Editor’s Corner, July 2007
I hope you all had a great 4th of July. Around where I live, we had overcast skies but the fireworks were great as usual. As we head into the warmest days of the summer, I hope you’ll have the opportunity to take a few days off here and there and make it either to the pool or the beach for a well-deserved break.
We have again put together for you an informative new issue with both news highlights and two featured articles on the recent ANA study on injectable medication errors and the ever-increasing use of robots in hospitals for tasks ranging from critical surgery to delivering goods around the hospital. We hope you’ll find them useful and thought provoking.
Just in case you are considering to take advantage of a new position or have a friend who would like to find a new nursing job, we have a great “Escape For Two!” promotion going on right now.
If you accept until August 31 a position with any of our sponsoring employers, you can enjoy a 2-nights vacation with a loved one in one of best holiday and entertainment spots in the United States. We pay for your round-trip airfare and room so you can enjoy your days in sun without any worries.
Hurry up and write your own ticket for a free and quick summer getaway!
Be well and see you in August!
Headline Nursing News
North Tonawanda, NY Nurse’s Research Garners International Attention
Theresa Arida, a registered nurse and instructor at Niagara County Community College in New York, was honored at the 18th International Nursing Research Congress in Vienna by being selected from more than 1,300 applicants to present the results of her Master’s research. Arida studied the difficulties faced by the nurses in making the transition from “learning in a clinical setting to working as a nursing graduate.” Arida said the problems with that transition constituted the number one reason why new nurses did not stay in the field and contributed to the growing shortage on registered nurses around the nation. Her research showed that 50 percent of new nurses leave their first job with the first year. For the more on this story, please visit: http://www.tonawanda-news.com/local/local_story_181134954.html National Study Shows Nurses are Concerned About Medication Errors and Syringe Safety
A new national study of 1,039 nurses conducted by The American Nurses Association (ANA) revealed that 97% “worry” about medication errors and 68% believe such errors can be reduced with “more consistent syringe labeling.” ANA President Rebecca M. Patton, MSN, RN, CNOR, said “proper and consistent syringe labeling is one way to reduce risks associated with medication errors.” The following factors were mentioned as contributing to such injection-related medication errors: 1) Too rushed or busy environment (78 percent). 2) Poor or illegible handwriting (68 percent). 3) Missed or mistaken physician’s orders (62 percent). 4) Similar drug names or medication appearance (56 percent). 5) Working with too many medications (60 percent).
Bug Bear Lake, CA Nurse Retires from Department of Water and Power
Susan Conley’s life is anything but typical. Despite being struck by polio at the age of 8, Conley never accepted any limits to her life. After receiving her degree as a pediatric nurse, she served at the Los Angeles County Medical Center and the neonatal intensive care unit at Los Angeles Children’s Hospital. The determined nurse with the can-do attitude later accepted a position as a healthcare administrator for Kaiser. When diagnosed with post polio syndrome in 1988, she had to retire from the healthcare system and open her own Colby’s Yogurt and Coffee in Big Bear Lake, California. After selling her business in 1994, Conley was asked to replace a board member on the Bear Valley Community Healthcare District. She accepted the appointment and was re-elected in 1996. This was followed by another challenge in 2000 and she was elected to the Big Bear Lake Department of Water and Power from where she has retired to devote more time to her family and grandchildren. “No matter how much I’ve given, I’ve received more,” she said about Big Bear Lake, her beloved hometown. To read more about Conley’s life story, please visit:http://www.bigbeargrizzly.net/articles/2007/06/27/news/susanconley.txt
Scottish Nurses Off to the Amazon for Medical Charity
The sick and the poor of Peruvian rainforest will soon be visited by a group of angels – the volunteer nurses and doctors from Lothian, Scotland. Organized under the leadership of West Lothian midwife Shirley Seabury from St John’s Hospital in Livingston, the medical team headed for the Amazon region includes nurses from Edinburgh Royal Infirmary, Bonnyrigg and Roslin, three GPs from Midlothian, as well as a nursing home manager from Perth. The group plans to reach Iquitos, the largest city in the Peruvian rainforest, in September. Charge nurse Linda Ferrier, from Rosslynlee Hospital in Roslin, out-of-hours Bonnyrigg nurse Marjory Thrusfield, Perth nursing home manager Dawn Sharp, and Eyemouth dentist Kim Horne are also on board. ERI charge nurse Andrew Eveleigh will work on a different ship with a team from London. For more on this story, please visit: http://edinburghnews.scotsman.com/health.cfm?id=992592007
Texas Nurse-Midwife Receives Highest Honor from American College of Nurse-Midwives
American College of Nurse-Midwives (ACNM) has honored Nancy Jo Reedy, CNM, MPH, FACNM, a certified nurse-midwife from Arlington, Texas with 2007 Hattie Hemschemeyer Award. The award was presented to Reedy on May 26, 2007 at the ACNM 52nd Annual Meeting & Exhibit in Chicago, IL. Reedy, a 1973 graduate of Mississippi Medical Center Nurse-Midwifery Education Program and holds a 1977 MPH degree from the University of Illinois, worked for over 30 years as a nurse-midwife at Parkland Memorial Hospital and held important positions within ACNM. She is currently serving as the Director of Nurse-Midwifery Services at Texas Health Care, PLLC in Fort Worth, Texas. Congratulations!
