The 15 Percent Solution

The 15 Percent Solution

You've heard it before and so have I: the average person only uses 10 percent of their brain. This means as you go through your daily activities on average you only use 10 percent of your mental capacities. Can you imagine how much more you could accomplish if you could use more of your brain?

I'm not asking you to use 90 percent, but how about 15 percent?

How much more could you accomplish if you were using 15 percent of your brain on a consistent and persistent basis? Could you do better assessments? Could you provide better care? Would you be better equipped to evaluate your treatments and avoid complications in your patients? I think most of us would.

But how do you squeak out another 5 percent if you are using only 10 percent of your brain and you feel like you’re using a lot. You’re stressed and at times you go home mentally exhausted. How can you squeeze that extra 5 percent out?

I believe the key lies in your knowledge base. The greater your knowledge base, the more information you have to go back to. The greater your knowledge base, the more connections you find between concepts. And the greater your knowledge base, the more creativity you can use in finding solutions to complex problems. So read, observe, pay attention, keep an open mind and be receptive to learning. Remember that there's plenty of room for extra potential and strive for a little more, just 15 percent.

15 percent of your mental capability is 50 percent more than you've been using. Your assessments would be 50 percent better. Your interventions would be 50 percent better. Your ability to respond in a crisis would be 50 percent better. That's a big jump for a little bump in brain power.

So how do you go about achieving this lofty 15 percent? The first step is to learn something new today. Learn something new every week. I use what I call the idea quota; I require myself to come up with one new idea every week. It maintains my creativity and it keeps me looking for unique and innovative solutions all the time. You could do the same thing with your care by making a creativity quotient or an idea quota for every week. Require yourself to learn something new every week. Come up with a new idea every week and you'll find that your brain power is expanding and before you know it you'll be up to your 15 percent which would dramatically improve your outcomes.

Best wishes,
David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Opportunity is all around us

Opportunity is all around us

For me the ground is too close, the walls are too close, but the sky is endless. I think this is also true of opportunity. Opportunity is all around us if we can only see it; but many times we spend too much time looking at the walls and the ground and not enough time looking up to the open sky.

As this pertains to goal setting, you might find that you are hesitant to make large goals because of the limitations that are right around you. When you look up, you can see that the possibilities are endless and that the goals that you achieve in your life can be endless as well. To go up, you must look up.

If you want better health, more opportunities and greater prosperity in your life, stop looking around at the limitations next to you, and below you, and start looking up at the endless opportunities that really exist. You are an incredible being born into a time of limitless opportunity. Look up to see the vastness of opportunity and abundance that really surrounds you.

To your success,
David W. Woodruff, MSN, RN
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Empowerment for Nurses

Empowerment for Nurses

October 27, 2007

Nurses have incredible power; but few realize it and even fewer use it to improve care and to help their patients. Empowerment is not a gift that someone gives you. Rather it is a gift you give yourself by realizing the excellence you already have, embracing it, and developing it further.

Your clinical practice will improve. By recognizing the excellence that others have, it will help patient care in general improve. Nurses are the only caregiver that is at the bedside 24 hours a day, 7 days a week. Nurses are also the largest body of employees in any hospital system. For these two reasons alone nurses have incredible power. For six of the last seven years the Gallup Poll has listed nurses as being the most ethical and trusted profession. Nurses are respected by their patients and by society.

So why is it that so many nurses feel disempowered?

I believe it is because most nurses do not embrace, develop, or use the incredible power they have for the good of the healthcare system. Empowerment comes from recognizing those things you do well, embracing them and wanting to validate and do them better. To “Embrace your Excellence” means to recognize what you do well and what your peers do well and to encourage your peers to embrace and develop those things that they excel at. Imagine what healthcare would be like if nurses embraced their excellence, developed it further and used their incredible power to change the healthcare system for the better. Could we solve the problems that we face in healthcare today? I think we could.

Nurses are an incredibly intelligent, creative and empathetic group of people who could come up with unique and powerful solutions to the problems we face today.

Embrace your excellence!

“Get out there and give real help!
Get out there and love!
Get out there and testify!
Get out there and create whatever you can to inspire people to claim their divine being and origin.
This is what has to be done now.
There is no time, there has never been any time for dallying and being depressed."
-Mother Teresa

Best wishes,
David W. Woodruff, MSN, RN, CNS
President, Ed4Nurses, Inc.
www.Ed4Nurses.com

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?

Are Nurses With a Doctor of Nursing Practice Degree Called "Doctor"?

Question:

I am thinking of going back to school to earn a DNP. If I earn this degree, can I be called "Doctor" when I practice? How must I identify myself to the public as a nurse practitioner?

The Clinical Doctorate

Practitioners, employers, credentialers, and the public may soon notice that the title "Doctor" applies to many health practitioners who are not physicians or dentists. The clinical doctorate (doctor of nursing practice [DNP]) signifies completion of a clinically focused, rather than research-focused, advanced degree program. Beginning in 2015, the DNP has been targeted as the accreditation standard for advanced practice nursing in accordance with the American Association of Colleges of Nursing (AACN) guidelines.[1] Whether schools and colleges of nursing will revise their program offerings in time to meet this deadline remains to be seen, but clearly the tide is turning toward doctoral preparation for allied health professions at the advanced practice level.

In this regard, nursing follows other professions, such as medicine, physical therapy, pharmacy, clinical psychology, and naturopathy. The call for interdisciplinary practice and education, envisioned by the Institute of Medicine in its report Health Professions Education: A Bridge to Quality, predicts that more professionals with the title "Doctor" will be working together in the same settings.[2] Many of these professionals will not be physicians.

