'Emergency nursing\r'

'Speaking more than or less the Emergency keep, we should mystify into account the role of the indispensability admit in the modern infirmary and to take into account the most widespread mistakes, d hotshot by the makes in the emergency department. Also, to analyze the causes of these mistakes.\r\nTo begin with, emergency halt is usu every(prenominal)(prenominal)y the first person, meeting the enduring in the hospital. Due to the triage ashes it is the nurse, who decide, according to the casing of the injury, to what kind of doctor the longanimous of should be sent. or sotimes nurses in the emergency department do count a role of the doctor as closely â€they nates prescribe or so kind of medicines and to go against them to the unhurried. The kind of mistake in this role digest be same(p) this:\r\n1.   Wrong diagnose.\r\n2.   Non â€well-organized work of the staff. As to the second bingle, here can be shown the contingency from one of the ho spitals, where the mistake was done according to the mis colloquy of two nurses.\r\nA 50-year-old man with sensitive atrial fibrillation was place on a diltiazem drip in the emergency department for score control. After arriving at the baitiac flush unit (CCU), he was none to be hypotensive and a saline response bolus was ordered. The nurse asked a coworker to get her a bag of saline and went to check on some some other longanimous. When she returned to the first patient’s bedside, she noticed that an intravenous (IV) bag was already hanging from the IV pole, and thought that her coworker must feature placed the saline bag at that place.\r\nBelieving the patient call for a rapid saline infusion, she exposed the IV up, and the solution inf utilize in rapidly. At that moment, her coworker arrived with the ergocalciferol cc saline bag, which caused the patient’s nurse to realize, in horror, that she had disposed the patient an IV bolus of more than 300 mg of diltiazem. The patient suffered severe bradycardia, which meetd temporary transvenous pacemaker placement and calcium infusion. Luckily, there was no permanent harm.\r\nThe commentary to this case was given by Mary Caldwell, RN, PhD, MBA, and Kathleen A. Dracup, RN, DNSc.\r\nThis case involve raises some(prenominal) troubling issues. A patient was given an unintended overdose of diltiazem during a hypotensive case due to a miscommunication involving two nurses. Intravenous diltiazem can cause bradycardia, hypotension, and reduced myocardial type O consumption, all serious side effects in an already unstable patient.Reported erroneous belief situates for the establishment phase of medicine procedures are significant, ranging from 26% to 36%.\r\nWith respect to intravenous medical specialty prepaproportionn and governance, the possibilities for error are magnified compared with oral agents. In one large study, the investigators reported an overall error rate of 49% f or intravenous medications, with 73% of those errors involving bolus injections. Providers are potential to encounter at least four complications particular proposition to intravenous dose administration.\r\nFirst, the do drugs can be infused too quickly or too slowly, foreign oral agents, which eat only one rate of administration.\r\nSecond, IV pumps used to control the rate of administration can fail to operate properly or can be set up falsely by a nurse.\r\nThird, preparation of the drug can lead to error, as when the drug is added to an incompatible solution or mixed using the wrong ratio of drug-to-IV solution.\r\nAnd finally, the medication can be given by dint of the wrong port, such as into the right atrium kind of than into a peripheral vein.\r\nIntuitively, one might blastoff that the critical safeguard environment would be the site of more medication- tie in errors than less acute units. In one study that compared intensive explosive charge unit (intensive aid unit) with non-ICU medication-related errors, pr traintable adverse drug events were twice as popular in ICUs as in non-ICUs. However, when these data were familiarised for the number of drugs used or ordered , there were no differences between the settings. The fact that the patient-to-nurse ratio in the ICU is usually less than or tally to 2:1, while a single nurse on a medical-surgical unit whitethorn be responsible for 5 to 10 patients, may excuse the risk of drug errors in the critical care setting.\r\nThe Institute for Safe Medication Practices cites the â€Å"five rights” of medication use (right patient, drug, time, dose, and route) as touchstones to aid in the measure of errors. In this case, following the five rights may have prevented the overdose. However, one must also recognize that many an(prenominal) performancees used to prevent errors are more laborious to design and implement in critical care units because of the rapidity with which nurses and phys icians must act.\r\nTherefore, the basics of safe drug administration practice take on even greater importance. Building in manual redundancies (such as verbal read-backs, quasi(prenominal) to those used when administering blood transfusions) may help when there are variances to standard protocol, such as an IV bolus. The last error level documented in IV bolus infusions provides important support for reviewing hospital policies related to their administration. System failures also contributed to the error in this case. \r\nIf the patient was unstable enough to require a 500 cc bolus of saline, why did the nurse leave the room to check on another patient? Was the staffing inadequate? Workforce issues have been an awful concern in recent historic period as nursing shortages reach crisis proportions. Nurses are stretched thin, and the shortage is matte most acutely among specialty nurses. The clinical dissemble of staffing shortages on growing mortality and ‘failure-to-r escue’ have been noted.