Vietnam-Vet-Turned-RN Leaves Behind a Legacy of Dedicated Service
Peter Simmons of Minnesota, 63, who served two tours of duty in Vietnam before going to school for his RN degree, passed away after battling with pancreatic cancer, leaving behind many who remembered him as a tough worker who devoted his life to helping others. During his 25 years of service as a Registered Nurse, Simmons worked at Hennepin County Medical Center “and other care facilities in several specialties, including orthopedics and intensive care,” according to Star Tribune. Most recently, Simmons worked at St. Louis Park Plaza Health Care Center until his passing away. d’Arcy Hughes, his friend and former co-worker, described him as follows: “He’s the best soul I’ve ever met. Patients loved him. He could get a laugh out of them. Co-workers loved him, too.” God bless his soul. To read more about RN Simmons’ exemplary life, please visit: www.startribune.com
National Survey Reveals Nurses’ Concern About Injectable Medication Errors
The results of a new national study should come as no surprise to any seasoned nurse or healthcare worker. The study found out that a great majority of the medication errors arise from mislabeling of the safety syringes used in hospitals and medical facilities.
The study which surveyed 1,039 nurses across the nation was conducted by The American Nurses Association (ANA) and sponsored by ANA and Inviro Medical Devices, a company that caters to the $1.6 billion safety syringe market.
This insider’s look at the safety syringe practices is crucial given the fact that 44% of the U.S. nurses use injectable medication more than five times per shift. That’s a lot of opportunities for error on a daily basis.
One overall result of the study stands above all others:
97 % of the nurses surveyed said they “worry” about medication errors, and more than two-thirds (68 %) said they believe medication errors can be reduced with more consistent syringe labeling.
So the question arises: what is preventing the healthcare professionals from applying “more consistent syringe labeling”?
To understand that question, we need to look at the existing syringe labeling practices.
An alarming 28% of nurses said they do not label the syringes at all.
Of the remaining 72% who do, this is how they said they do it:
* Writing on self-adhesive labels then applying to syringe (54 %).
* Writing on pieces of tape and adhering to syringe (31 %).
* Using a Sharpie pen and writing directly on syringe (11 %).
* Writing on paper or sticky note and taping to syringe (4 %).
The bottom line is, it is hard to read the gradation marks on syringes labeled with such improvised methods. There is plenty room for error there.
Sixty five percent of nurses have mentioned labels that cover the syringe barrels and thus make it hard to read the volume markings as a major issue in administering correct amount of medication.
Thirty nine percent said a label makes it hard for the nurses to compare the syringe dosage to the one specified in the doctor’s order.
And when the syringes are not even labeled at all (over one-quarter of all cases) then there is of course the additional risk of delivering the wrong medication.
This leads to yet another important question that survey addressed in detail: why do the hard-working and well-qualified nurses of our nation resort to such makeshift measures?