Current Law

According to the 2007 Pearson Report, only 7 states (Georgia, Illinois, Maine, Missouri, Ohio, Oklahoma, and Oregon) have statutes or regulations prohibiting a nurse practitioner (NP) or other doctorally prepared health professional from using the title "Doctor.[3]" Several other states have provisions in law allowing nonphysician healthcare professionals to use the title "Doctor" as long as they also include their title of licensure or specialty (NP, physical therapist, etc) in patient communication. The American Medical Association (AMA) has identified use of the professional title of "Doctor" as a topic for legislative initiative on behalf of its membership. Resolution 211, passed by the AMA House of Delegates, accused nurses and other "nonphysicians" with doctoral degrees of misleading patients "to believe that they are receiving care from a doctor.[4]" The resolution states further that the AMA resolves to work with individual states to "identify and prosecute those individuals who misrepresent themselves as physicians to their patients.[4]"

Although the AMA resolution has no binding effect on individual state law, it does indicate intent to mount a campaign that challenges the abilities of nurses and other health professionals to claim the title "Doctor," even if a degree is earned and recognized by the public.

How Can I Approach This Question in My Professional Setting?

The first recommendation is to clearly understand what your state titling law, generally found in your state's Nurse Practice Act, requires that you must call yourself. Although all NPs are required to meet registered nurse (RN) licensing requirements, in Utah, the RN license is expired when the NP is granted. Check with your state Board of Nursing to determine whether the practice title in your state is "ARNP," "CRNP," or whether you should use a specialty title, such as "FNP." Professionally, this is the title that you must use on all materials that you present or hold out to the public. There may also be a requirement that "RN" is used for any nursing practice.

National certification titles, such as APRN-BC, CNM, or RNC, designate that a certification exam was passed, but these titles do not tell the public whether you currently hold a state professional license. Similarly, professional degrees, such as MSN or PhD, are earned titles that may be legally used in any setting, but do not by themselves tell the public clearly in what capacity you are licensed to practice. Using these titles in addition to your legal title of licensure may or may not be required when practicing in a clinical or academic setting.

The second recommendation is to begin working with other health professionals in your employment setting to implement nurse-positive language as advised by the Center for Nurse Advocacy. They rightly note that the way nurses refer to other professionals models language that is then adopted by patients and by the media. As the Center for Nurse Advocacy observes, "media, like most people, often use the term doctor to mean physician. Although this usage is deeply ingrained, it gives many people the impression that physicians are the only health care workers who can earn doctoral degrees.[5]"

Clearly, this is not the case, as more advanced practice nurses seek doctoral degrees for professional or clinical goals. Be ready for the discussion where you practice; understand and use your licensure title appropriately and assertively; and initiate nurse-positive language where you practice. The AACN has a document that reviews talking points in response to the AMA Resolution 211 that could be used in the workplace, or by your professional organization, to introduce the concept that doctorally prepared nurses are likely to be a strong presence in healthcare for many years to come.

In summary, you must always use your legal title of licensure in the state that you practice in your communications with the public. You may use your academic degree credentials in all settings, to indicate educational credentials. You can legally use the title "Doctor" in conjunction with the appropriate licensure title in the majority of states. In states where the legal statutory language is unclear, your professional organization on a state or national level should be contacted to initiate appropriate legislative or interpretive action, so that you may confidently use the title you worked diligently to earn.

References
1. American Association of Colleges of Nursing. Commission on collegiate education moves to consider for accreditation only practice doctorates with the DNP degree title. 2005. Available at: http://www.aacn.nche.edu/Media/NewsReleases/2005/CCNEDNP.htm Accessed July 22, 2007
2. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academies Press; 2003. Available at: http://www.nap.edu/catalog/10681.html Accessed July 22, 2007.
3. Pearson L. The Pearson Report. Am J Nurs Pract. 2007;11:2.
4. American Medical Association House of Delegates. Resolution 211 (A-06). June 13, 2006. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/471/211a06.doc Accessed July 22, 2007.
5. Center for Nurse Advocacy. Should we refer to physicians as "doctors"? Available at: http://www.nursingadvocacy.org/faq/nf/physician_vs_doctor.html Accessed July 22, 2007.

Nurse Faculty Preparation: Recommendations for the Future

Nurse Faculty Preparation: Recommendations for the Future

It is time for nursing education to recognize that a research doctorate without coursework preparing the graduate to function in academic environments is a real disservice to the student. As the DNP comes of age, it is important to include content that will prepare the graduate to be effective in teaching and evaluation as well as research and clinical practice.[3] Curricula currently available online seldom include nursing education courses. When they are available, it is often almost as an afterthought, an elective that can be taken when other coursework is reduced or less demanding.

PhD graduates who seek employment in institutions of higher learning should be required to complete basic coursework to prepare them for teaching and evaluating baccalaureate and master's degree students. NPs who are to participate in classroom and clinical teaching need similar preparation, which could be delivered in a series of online modules. This is just the beginning, as experienced mentors are needed to guide them in applying that knowledge as well.

When considering doctoral education, potential students who plan to pursue a teaching career or to teach and conduct research should review curricula to see whether they provide opportunities for didactic and practicum experiences. The minimum should include courses in curriculum, evaluation, and teaching strategies (approximately 9 hours of coursework). The addition of a residency or practicum with the availability of a master teacher would be desirable. Most PhD and some DNP programs already have these courses or they may be added as electives.

