Clinical Notebook
Time Out for Patient Safety
For more than a decade, health care organizations have stepped up their efforts to promote patient safety. Nurses, as patient advocates, understand that critical communication and teamwork are key elements in moving toward a culture of patient safety.1,2 The value of sound communication is fundamental to the prevention of sentinel events.3 Yet, during critical situations, a nurse may not feel empowered to speak up when a patient is at imminent risk of harm.4 In an effort to improve communication, a standardized communication technique called “time out for patient safety” was developed to provide universally accepted critical language for these situations and empower nurses to assert themselves.Situation, Background, Assessment, and Recommendation (SBAR) May Benefit Individuals Who Frequent Emergency Departments: Adults With Sickle Cell Disease
Evidence-based research supports the use of situation, background, assessment, and recommendation (SBAR)—a collaborative communication strategy—to improve communication among health care providers.1-3 SBAR has been found to assist with structuring and standardizing communication and is considered an easy-to-remember technique that provides for consistent, structured communication between members of the health care team.4 However, there has been no published support for the usefulness of SBAR as a communication technique between health care providers and patients.The Use and Need for Standard Precautions and Transmission-Based Precautions in the Emergency Department
Protecting ourselves, colleagues, and patients from infection is paramount to delivering safe care. Implementing policies and practices in the emergency department that support current infection control methods to reduce or prevent the transmission of infecting agents is our professional responsibility. This article seeks to provide a review of standard precautions and transmission-based precautions along with a few common examples of patient presentations to the emergency department.Education and Culture: Mitigation for Workplace Violence
Workplace violence in the health care setting is 16 times greater than the general workplace.1 In Massachusetts, Norfolk County District Attorney William Keating has recorded the rate of assaults against health care workers as 4 times greater when compared with other industries.2 On June 3, 2010, The Joint Commission (TJC) released a sentinel event alert entitled “Preventing Violence in the Health Care Setting.”3 This TJC alert suggests that increased training and education be provided with regard to identifying potentially violent individuals, de-escalating anxious behaviors, and managing violence.Urgent Care of Neck Breathers
As an infectious diseases specialist for over 40 years, I also had extensive experience in emergency care. After being diagnosed with throat cancer 4 years ago, I had undergone laryngectomy, thus becoming a neck breather. I no longer breathe through my nose or mouth but through a stoma in my neck. Unfortunately, neck breathers are at a higher risk of receiving inadequate therapy when seeking urgent medical care.1,2 I experienced this myself when I needed such care because of shortness of breath at one of the local emergency departments.“I Want To See The Doctor”: Meeting Patients' Expectations in the Emergency Department
One of the primary reasons a patient presents to the emergency department is to see a doctor. Patients expect rapid or immediate treatment for their symptoms. Many think there is a doctor waiting to immediately see them and take care of them once they arrive at the emergency department. When this expectation is not met, patient satisfaction significantly decreases. Waiting to see the doctor promotes aggravation, anxiety, and stress to the patient and his or her family and friends. Waiting room times for emergency departments across the country are at the highest levels ever.“Stand Clear!” Tracing the Practice and Principles of Human Revival
In essence, people often stumble across discoveries of scientific significance during a caprice of Mother Nature, aided by our extraordinary drive forward in the quest for immortality. The moral fiber of human intuition impels us to preserve hopes and dreams by passing on the baton of knowledge gathered in our lifetime and by joining pieces of a jigsaw, assembling the means to continue our existence.Poison Control in the Emergency Department
There were 61 participating poison control centers in 2007 for the American Association of Poison Control Centers 2007 Annual Report of the National Poison Data System, with 2,482,041 human exposures reported. The health care setting calls to poison control throughout the United States accounted for over 15% of total call volume.1 Many of these calls were generated from the nation's emergency departments.Assessing Cranial Nerves With a Stick of Gum
Most nurses recall the class in anatomy and physiology when we learned the great common memory aid, “On Old Olympus Towering Tops A Finn And German Viewed Some Hops” in an effort to learn the names of the 12 cranial nerves. For many of us, that moment was one of the last times we gave cranial nerves any thought. However, with diagnoses such as head injury and stroke continuing to rank highly on the morbidity and mortality charts, the ability of an emergency nurse to identify and monitor symptoms of neurologic dysfunction has become ever more critical.The Crystal Chalice: Investigating the Source of Fiberoptic Science
Devices using the technology of fiberoptics, from the direct visual laryngoscope to the flexible endoscope, all share a common light source; nevertheless, throughout their daily use in clinical areas, to even consider excluding the knowledge of focused illumination would be unimaginable. Endoscopes for medical examinations were widely manufactured in Tuttlingen, Germany, by Karl Storz in the 1940s1; however, the more agile digital equipment together with a variety of synthetic materials only appeared within the past 20 years following the birth of fiberoptics—the vanguard in the dawn of robotic surgery.Stroke Scales You Can Use
Stroke is the third leading killer in the United States.1 Stroke is an emergency and has recently been an initiative for many quality teams, emergency departments, and public health education programs.2,3 The mantra “time is muscle” for myocardial infarctions has been adapted to “time is brain” for stroke. The crux of both of these ailments is tissue perfusion.Checking Hospital-acquired Infections at the ED Door: Are We Missing a Significant Opportunity?