The answers again are no surprise to seasoned veterans of the health care system:
- 78% said they were “too rushed” during their shifts and that there was not enough help to take care of the assignments at a slower pace.
- 68% said “poor, illegible handwriting” contributed to injectable medication errors.
- 62% said missing the physician’s orders, or “mistaken orders” by the doctors themselves contributed to the errors. (62 percent)
- 60% said “working with too many medications” was a major error factor.
- 56% mentioned “similar drug names or medication appearance” as the culprit.
One “solution” adopted to prevent such errors is to pre-label the injectors well in advance.
But that certainly violates the guidelines specified by the Joint Commission’s 2007 National Patient Safety Goals document which demands that the syringe labels be prepared only at the time the medication or when the solution is prepared.
The solution to all this is really not that mysterious at all and lies in a simple technological innovation: syringes that come with built-in writable stripes on their barrels.
95% said such syringes, since they will not cover the gradation markings, will make it easy to read the correct amount of medication.
Moreover, 93% also said such improved visibility would also reduce the number of medication errors at the hospitals and healthcare facilities.
Just like the safety syringes with retractable needles or protective needle sheaths used by 81% of the nurses surveyed, such “writable syringes” should also become a standard equipment in all hospitals.
Actually such syringes do exist and are already manufactured by companies like Inviro. We hope their use will spread throughout the industry to reduce medication errors.
Last but not least, we believe this case again points at the importance of the participation of the nurses in the decision making process of their institutions.
Not only the nurses are the best qualified parties to recommend optimal methods to reduce such errors (by, for example, adopting writable syringes) but they are also the ones who suffer the most from syringe-related accidents.
The ANA study has found out, for example, that 35% of nurses are worried about “getting HIV or hepatitis from a needlestick injury” and for good reason.
Increased decision-making participation would not also make it easier to find the correct solution to medication errors but also help the healthcare workers design and implement a much safer and more efficient working environment. We owe it that much to the hardworking nurses of our nation.
Robots in Hospitals – The Trend is Picking Up
Three locust like robotic arms reaching into the chest cavity of the patient lying on the surgery table hum quietly while… the surgeon is sitting in a nearby remote-control booth, directing the delicate operation from a distance with a 3-D precision that was not possible before…
Or, just look at the 5-feet high porter robot with blinking lights, moving slowly on its rubber wheels through the crowded hallways of a hospital… it is quietly waiting for the elevator to arrive so it can deliver the blankets it is carrying to the nurse station at the top floor…
Such scenes will become increasingly frequent in the hospital of the future. But guess what? Such a development was prophesied over a hundred years ago by the early pioneers of the 19th century political economy – that in a capitalist market, any given set of manual skill eventually gets replaced with machines for higher productivity and profits. And that creates both new pressures and opportunities for the workforce to renew itself through new training and career planning.
The inevitable trend is already visiting our hospitals in a form that will certainly impact the way our nurses and healthcare professionals will be trained and employed in the near future: robots are taking over an increasing number of functions, ranging from critical surgical operations to delivery of goods around a hospital.
More and more hospitals in the developed world are employing robots in surgery, including Japan, for example. Iseikai Hospital in Osaka and Nagoya Kyouritsu Hospital in Nagoya are just two Japanese hospitals that use these labor-savings surgery robots.
One unintended consequence is the way the insurance companies are billed for “services rendered.” Billing for operations performed by robots are already a topic of controversy in Japan since they are not categorized as “regular surgical operations.”
In British Columbia, Canada, a robotic system named Da Vinci will start operating this Fall to help doctors during surgeries that require accessing tight areas like the pelvis or the chest. Vancouver General Hospital is planning to use Da Vinci in urological (e.g., Radical Prostatectomy), cardiac (e.g., Mitral Valve Repair) and gynecological (e.g., Hysterectomy) surgeries.
Canadian news reports claim that “robot-assisted surgery offers patients fewer surgical complications, less post-operative pain, faster recovery times, shorter hospital stays and improved health outcomes.” Purchasing Da Vinci, installing it, training the personnel and maintaining it for three years will cost the hospital $6.5 million.