Our students deserve high-quality instruction that is based on sound educational principles, carefully crafted curricula, and valid measurement and evaluation. This preparation is essential rather than optional for potential faculty members.

Current Focus on Nurse Faculty Preparation

Current Focus on Nurse Faculty Preparation

The nursing faculty shortage and recurrent nursing shortages have renewed interest in promoting nursing education as a career. However, when new PhD faculty or master's-prepared NP faculty are recruited into nursing education, there are distinct problems. In a study of nursing doctoral (EdD, DNSc, and PhD) students, Hudacek and Carpenter[1] reported that PhD students "did not perceive the doctorate to be preparing them for roles as educators, practitioners, or administrators." These programs do not traditionally include curriculum development; evaluation or instructional design; preparation of lesson plans/teaching strategies; measurement and evaluation of student learning; or how to chair a committee, participate in a self-study for accreditation, or chair a faculty meeting.

For these reasons it seems misleading, if not unethical, to tell graduates of research-intensive PhD programs that they are prepared for a career in academia. NPs recruited for precepting and assisting with NP education are also unprepared for this role. Learning how to teach while also trying to develop a research program is an unnecessary barrier to junior faculty. Evaluating student learning without knowledge of appropriate evaluation methodology and strategies does not produce fair and valid decisions about student progress.

Ketefian and colleagues[2] considered international doctoral education in nursing. They pointed out that qualified nurses don't find academic careers attractive because of salary levels, the heavy faculty workload, and the "struggle to balance" career and family needs. They suggested that other roles of the faculty need to receive attention in doctoral education.

The Preparation of Nurse Faculty: Who Should Teach Students?

The Preparation of Nurse Faculty: Who Should Teach Students?

Jean B. Ivey, DSN, CRNP

History of Nursing Doctoral Education

The preferred level of preparation for nursing faculty is the doctoral level. Doctor of philosophy (PhD) programs predominate in nursing, and -- recently -- the doctor of nursing practice (DNP) has been supported for nurses who wish to focus on clinical practice, rather than research. What preparation do these programs provide for teaching undergraduate and graduate students? What qualifications should faculty possess? Is a recent graduate of a typical PhD program prepared to develop a curriculum, plan classroom and online classes, write exam questions, plan clinical practice experiences, and evaluate student performance?

A historical review of the development of doctoral education in nursing is beyond the scope of this article, but it is important to note that its foundations were in the education doctorate (EdD). This preparation route might not have fostered research into nursing phenomena and nursing issues, but it did prepare educators who could write curricula, develop effective teaching strategies, and evaluate student learning skillfully.

The development of doctoral programs in nursing then took divergent paths into the doctor of nursing (DNS), the doctor of nursing science (DNSc), the nursing doctor (ND), and the doctor of science in nursing (DSN). These degrees were said to be more clinically focused, hence more concerned with nursing issues and nursing practice. Curricula included nursing theory and strong research and statistics components. Later options to focus on clinical practice, administration, and education were added as role tracks.

The PhD was developed to prepare nurse researchers and nurse leaders needed by the profession. Statistics, research design, theory development, informatics, health policy, and outcomes measurement were emphasized. The addition of content on qualitative methods, consideration of the context of phenomena, and appropriate measures for these designs were significant in the development of nursing research. These programs were initially conceived as built on the foundation of a traditional master's degree program, which frequently included some "education" courses.

However, many master's degree programs converted rapidly from curricula that boasted several options into nurse practitioner (NP) programs. Both the administration and education options were downplayed, if not completely dropped, as the demand for NP programs increased. At the same time, administration and education majors were no longer emphasized and were seen as less essential to PhD students because of their research focus. NP programs were focused on clinical practice, with fewer hours and emphasis on theory and research.

Nurses are in a prime position to prevent pediatric medication errors

Nurses are in a prime position to prevent pediatric medication errors

Source: Contemporary Pediatrics Dateline
Originally published: September 1, 2005

The inability to calculate therapeutic dosages for children accounts for the majority of pediatric drug errors, according to Ronda G. Hughes, PhD, MHS, RN, and Elizabeth A. Edgerton, MD, MPH, of the Agency for Healthcare Research and Quality. But there are practical ways for nurses—who often have primary responsibility for ensuring patient safety in the hospital and are usually the providers who administer the medications—to reduce the likelihood of a mistake.

Most pediatric medication errors occur in the prescribing or ordering phase—usually dosing errors—followed by mistakes in administration of the drug, note Drs. Hughes and Edgerton in a recent article in the American Journal of Nursing. Because most medications are developed in concentrations for adults and do not include pediatric dosage guidelines, the correct dosage must be calculated according to the child's weight. The dosage must also take into account the child's prematurity status and particular disease or health.

Because of their immature physiology, children are more likely than adults to be harmed by medication error. Pediatric nurses are in a position both to catch mistakes before the drug is given and to avoid mistakes in administering the medication. How, specifically? Recommendations by Drs. Hughes and Edgerton include the following:
- Report medication errors—to understand how to avoid future mistakes
- Know the medication before administering it. Double-check drugs prescribed off label and be cautious when administering "high-alert" medications such as corticosteroids, antibiotics, and insulin
- Confirm patient information before administering medications. Check, for example, that the patient's most recent weight was used in calculating the dose.
- Double-check orders and collaborate with other clinicians to verify information, especially for illegible or verbal orders and discrepancies between standard drug protocols and the patient's order
- Minimize distractions during administration
- Communicate with parents and families and involve them in patient care, and educate them about medication administration when the child is discharged

Pay attention to patient positioning!

