Should family members be present during a bedside PICC placement? This is an issue that PICC team members face with every PICC insertion. Lynn Hadaway, M.Ed., RNC, CRNI tackles the issue in a recent blog post here.
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Each year U.S. News & World Report releases "America's Best Hospitals" rankings which is a listing of top hospitals in the United States. One category in the report is nursing care. Patients filling out the survey are asked how often their nurses were courteous, listened carefully and gave clear explanation. The hospitals ranked highest for nursing for the year ending December 2008 are:
Mayo Clinic Hospital, Phoenix, AZ
New England Baptist Hospital, Boston, MA
Mayo Clinic, Rochester, MN
University of Kansas Hospital, Kansas City, KS
Brigham and Women's Hospital, Boston, MA
Methodist Medical Center of Illinois, Peoria, IL
Poudre Valley Hospital, Fort Collins, CO
University of North Carolina Hospitals, Chapel Hill, NC
Central DuPage Hospital, Winfield, IL
Christ Hospital, Cincinnati, OH
To see the other top hospitals for nursing care and those hospitals ranked as worst, continue here.
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At West Virginia University Hospital (WVUH) a team of nurses is responsible for placing peripherally inserted central catheters (PICCs). The WVUH PICC team places approximately 200 PICCs per month and noticed a lag time between placement and clearance of the PICC. The standard of care for PICCs is for a nurse to place the PICC and wait for clearance for use from a radiologist. Since radiologists are responsible for films hospital-wide, the clearance step was slowing down the process. To take the first step towards solving the issue, the PICC team at WVUH enrolled in a PICC tip interpretation class. After the educational step, a study was conducted to determine if the PICC team interpreting tip placement was faster than and as accurate as waiting for a radiologist.
The study included all adult PICC placements between April 10, 2008 and July 10, 2008. Any patient with incomplete documentation was removed from the sample. The interpretation time was compared for MDs and RNs. The study determined that MDs take longer to interpret the X-rays than RNs. Agreement on X-ray interpretation was also studied. It was determined that RNs and MDs will agree on interpretation of X-rays between 93.8% and 97.8% of the time.
Based on the results of the study, the policies at WVUH will be rewritten to allow nurses to give radiological clearance of PICCs. In addition, PICC team members will complete yearly competency updates along with radiology department physicians to maintain proficiency. PICC patients will benefit by not having to wait as long for radiologist clearance to start IV therapy.
To read the abstract of the study or to purchase a copy of the full study, click here.
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Coming soon to a hospital near you: nurses with mobile technology. And for patients at the University of Minnesota Medical Center and Sarasota Memorial Hospital smartphones are already in use. In Minnesota, the phones have created a direct line between patients and nurses. Prior to adopting the technology, patients would ring their call button which someone at the nurse's station would answer. Then the patient request would be relayed to their specific nurse via pager. With this method, patients could be waiting upwards of 10 minutes for a response. With the new system, patient requests are answered almost instantaneously. For more information, click here.
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Nurses working in oncology often see people at their worst. Facing a tough diagnosis, some patients choose to forgo lengthy hospital stays and intense chemotherapy infusions. Instead they decide on quality of life instead of quantity and choose to spend their time at home with friends and loved ones. A question open for debate is how much influence should healthcare providers have on end-of-life decisions? Continue reading here about an oncologist and nurse's differing opinions in a newly-diagnosed cancer patient.
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A national task force of infusion therapy experts was recently convened by the Infusion Nurses Society (INS) to examine the practice of registered nurses determining the distal tip placement of peripherally inserted central catheters (PICCs) by chest radiograph. To reach a conclusion, the task force examined current practices and reviewed existing studies. A survey of state nursing boards was also conducted. Task force analysis determined a need for the expansion of the RN scope of practice to include viewing chest radiographs to determine distal tip placement of PICCs. To read the entire position paper, continue here.
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IV insertion is often required for administering chemotherapy, antibiotics, blood products, fluids or other medical therapies. In patients with cancer, particularly people receiving repeated courses of chemotherapy, IV insertion may be difficult to achieve. There are various techniques nurses can use to improve IV insertion but few are evidence based.
A study published in the September 2009 issue of Oncology Nursing Forum studied whether dry or moist heat application to the upper extremity improves IV insertion rates. To read the full study, click here. (free registration required)
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Many hospitals around the country are expanding their use of wireless technology. With the increase in technology, nurses are becoming more tech-savvy and leveraging new tools to improve patient care.
One medical center in Ohio is utilizing a hands-free communication system to enable clinicians to call for assistance or answer pages by utilizing voice recognition. This system helps nurses effectively manage multiple tasks while increasing inter-departmental communication.
Hospitals are also using new technologies to streamline process flow and improve patient safety. Children's Hospital Boston uses a patient flow platform that has helped eliminate many manual processes and keep patients moving. The hospital is also piloting bar-coding for medication administration in three of its units. The system can sound an alert if a medication is about to be given inappropriately. This alert can allow for intervention before a medication error occurs.
One key to successfully implementing new technology in a hospital is including clinical stakeholders in the planning phases. "Nursing is at the table. They are the drivers. We've been very successful, largely because I think we're a very listening organization. We pay close attention to what is needed, rather than the next bells and whistles that technology can deliver," said Mary Alice Annecharico, M.S., CIO of University Hospitals of Cleveland.
To read more about new hospital technology and how nurses are at the forefront, click here.
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Jeanne Hahne was working as a nurse in a burn ward when inspiration struck. Because the patients were so vulnerable to infection, Hahne and other healthcare providers had to wear full protective gear including a cap to cover her hair and a mask that covered the majority of her face. Even though she worked with many of the burn patients every day, most couldn't recognize her.
Flash forward almost 30 years and Hahne has designed a face mask made of clear plastic so patients can see her smile. Hahne believes she can reassure patients with a smile and help decrease their anxiety. The masks also have utility for patients and healthcare providers with hearing loss since they allow for lip reading. In addition, the masks have helped improve communication between healthcare workers which can help decrease the chance for mistakes or misunderstanding. To read more and see pictures of the face mask, click here.
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Interventional radiologists and oncologists utilize non-invasive approaches for disease screening, detection and treatment. Patient demand for a non-invasive approach is increasing and doctors who perform these procedures are also doing more patient follow up. The increased procedure load and higher level of patient contact present both challenges and opportunities for nurses working in interventional radiology.
Since IR is performed at a number of levels, each nursing opportunity is unique. In some facilities, nurses are responsible for patient intake and monitoring during procedures and in the recovery room. At a full-service IR facility, a nurse could be more involved and may assist with procedures including ablation and chemoembolization. Catch up with some nurses working in the field
here.
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