\r\nA survey conducted by NurseWeek/A-ONE found that 65% of RNs felt the shortage impeded their ability to maintain patient safety. Although specific figures regarding the extent of shortages in critical care are not available, the American railroad tie of searing Care Nurses states that requests for registry and traveling nurses have increased substantially across the country, with a 45% increase for adult critical care, 50% for Pediatric/neonatal ICUs, and 140% for Emergency Departments.\r\nIn the past, most ICUs veritable only visualised nurses (with more than 2 days clinical post-graduate experience) as staff. However, this requirement of previous experience is often waived in times of staff shortages. Although parvenu graduates usually participate in hospital ICU training programs, the learning curves are steep and new nurses may become overwhelmed, leading to errors in communication and execution. A recent Food and Drug administration (FDA) report listed a number of human factors associated with medication errors.\r\nPerformance deficit (as opposed to knowledge deficit), such as seen in this case, was the human factor listed most ordinarily (30%). Poor communications contributed another 16% to total errors. Thus, this case illustrates a common reference work of errorâ€a problem of performance related to poor communication. This case study also provides an fortune to evaluate mistakes on the personal level. A serious, commonly identified shortcoming of the current medical system is the fear of disclosing errors.\r\nWhen errors occur, the responsible staff member should be an active participant in an evaluative process aimed at preventing similar errors from reoccurring. Results of the evaluation on an individual, unit, and hospital level should be shared with the entire hospital so that similar errors might be prevented in the future.\r\nThe tradition of morbidity and mortality conferences, used commonly by phys icians, has not been adopted by nursing staff and might be an appropriate scheme if it provided a blame-free environment in which mistakes and system level issues could be discussed openly. Specific measures to prevent errors in situations similar to this case might include:\r\nStandard indemnity typically dictates the use of IV pumps on all vasoactive drips. (Because it was not specifically noted in this case study, we are compelled to state the obvious.)\r\nStandard policy usually dictates that vasoactive drugs be infused through a site give to only that drug. Therefore, at least one other separate IV site should be used for other fluids and medications. This practice eliminates the need to use the high risk IV and the potential for an inadvertent overdose.\r\n much obvious labeling of ‘high risk’ IV drips (eg, bigger, brighter labels; iterate labeling on IV   bag, pump, monitor).\r\nIndependent double-checks of bolus fluids by nurses introductory to admini stration. Reevaluation of staffing requirements if a patient becomes unstable so that the patientâ€nurse ratio can be appropriately adjusted. Participation of nurses as well as physicians in morbidity and mortality conferences.\r\nSometimes the mistakes occur because of inadvertency of the nurse. By the way, the documents, fulfilled by the nurse, have to be readable and clear not only for the nurse herself, but for the other well-educated staff as well (I mean, the doctors, etc. ). The data’s have to be collected precisely and correctly. But permit’s have a look at one of the patients cards, taken from the Hospital. (Pict.1)\r\nThe information is just not readable, and it is rather difficult to understand, what were the results. This patient’s card look likes an album of the child, but not as a professionally made card of the qualified staff.  Speaking about this case of the 72 years old woman, it is possible to suggest, that the wrong diagnoses have b een done, what nearly lead to the death of the patient.\r\nAs to the medicines given, it is seen, that not all the medicines needed were given to the patient (at the age of 70 there have to be given some medicines for blood â€Heparin and as well some medicines for keeping the heart activity. In this case it looks like that on the base of the cough (probably pneumonia) there was a kind of heart attack (probably cardiac infarction) with the complications as pulmonary edema(or edema of lungs).\r\n1. Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE legal profession Study Group. JAMA. 1995;274:29-34. [ go to pubmed]2. Taxis K, Barber N. Ethnographic study of incidence and severity of intravenous drug errors. BMJ. 2003;326:684. 3. Cullen DJ, Sweitzer BJ, Bates DW, Burdick E, Edmondson A, Leape LL. preventable adverse drug events in hospitalized patients: a comparative study of intensive care and general care units. Crit Care Med. 1997;25:1289-1297. ]4. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288:1987-1993. 5. NurseWeek. NurseWeek/A-ONE National Survey of Registered Nurses: NurseWeek/A-ONE; 2002. ]6. critical Care Nursing Fact Sheet. American Association of Critical-Care Nurses. ]7. Phillips J, Beam S, Brinker A, et al. Retrospective analysis of mortalities associated with medication errors. Am J Health Syst Pharm. 2001;58:1835-1841.\r\n'