Pay attention to patient positioning!

Source: RN

By: Carla Millsaps, RN, BSN

Originally published: January 2, 2006

A patient undergoing abdominal surgery in a Louisiana hospital was placed on the operating table with his arms extended 45 degrees on armboards. The surgeon stood at the patient's right side throughout the hour-and-20-minute procedure. Postoperatively, the patient reported numbness and tingling in his right hand, which persisted well after his discharge from the hospital.

Eventually the patient was diagnosed with an ulnar nerve injury, with numbness and pain that didn't respond to physical therapy. The injury occurred in the OR, the patient alleged in a lawsuit; tests ruled out other causes.

After hearing expert testimony at the trial, the jury found for the plaintiff. The most likely scenario: The patient's arms weren't properly positioned, so the surgeon had to lean on the patient's right arm to perform the operation. The jury assigned fault to the anesthesiologist, the surgeon, and the nurse, as well, for failing to meet the standard of care.1,2

The positioning payoff, short- and long-term
This case, which was decided a decade ago, illustrates the importance of a nurse's role in helping to prepare patients for surgery. Whether you work in a traditional OR, an ambulatory surgery unit, or any other setting where procedures are performed, you'll need to help plan for and maintain proper patient positioning—which can prevent immediate problems as well as long-term pain and disability.3

Proper positioning ensures that the surgical team has ready access to the patient and a clear view of the surgical site. It reduces bleeding, mostly by avoiding venous congestion; minimizes cardiac and respiratory problems; and decreases the risk of pressure-related damage to the skin, nerves, joints, and muscles.4 Proper positioning techniques, used with supportive equipment and devices, contribute to patient safety, according to the Association of Perioperative Registered Nurses.5

Good positioning starts with an assessment
There are many factors to consider in planning how best to safeguard your patients. In addition to finding out what type of procedure is scheduled, how long it will last, and what type of anesthesia will be administered, you will need to determine whether any equipment that could affect positioning will be used—and to identify patients at high risk. Take note of the patient's age, height, and weight. Obese individuals face a greater likelihood of nerve and pressure point injuries, for example, and older people tend to have less flexibility and poorer peripheral circulation than their younger counterparts, making them more susceptible to injury.6

Bear in mind, though, that advanced age alone isn't necessarily an independent risk factor: A healthy 82-year-old may be less vulnerable than an overweight 35-year-old with diabetes.3

Be sure to assess nutritional status and examine the skin of all patients. Lesions, bruises, and dry skin can all contribute to impaired blood flow during surgery.6 Note any preexisting conditions, particularly those affecting the vascular, respiratory, circulatory, neurologic, or immune system. And look for signs of impaired mobility or any physical limitations, such as a bad back, prosthesis, or an implant.

Use your findings to help create a positioning plan well before the procedure, in accordance with your facility's policy and procedure manual, and if applicable, the surgical OR checklist. Share the information with the other clinicians to determine the best way to position the patient before, during, and after the procedure and to shift him from one position to another, as needed.3

There are four basic surgical positions: supine, prone, lateral, and lithotomy. (See the "How to avoid positioning injuries" at the end of the article for illustrations, risks, and safety considerations associated with each.)

Variations include Trendelenburg (patient is supine with head lower than feet), reverse Trendelenburg (patient is supine with head higher than feet), modified Fowler's (variation of reverse Trendelenburg; patient is sitting), and Kraske (variation of prone position; patient lies on his stomach in a jackknife, achieved by flexing the table at center break).7

The choice of position will depend on the type of procedure. But any of them can affect the major body systems, and, coupled with the effects of anesthesia, become a potential danger for patients in the following ways:

Respiratory

Some positions—including supine—can restrict movement of the rib cage or diaphragm and impede airflow, particularly with obese patients. Obese patients must be seated upright for the duration of most procedures because of increased abdominal pressure on the chest when they are supine.3,6

Circulatory

Lithotomy positions and the severe head-down positions used during some laparoscopic procedures may compromise blood flow to the lower extremities or venous blood return to the heart.3 Pressure or obstruction of a vessel can cause the greatest amount of damage to the cardiovascular system.7 This can be avoided by reducing the procedure time, if possible, or by moving limbs and massaging them at regular intervals during the procedure.

Skin

Friction and pressure on soft tissues, especially over bony prominences, may result in changes ranging from mild irritation to severe pressure-induced ischemia.3

Neurologic

Pressure or obstruction caused by faulty positioning is a common cause of nerve injury, as the case of the patient with ulnar nerve damage makes clear. Motor or sensory nerve damage can happen within minutes, and can have a long-term effect.7

Some positioning problems are particularly likely in specific patient groups: Men 40 – 70 years old who undergo abdominal or pelvic procedures have a higher risk of developing ulnar neuropathy, for example.3 Women over 60 have a greater risk of developing obturator and lateral femoral cutaneous neuropathies after procedures in which they remain in the lithotomy position, such as cystoscopies and other gynecologic outpatient procedures.3 Being aware of patients' particular risks will help you determine when—and where—to provide extra protection.

Complete article

The power of low-tech nursing

The power of low-tech nursing

Source: RN
By: Jennifer L.W. Fink, RN, BSN
Originally published: June 1, 2005

Emily looked up at me, her eyes filled with pain.