A fundamental purpose of the nation’s hospital system is to provide places for the treatment of disease. As such, patient acquisition of disease while hospitalized presents a disturbing health care dilemma. Approximately 37 million Americans are hospitalized annually,1 over 15 million of whom arrive through emergency departments.2 Of those hospitalized, 1.7 million acquire an infection during their stay, 99,000 of whom die from those infections,3 resulting in a mortality rate that is double the annual number of deaths on all of our nation’s highways combined.On the Origin of Nursing and the Social Conflicts of Emergency Health Care
The divide between doctors and nurses has always raised the question as to the proficiency of who should perform emergency surgical procedures, especially during extreme circumstances. By examining our past, we can explore and understand how, when, and why medicinal practices were ruled and restricted. I am constantly reminded by natural acts of bravery in these troubled times by unskilled bystanders together with EMS providers who put their lives foremost in the face of a new world of terrorist violence.Triage, Diagnose, Treatment, and Disposition (‘2 TDs’)
When I am asked to talk about what the emergency department does, I say it is “2 TDs.” Breaking down complex concepts into an acronym occurs throughout science and health care (think E = mc2 or ABC). The other piece of explaining the emergency department in this manner is to relate it to popular terms, such as football terms; I believe “2 TDs (touchdowns)” works best. The 2 TDs are triage, diagnose, treatment, and disposition.The Increasing Geriatric Population and Overcrowding in the Emergency Department: One Hospital’s Approach
Next time you walk through your emergency department on a very busy day, stop for a moment and take in the bright lights, the sounds, and the smells. For the average adult patient anxiously awaiting test results, a ride to the radiology department, or a transfer to an inpatient bed, the ED atmosphere can be stressful. For a geriatric patient, the average ED activities can be frightening. Imagine a nurse educated for and dedicated to facilitating the care of geriatric ED patients. Someone who works with all team members to expedite care and reduce the length of the ED wait time, answers patient and family questions, and works with outside agencies and facilities.Safe Haven Laws
Recent national news has persecuted the state of Nebraska for its handling of the safe haven law to protect children from parent abandonment, neglect, and most horribly, infanticide. Emergency departments are the largest gateway for parents to use the safe haven laws. The need to understand the state’s laws and hospital’s policies is very important to emergency nurses, especially the triage nurse. This article will provide a brief recent history of the safe haven efforts, along with practical tips for emergency nurses being asked to implement the laws.Discharge Vital Signs: An Enhancement to ED Quality and Patient Outcomes
Hurried discharge of patients from emergency departments occurs at an overwhelming rate because teams are dedicated to reducing turnaround times and lessening overcrowding burdens. This practice, however, does not go without risk, because a growing body of evidence suggests that patients discharged from the emergency department with abnormal vital signs are at significantly greater risk for return to the emergency department, return with admission, or unexpected death.1,2 The response to this alarming trend necessitates re-evaluation of discharge processes in the ED setting.Development of a Certified Emergency Nurse Certification Initiative
Specialty certification has long been known as a contributor to positive patient outcomes. The American Association of Critical-Care Nurses has published substantial evidence to this effect.1 ENA has long championed the same belief. In 2006 the American College of Emergency Physicians adopted a policy statement that “supports the efforts of the Emergency Nurses Association (ENA) and the Board of Certification for Emergency Nursing (BCEN) regarding defining standards of emergency nursing care and the provision of resources, support, and incentives for emergency nurses to be able to readily attain Certified Emergency Nurses (CEN) certification.”2 Certification is a primary component of 1 of the 14 Forces of Magnetism.