Closer to home, did you know that robots are performing cancer surgeries in Charlotte, North Carolina? CyberKnife, a $3.7 million knifeless robot, is operating on cancer patients with precision radiation at the NorthEast Medical Center. CyberKnife is also used in Mission Health and Hospitals in Asheville and UNC Hospitals in Chapel Hill.
Other “radiosurgery” machines used in surgery include the Gamma Knife in Winston-Salem and Greenville and the XKnife and a Varian device in Durham.
One advantage of such robots performing surgery with high-energy radiation is that they can remove tumors contained in a given area or close to critical body parts like the spinal cord with high precision and reduced side effects (like fatigue) for the patients. But other types of cancers still require traditional surgery or a combination of both.
Cookeville (Ohio), Nashville, Memphis, Chattanooga, Knoxville, Oak Ridge and Franklin (Tennessee) are other cities that employ robots in surgical operations. Cookeville Regional Medical Center became the eleventh hospital in Ohio to buy a Da Vinci. The $1.5 million robots is especially favored by urologists in prostate surgeries. CRMC officials confirm that the robot helps “shorter hospital stays, quicker return to work time and fewer complications.”
In Texas, a heart bypass surgery was accomplished under two hours thanks to Da Vinci. According to Dr. Lewis Wilson, a cardiothoracic surgeon at CRMC, the bypass patients of the Texas surgeon are “back at work in two weeks.”
The below comparison of Da Vinci assisted Gynecologic Surgery with traditional Open Abdominal Surgery, as provided by Women’s Specialty Health Centers of Indianapolis, shows the typical advantages of operations performed by robots (with the exception of actual surgery time):
- Incisions: Five 1-inch incisions versus one 8-to-10 inch incision.
- Surgery time: 2-3 hours versus 1-to2 hours.
- Hospital stay: 1-2 days versus 3-5 days.
- Recovery time: 1-2 weeks versus 4-to-6 weeks.
- Pain medication: Motrin/Darvocet versus Vicodin/Percocet.
With the spreading popularity of such robotic systems, training of our nurses should also be expected to undergo respective changes, with new opportunities for career training and development.
Another area in which machines are rapidly replacing human labor is the transportation of various goods around a hospital to the nursing stations. It is a thankless and physically demanding job that needs to be taken care of, day in day out. Perhaps robots will save our nurses from such physical drudgery and allow them to concentrate on more technical and “higher value added” assignments — despite the ever-present “labor displacement” potential that all machines represent.
Probably Japan, again, is one country leading the way in the employment of robots in all kinds of hospital services including an “android” robot meeting the visitors at the greeting area and showing them the way to wherever they want to go around the hospital site. There are hospital robots in Japanese hospitals which carry food trays as well as mail, paperwork, luggage, lab specimens, bandages, X-rays, blankets and linens.
The initial investment could be considerable for some of these hi-tech workers but they do not eat or drink, and they usually take only a six-hour break per day. They do not go out on vacation. They do not take any sick leaves or personal days off. . Neither do they need any promotion or health insurance.
According to the Pittsburgh-based Aethon corporation which makes some of these porter robots, they cost 30% less than a human courier. There is one (named “Chad”) in use at the Lehigh Valley Hospital in Pennsylvania and another one will soon be rolling down the corridors of The Hospital of the University of Pennsylvania.
Aeton has 150 porter robots operating in various U.S. hospitals, which is 120 robots more than employed back only two years ago. The adoption rate is alarming for the human couriers and sweet music to hi-tech companies like Aeton.
Some of these robots have TV camera installed on them so that a doctor can “visit” and “examine” a patient by remote control. Thanks to the radio frequency chips that nowadays can be affixed to almost any object, these robots can also go and find left over or lost equipment around the hospital. Given the fact that a 500-bed hospital on the average has 1,500 IV pumps, the savings of such a capability can be considerable in the long run.
Robots, whether used in delicate surgery or just to carry goods around the hospital, are here to stay. This trend will eventually both present new challenges for some of our nurses as well as providing them with new and exciting venues to ratchet their credentials to new heights of professional excellence. That’s why in our hi-tech future, the education and on-the-job training of our nurses will be more important than in any other period in our nation’s history.