"I don't have much longer, do I?" she asked, her thin voice wavering.

I watched a single tear trace the deeply creased line of her cheek. I shook my head No. Emily had metastatic liver cancer, and the end was near.

"That's what I thought," she replied. Her entire body began to shake as silent sobs overtook her.
I reached out to touch her hand. She grasped it so tightly that my wedding ring dug into my flesh. Feeling her need, I asked, "Emily, can I hug you?" She nodded. I wrapped my arms around her, and she buried her head in my shoulder. Her thin arms clutched me tightly. As I held her, I felt her fear, pain, and suffering mix with my sense of frustration and helplessness. After several minutes, she asked for a tissue.

"Thank you," she said as she dabbed the corners of her eyes. "You don't know how much that meant to me."

In my 10 years as a med/surg nurse, I came to realize that many of the most important nursing skills are not learned in the classroom. The skills patients value most are not a superb nursing assessment or a flawless IV insertion technique (though they of course benefit from such skills). Instead, patients are most impressed by our care when we show them we're human, by listening to them, attending to them, and touching them. Twenty-first century healthcare may be a high-tech world, but sometimes a low-tech approach works best.

How "being there" helps patients What I call "low-tech nursing" actually means being there for your patients, physically and emotionally. It encompasses—among other things—touch and conversation.

Research has shown that touching patients has several benefits. One study found that patients whose hands were held during cataract surgery reported less anxiety and had lower blood epinephrine levels than those who underwent cataract surgery without hand-holding.1 Another study found that elderly female nursing home residents who received comforting touch—touch intended to reassure, calm, or encourage them—showed an improvement in their assessments of their self-esteem, well-being, health status, life satisfaction, and faith.2 Touch has also been found to positively affect patients' attitudes to ward their nurses.3

In addition, simply talking and listening helps. Patients often welcome the opportunity to express their worries and concerns.4 For some patients, a conversation with their nurse may be the only social interaction they have all day. Speaking with a patient—even about the weather—is a way of being there for him.

I once cared for an 80-year-old woman recovering from lower leg cellulitis. When I entered her room, she was alone and sitting in bed with her head down. I introduced myself and asked about her leg, her recovery, and her family. I looked at pictures of her newest grandchild. We talked for about 10 minutes. By then, her head was up and she was smiling. "You know, you're the best nurse I've had yet," she told me. I hadn't even touched her!

Overcoming barriers to low-tech care For some nurses, touching and talking to patients doesn't come naturally. They may hesitate to touch patients, particularly those of the opposite sex, for fear of being accused of inappropriate behavior. The threat of sexual harassment has led some institutions to implement policies that severely restrict how and when nurses can touch patients. In some cases, too, nurses may limit their personal interaction with patients out of concern for maintaining appropriate professional boundaries.

Another barrier to practicing low-tech nursing is a healthcare system that focuses on cure rather than comfort.4 And short-staffing, coupled with heavy workloads, leaves little time to connect with patients.

But connecting with patients is crucial and does not have to take a lot of time. One study found that nurses were able to increase nursing home residents' outlook on not just their health but life in general with only 10 minutes of touch a week.2

Complete article

Patient Safety: Medication Use and the Ageing Population

Patient Safety: Medication Use and the Ageing Population
World Health Professions Alliance Fact Sheet

Background: Medication Use in the Ageing Population

Worldwide, the proportion of people age 60 and over is growing faster than any other age group. Between 1970 and 2025, a growth in older populations of some 870 million or 380% is expected. This would lead to a total population of about 1.2 billion people over the age of 60 in the year 2025.

As the population ages, the demand rises for medications that are used to delay and treat chronic diseases, alleviate pain and improve quality of life. This increased use of a number of medications raises the risk that medicine-related problems will occur. A 1991 study concluded that adverse medicine-related illnesses in the elderly are significant causes of personal suffering and costly preventable hospital admissions.

In many parts of the world up to 80% of illness episodes are self-treated with modern pharmaceuticals. In developing countries it is confirmed that pharmaceuticals account for 60 to 90 % of out-of-pocket household spending on health, while pharmaceutical expenditure ranges between 25% and 65% of total public and private health expenditure. With the proper use of these medicines individuals can experience increased longevity and quality of life and in many cases illnesses can be treated or delayed without the need of more invasive procedures such as surgery. However due to the high consumption of medicines and self-treatment by all, especially the ageing population, the topic of proper medication use and safety is being brought to the forefront of public health discussions.

Patient Safety and Medication Use
In general, medicines are registered by government bodies to certify that they contain the active ingredients to ensure safety and hold a minimum standard of good quality. Serious concern about patient safety exists when the source and content of medicines are unknown and when medicines are distributed and sold without proper regulation (ie. medications sold in outdoor markets). The public health risk associated to the use of medicines of poor quality, or which contain little or none of the active ingredient/medicine or other ingredients, is high.

Apart from the safety of the medicinal product itself, adverse events or 'medication errors' that may lead to inappropriate medication use or patient harm can be related to many causes such as professional practice, procedures, and systems including prescribing; order communication; product labelling; packaging; compounding; dispensing; distribution; administration; education; monitoring; and use. Patient Safety is at risk when patients do not take medicines appropriately. Unclear instructions and unclear labelling of the medication, non-adherence when using medications for chronic conditions, as well as, taking non-prescription medicines or herbal products without the advice of a health professional may lead to serious adverse events. It is estimated that in the range of 50% of patients in developed countries, and less in developing countries continue to take chronic medications on a long-term basis. Patients taking various medications simultaneously can benefit from medication reviews held by health professionals to ensure that the prescribed and non-prescribed medicines offer the most optimal therapy for the individual.

