a professional organization that’s relevant to your practice environment. Understand why we do what we do. Learn how to know when what we’re doing isn’t working, isn’t correct, or isn’t prudent. Follow and understand new guidelines, and bring your thoughts, concerns, and perceived failures to the attention of your peers, your administration team, and your quality management team. Your patients’ quality of life depends on it.

Lisa Lockhart, MHA, MSN, RN

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Monday, July 21, 2014

There has been a lot of focus lately on clinical alarms in the patient care setting. In 2002, there were 23 deaths reported in the United States linked to issues with clinical alarms. These were investigated by The Joint Commission. What it found was that the reported number seriously underestimated the problem. Alarm safety is one of the National Patient Safety Goals for good reason. In 2008, alarm safety made the top 10 potential safety risks in acute care facilities. These alarms that are designed to improve recognition and safety are causing safety issues. Why?

There are many reasons for the problem. Alarm overload or alarm fatigue make the top of the list. Healthcare personnel are now bombarded with alarms. The noise level is amazing in most acute care settings. We have alarms for fall prevention, bed rails, ventilators, oxygen saturation, cardiac monitors, and on and on. It can be an overwhelming cacophony of sound that the experienced caregiver learns to tune out. We say we know the difference between a red alarm (meaning urgent) and a nuisance alarm. But can we really tell?

What’s a nuisance alarm? These are alarms on restless patients that make the bed sound off, the pulse oximeter act up, the heart monitor sound off for ectopy that’s actually artifact, and the ventilator sound off for pressure and coughing. What’s the most common cause of nuisance alarms and alarm fatigue? Failure to set the alarms and parameters appropriately in the first place.

Clinical staff will hit reset repeatedly instead of fixing the actual problem. How long will that happen before you’re ignoring the sound all together because you’re busy with something really important? Then it happens: self extubation, a serious fall, v-fib/v-tach, and the list goes on. That’s the single most important factor in alarm safety. Set them correctly, understand their purpose, and respond without fail.

Think about your practice environment and the alarms you hear every day. Do you understand their implications? Do you clearly understand how to set the parameters and why? Your patient’s life depends on it.

See the upcoming September/October issue for our On the Horizon column on alarm fatigue.

Lisa Lockhart, MHA, MSN, RN

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Monday, July 14, 2014

Do you know what the term “just culture” means? As a nursing professional, are you familiar with the American Nurses Association’s (ANA) stance on just culture as a provision and standard for safety and process improvement? It’s vital that we embrace and understand just culture and its value to our profession, our patients, and our organizations. 

Just culture refers to a way of looking at events/errors that focuses on cause and process. It steers clear of punitive approaches. The idea is to not only avoid being punitive, but also foster an environment of trust. Findings have shown that, in the past, healthcare workers used occurrences as punishment and reward. The failure to report was high and being involved in such a report was considered punitive and wielded as a punishment and behavior deterrent. Rarely were the processes evaluated and addressed.

In a just culture, an organization and the individuals involved seek to improved processes and reporting of safety concerns without fear of retribution. A just culture fosters organization-wide involvement in safety and trust. The ANA places such value on just culture that it’s a requirement for any organization seeking Magnet® recognition.

What role, if any, does just culture play in your organization? What training in process improvement and problem resolution and delineation does your organization provide for its stakeholders? What are the nursing standards of care and conduct for your organization? What role does process improvement play in those standards? What are your beliefs regarding your organization’s positions on trust and safety?

Examine where you work and the level of trust among your peers and supervisory staff. Are you working in a trusting and just environment?

Lisa Lockhart, MHA, MSN, RN

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Tuesday, July 08, 2014

Adult respiratory distress syndrome (ARDS) is most commonly found in critically ill patients ages 1 and older. The syndrome involves the sudden failure of the respiratory exchange system, resulting in inadequate oxygenation of the blood and vital organs. In its simplest form, the alveoli fill with fluid and are rendered ineffective at filling with air to make the exchange of oxygen into the bloodstream. The fluid comes from blood vessel leakage.

There are many causes of ARDS. The most common include sepsis; trauma or shock; pneumonia or other lung infections; multiple blood transfusions; aspiration of salt water; smoke or fume inhalation; aspiration of vomit into the lungs; and overdoses of tricyclic antidepressants, opioids, or other sedatives. Of these possible causative factors, sepsis has the highest mortality.

Patients with ARDS often experience feelings of air hunger, shortness of breath, low oxygen saturation, tachypnea, low BP, and, eventually, respiratory failure. The syndrome can be reversed with early recognition and treatment. Treating the cause is the priority for recovery. These patients are maintained in the ICU and are commonly intubated to facilitate respiratory support and oxygen exchange. Although damage to the lung tissue can be reversed over the course of months, it may be permanent.

Our treatment of ARDS has progressed due to research and evidence-based practice in the care of the critically ill patient. Protocols for care, early recognition, and intervention are essential to caring for patients at risk for this possible life-altering disease process. Mortality has gone for greater than 60% to 30%, which is a phenomenal improvement in outcomes.

Lisa Lockhart, MHA, MSN, RN

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.

 


Monday, June 30, 2014

Keeping our focus on the season and the summer heat, I thought we should take a look at heat stroke. This will drive patients into the acute care setting. Heat stroke is the most serious of the heat-related ailments and can be deadly for the very young and the very old.

In addition, it's important to remember that there are also extenuating factors that affect the onset of symptoms. Dehydration, enclosed areas, lack of air flow in an area, age, and co-morbidities also affect the patient and the outcome. With that said, no one is exempt from the danger; even star athletes can be affected. Have a healthy respect for the body and its limitations--know the warning signs.

By definition, heat stroke is the core body temperature rising to 105 degrees Fahrenheit, with resulting effects on the internal organs and the brain. Common signs and symptoms include nausea, vomiting, confusion, loss of consciousness, coma, and even death. Early warning signs may seem benign if a person isn't alert to the possible dangers. These include headache, muscle weakness, cramps, lack of sweat, seizures, rapid heart rate, and altered level of consciousness. Often, the first sign of danger noted is when the person faints. This is an individual who's already severely compromised and alerting 911 would be a first-line intervention.

Other immediate interventions include moving the person out of direct sun, providing air flow, and cooling measures such as ice packs, a sponge bath, and immersion in ice water. Rehydration is essential after the person is awake.

Be aware. Every year there are stories of tragic losses to our human and animal population due to careless attention to heat and its dangers. Be safe, stay cool…

Lisa Lockhart, MHA, MSN, RN

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.

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NursingMadeIncrediblyEasy
The mission of the peer-reviewed journal Nursing made Incredibly Easy! is to meet the ongoing educational needs of nurses in a refreshingly original, easily understood format.

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