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An ED physician prescribes nalbuphine or butorphanol for pain, thinking that the patient might have less severe drowsiness than from other pain medications, but doesn't check to see if the patient is chronically on a narcotic for pain control.
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Were you concerned that your ability to use standing orders at triage was in jeopardy? A February 2008 interpretive guideline from the Centers for Medicare & Medicaid Services (CMS) alarmed emergency nurses by requiring patient-specific practitioner approval for standing orders prior to treatment.
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Here are three scenarios in which noninvasive hemoglobin measurements could affect an ED patient's care:
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At Beth Israel Deaconess Medical Center in Boston, ED nurses "made some huge changes" to their medication reconciliation process, reports Shelley Calder, RN, CEN, MSN, clinical nurse specialist for the ED.
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A patient reports stroke symptoms that began four hours ago outside the window for treatment with intravenous tissue plasminogen activator (IV tPA).
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Anticoagulant safety is in the spotlight. A recent Sentinel Event Alert issued by The Joint Commission says that 59,316 medication errors involving blood thinners were reported between 2001 and 2006 to a database run by U.S. Pharmacopoeia, a nonprofit public health organization that supports research and development of patient safety initiatives. Of those, about 1,700 resulted in patient harm or death.
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Standing orders used by emergency nurses not only speeds patient care; it also "adds a measure of safety in that they are standardized," says Gayle Walker-Cillo, RN, MSN/Ed, CEN, an ED clinician at Morristown (NJ) Memorial Hospital.
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Although it's impossible to know what an Obama administration means for emergency nurses, there is reason to be encouraged, according to Denise King, RN, MSN, CEN, president of the Emergency Nurses Association (ENA).
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Over the past decade, several large-scale disasters have tested emergency response teams and healthcare providers. They've also tested the research community's ability to quickly, efficiently and ethically dispatch investigators to do vital research that could help prevent and respond to future disasters.
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Haverford College of Haverford, PA, has spent more than a year dealing with a problem that IRBs do everything they can to avoid: a research noncompliance investigation requested by the Office for Human Research Protections (OHRP).