Health Professionals and Medicines
Pharmacists, physicians and nurses are involved in patient medication use through dispensing, prescribing and administering medications. As health professionals they provide appropriate care and medicines, and act as sources of information and advice to patients.

To avoid complications, medicine use, contraindications, and potential adverse effects need to be discussed between patients and health professionals. This allows both the patient and health professionals to monitor the medical condition and to take appropriate actions if a medication error occurs. An open dialogue and regular communication between patients and health professionals is a positive means towards improving patient safety in medication use.

1 Need study details for Gurwitz and Avorn
- The International Council of Nurses (ICN) is a federation of more than 120 national nurses' associations representing the millions of nurses world-wide. Operated by nurses for nurses since 1899, ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally.
- The International Pharmaceutical Federation (FIP) is the world-wide federation of pharmacists and pharmaceutical scientists, with the mission of representing and serving pharmacy and pharmaceutical sciences around the globe. Founded in 1912, FIP promotes appropriate use of, and access to, medicines for all through achieving the highest standards in pharmaceutical science, professional practice, public health and patient care.
- The World Medical Association (WMA) is a global federation of national medical associations, representing the millions of physicians world-wide. Acting on behalf of physicians and patients, the WMA endeavours to achieve the highest possible standards of medical science, education, ethics and health care for all people.

For further information contact Linda Carrier-Walker
Tel : (+41 22) 908 0100 -
Fax : (+41 22) 908 0101
email: carrwalk@icn.ch
Web site www.whpa.org

Related Documents
FIP Guidelines for the Labels of Prescribed Medicines, FIP 2001, http://www.fip.org
ICN on Healthy Ageing: A Public Health and Nursing Challenge, ICN Fact Sheet, http://www.icn.ch
Nursing Care of the Older Person, ICN Position Statement, ICN 1998, http://www.icn.ch
World Medical Association Declaration on the Abuse of the Elderly, WMA September 1989, http://www.wma.net
_______________________
References
Adherence to Long-term Therapies: Policy for Action, World Health Organisation 2001, WHO/MNC/CCH/01.02
FIP Statement of Professional Standards: Medication Errors Associated with Prescribed Medication, FIP 1999, http://www.fip.org
FIP Statement of Policy on Counterfeit Medicines, FIP 1999, http://www.fip.org
Health and Ageing: A Discussion Paper, World Health Organisation 2001, WHO/NMH/HPS/01.1
Public Education in Rational Drug Use: a Global Survey, World Health Organisation 1997, WHO/DAP/97.5, http://www.who.int/medicines
WHO medicines strategy: Expanding access to essential drugs, Report by the Secretariat, 109th World Health Organisation Executive Board Meeting 2002, EB109/7

ICN/FS/02 #02May 2002

Patient Safety

Patient Safety
World Health Professions Alliance Fact Sheet

Press Release 29 April 2002 -
Health Professionals Call for Priority on Patient Safety

Background
Health care interventions are intended to benefit the public, but due to the complex combination of processes, technologies and human interactions there is an inevitable risk that adverse events will happen. Much evidence has been built on risks in hospitals, however information about adverse events occurring in healthcare settings such as physicians’ offices, nursing homes, pharmacies and patients’ homes are not very well documented. Identifying and reducing the occurrence of these errors and improving the safety and quality of health care has therefore been brought forward as a priority issue for health services around the world.

An adverse event can be defined as harm or injury caused by the management of a patient’s disease or condition by health care professionals rather than by the underlying disease or condition itself. Although human errors may sometimes precipitate serious failures, there are usually deeper, systemic factors, which if addressed earlier would have prevented the errors. Hence, the enhancement of patient safety involves a wide range of actions in the recruitment, training and retention of health care professionals, performance improvement, environmental safety and risk management, including infection control, safe use of medicines, equipment safety, safe clinical practice and safe environment of care.

There is a growing evidence that inadequate institutional staffing levels are correlated with increase in adverse events such as patient falls, bed sores, medication errors, nosocomial infections and readmission rates that can lead to longer hospital stays and increased hospital mortality rates. In short, inadequate human resources present a serious threat to the safety and quality of health care.

Some facts and figures about patient safety
- The 1995 Quality in Australian Health Care Study (QAHCS) found an adverse-event rate of 16.6% among hospital patients.
- The Hospitals for Europe’s Working Party on Quality Care in Hospitals estimated in 2000 that every tenth patient in hospitals in Europe suffers from preventable harm and adverse effects related to his or her care.
- 75% of the adverse drug events in a Utah-Colorado Study in the United States were attributable to system failures. Most adverse events were not the result of negligence or lack of training, but rather occurred because of latent causes within systems.
- In NHS Hospitals adverse events in which harm is caused to patients occur at a rate in excess of 850,000 a year.
- According to a survey conducted by the Robert Wood Johnson Foundation, 95% of doctors and 89% of nurses in the United States have witnessed a serious medical error.
- Poor quality healthcare is responsible for more than 30% of avoidable deaths in Italy.

The situation in developing countries
In developing countries the probability of adverse events is much higher than in industrialized nations due in part to the poor state of infrastructure and equipment, unreliable supply and quality of medicines, shortcomings in waste management and infection control, low number and poor performance of personnel because of low motivation or insufficient technical skills, and severe under financing of essential operating costs of health services.
- At least 50% of all medical equipment in most developing countries is unusable, or only partly usable, at any given time.
- In the Newly Independent States, about 40% of hospital beds are located in structures originally built for other purposes. As a result the correct infrastructure for radiation protection and infection control is very difficult to install.
- Approximately 77% of all reported cases of substandard and counterfeit drugs occur in developing countries.

Financial impact
Adverse health care events carry a high financial cost. About half of the expenditures for preventable errors are for direct health care costs.

The total national cost of preventable adverse health care events in the United States, including lost income, disability and medical expenses, is estimated at between US$17 000 million and US$ 29 000 million annually.

In the UK the NHS estimates that adverse events cost £2 billion a year in additional hospital stays alone.

Recommendations for action
1. Patients and the community
- Inform healthcare professionals of all your medicines taken and medical conditions.
- Ask questions to clarify information and increase understanding about health conditions, medicines and healthcare provision.
- Make sure to get the results of any test or procedure.
- Report errors or adverse events to the proper authorities.
2.Health Professionals
- Take an active role in assessing the safety and quality of care in practice.
- Improve communication with patients and other healthcare professionals.
- Inform patients of potential risks.
- Work to improve practice-related systems.
- Report adverse events to the appropriate authorities.
- Strengthen collaboration aspects of drug treatment plans.
3.Hospitals, clinics, general practice, drug distribution and other facilities
- Maintaining adequate human resource levels.
- Focus on improving the systems of delivering care, not blaming individuals.
- Establish rigorous infection control programmes.
- Standardise treatment policies and protocols to avoid confusion and reliance on memory, which is known to be fallible and responsible for many errors.
- Avoid similar-sounding and look-alike names and packages of medication.
4.Governments
- Establish national reporting systems to record, analyse and learn from adverse incidents.
- Promote a culture of reporting.
- Emphasise safety as a prime concern in health system performance and quality management.
- Implement mechanisms for ensuring that, where lessons are identified, the necessary changes are put into practice and progress is tracked.
- Develop evidence-based policies that will improve health care.
- Develop mechanisms, for example through accreditation and other means, to recognize the characteristics of health care providers that offer a benchmark for excellence in patient safety.

The International Council of Nurses (ICN) is a federation of more than 120 national nurses' associations representing the millions of nurses world-wide. Operated by nurses for nurses since 1899, ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally.

The International Pharmaceutical Federation (FIP) is the world-wide federation of pharmacists and pharmaceutical scientists, with the mission of representing and serving pharmacy and pharmaceutical sciences around the globe. Founded in 1912, FIP promotes appropriate use of, and access to, medicines for all through achieving the highest standards in pharmaceutical science, professional practice, public health and patient care.

The World Medical Association (WMA) is a global federation of national medical associations, representing the millions of physicians world-wide. Acting on behalf of physicians and patients, the WMA endeavours to achieve the highest possible standards of medical science, education, ethics and health care for all people.

For further information contact
Linda Carrier-Walker Tel : (+41 22) 908 0100 - Fax : (+41 22) 908 0101
email:carrwalk@icn.ch
Web site www.whpa.org

References
Quality of care: patient safety ,World Health Organization Executive Board EB109/9, 5 December 2001 http://www.who.int/gb/EB_WHA/PDF/EB109/eeb1099.pdf (accessed 22 April 2002)
Italy: Better Healthcare could cut deaths, Reuters Healthcare, January 18, 2002 citing study of The 2001 Prometeo Atlas of Italian Healthcare.
Health Care Professionals: backbone of quality and safety of care, Statement of the WHPA At the WHO Executive Board, 16 January 2001
An Organisation with a Memory, Report of the UK Department of Health, 2000 http://www.doh.gov.uk/orgmemreport/index.htm (accessed 22 April 2002)
Building a Safer NHS for Patients, Report of the UK Department of Health, April 2001 http://www.doh.gov.uk/buildsafenhs (accessed 22 April 2002)
Pursuing Perfection, Research conducted for the Robert Wood Johnson Foundation, March/April 2001. http://www.rwjf.org/news/releaseDetail.jsp?id=1017609851350&contentGroup=rwjfreleases (accessed 22 April 2002)
To Err is Human: Building a Safer Health System, Institute of Medicine. November 1999.
29 April 2002

Kursus Elektrokardiografi (EKG)

Kursus Elektrokardiografi (EKG)

10-11 Nov 2007, 8-9 Des 2007
Lokasi : Wisma Bidakara (Rs. Jantung Harapan Kita) Slipi
Jam : 08.00- 17.00 WIB
Biaya : Rp. 850.000,-

Dapat dibayarkan melalui : BUKOPIN Cab. FKUI No. Rek. 0601880494 a.n HANANTO. A, DR (CDC-FKUI)

Pendaftaran : Sekretariat CDC-FKUI
Gedung FKUI Lt. 2 Jl. Salemba Raya No. 6
Jakarta Pusat Telp/Fax (021) 3910408

Contact Person : Yani, 081317424420
E-mail : cdcfk@fk.ui.ac.id www.cdc.fk.ui.ac.id

Note : Pembayaran paling lambat 1 bulan sebelum hari H pelatihan, lewat dari tanggal tersebut tanpa konfirmasi ke sekretariat dianggap mengundurkan diri.

Pelatihan HIPERKES

Pelatihan HIPERKES

10-19 Desember 2007
Lokasi : Departemen Ilmu Kedokteran Komunitas FKUI

Biaya Rp. 1.600.000,-

Dapat Dibayarkan melalui : BUKOPIN Cab. FKUI No. Rek. 0601880494 A.n. Hananto.A, DR (CDC-FKUI)
Pendaftaran : Sekretariat CDC-FKUI Gedung FKUI Lt. 2 Jl. Salemba Raya No. 6 Telp/Fax (021) 3910408

Contact Person : Yani, 081317424420

Catatan : Pelatihan Hiperkes diselenggarakan selama 9 hari, Sabtu-Minggu libur

Kursus ACLS

Kursus ACLS

14-16 Des 07, 25-27 Jan 2008
Lokasi : Ibis Hotel, Slipi

Medical-CDC FKUI bekerja sama dengan PERKI JAYA (Perhimpunan Dokter Spesialis Kardiovaskular Indonesia) mengadakan ACLS (Advance Cardiology Life Support).

Pesertanya adalah Dokter umum maupun Dokter Spesialis, terbatas untuk 36 orang.
Pelatihan ACLS diadakan setiap hari Jum'at, Sabtu, dan Minggu mulai jam 07.30-18.00
Peserta yang ikut, akan mendapat sertifikat ACLS dan buku dari PERKI-Jaya

Biaya Rp. 2.200.000,-

Pendaftaran Bukopin Cabang FKUI
No Rek. 0601880494 a/n HANANTO A., DR (CDC-FKUI)

Pendaftaran langsung
Sdri. Yani Sekretariat CDC FKUI Gedung FKUI Lt. 2 Jl. Salemba Raya No 6 Jakpus.
Telp/Fax (021) 3910408
HP. 081317424420

Note : Pembayaran paling lambat satu bulan sebelum hari H pelatihan, lewat dari tanggal yang ditetapkan tanpa konfirmasi ke sekretariat dianggap mengundurkan diri.

Prevalence of Hand Dermatitis in Inpatient Nurses at a United States Hospital

Prevalence of Hand Dermatitis in Inpatient Nurses at a United States Hospital

Posted 10/19/2007
Heather P. Lampel; Nisha Patel; Kathryn Boyse; Sarah H. O'Brien; Matthew J. Zirwas

Abstract

Background: Hand dermatitis is a significant problem among inpatient nurses. Accurate population-based data on the prevalence and risk factors for hand dermatitis in this group are lacking.

Objective: To determine the prevalence of hand dermatitis in inpatient nurses at a US hospital.

Methods: Each nursing unit in a single hospital was visited twice by a single physician. All nurses working at the time of each visit were questioned and examined. No nurses were enrolled twice.

Results: Fifty-five percent (92 of 167) of the nurses had hand dermatitis. Among intensive care unit (ICU) nurses, the prevalence was 65% (35 of 54); among non-ICU nurses, the prevalence was 50% (57 of 113). In nurses with self-reported atopic dermatitis, the prevalence was 71% (12 of 17); in nurses without self-reported atopic dermatitis, it was 53% (80 of 150). Data collection on variables such as hand hygiene and glove use relied on subject recall and was considered unreliable. There was a low prevalence of atopic patients.Conclusions: Hand dermatitis affects over 50% of inpatient nurses. Hand dermatitis appears to be more common in the ICU setting and in nurses with a self-reported history of atopy.

Introduction
It is well known that hand hygiene is encouraged and even mandated in the health care profession in order to reduce the spread of nosocomial infections.[1-5] Hospital workers who provide direct patient care are encouraged to wash their hands frequently.[1] Hospitals offer both soap and water (SW) and alcohol-based cleansers (ABCs) for hand hygiene. Both SW and ABCs have been associated with hand dermatitis although it appears that the risk with ABCs is lower than with SW.[6]

The aim of this study was to determine the prevalence and risk factors for hand dermatitis in an unselected cross section of intensive care unit (ICU) and non-ICU inpatient hospital nurses at a US hospital. In reviewing the existing work on this topic, we performed literature searches with keywords and word combinations including both "hand dermatitis" and "nurses/nursing staff/hospital staff." Several studies in the United States used self-reporting or questionnaires,[7-11] some of which included physical measurements of epidermal characteristics.[12] This search revealed no studies in the United States that rely on direct standardized examination by a single physician. This method of data collection would be expected to provide a more accurate measure of the prevalence of hand dermatitis.[13]

Methods
Data were collected from January 2005 through May 2005 at a large academic hospital. Institutional review board approval was obtained prior to beginning the study. Each inpatient floor was visited twice by an occupational medicine physician; each visit occurred during a different nursing shift to maximize nurse participation. All nurses working at the time of each visit were asked to participate, and 98% (167 of 170) participated.

After verbal consent was obtained, each participant was surveyed in a standard manner. Survey questions regarding potential risk factors were derived primarily from the authors' experience ( Table 1 ). A visual examination of the hands was then recorded ( Table 2 ). Fissuring, blistering, erythema, and edema were noted on a scale of 0 to 5. A nurse was defined as having hand dermatitis if the investigator graded erythema as greater than or equal to 1 and graded scaling, fissuring, or both as greater than or equal to 1. These criteria were designed to differentiate simple xerosis (scaling and/or fissuring without erythema) and simple palmar erythema (due to hormonal or other causes) from true hand dermatitis. The prevalence of hand dermatitis in ICU versus non-ICU nurses and in nurses with and without self-reported histories of atopic dermatitis was compared with the chi-square test. Possible risk factors for hand dermatitis were analyzed with logistic regression.

(read more)