PARADIGM BYTES
Newsletter for Paradigm97
March 9, 2007
Our website...... http://paradigm97.blogspot.com
PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.
2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to
help survive them. We offer research results and other ideas to enrich the nursing experience.
Members, please take the time.to drop in to the AOL Paradigm97 chatroom which is
"manned" by GingerMyst for 45 min on Tuesday evenings: 9 pm EST, 8 pm CST, 7 pm MST,
Newsletter for Paradigm97
March 9, 2007
Our website...... http://paradigm97.blogspot.com
PARADIGM DEFINED:
1) an outstandingly clear or typical example or archetype.
2) a philosophical and theoretical framework of a scientific school or discipline within which theories, laws, and generalizations, and the experiments performed in support of them, are formulated.
MISSION STATEMENT
We believe that nurses need each other for support during the "lean and mean" days to
help survive them. We offer research results and other ideas to enrich the nursing experience.
Members, please take the time.to drop in to the AOL Paradigm97 chatroom which is
"manned" by GingerMyst for 45 min on Tuesday evenings: 9 pm EST, 8 pm CST, 7 pm MST,
6 pm PST (Please note that these are actially the same time)
The Paradigm97 chatroom is always there....door open, lights on, waiting for visitors
to come in. Check your Buddy List.....and invite your nursing friends in for a little chat
Let me know if you want others involved e.g. prospective new members.
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SNIPPETS
This snippet information is from JCAHO
The Paradigm97 chatroom is always there....door open, lights on, waiting for visitors
to come in. Check your Buddy List.....and invite your nursing friends in for a little chat
Let me know if you want others involved e.g. prospective new members.
~*~*~*~*~*~*~*~*~*~*~*~*~*~
SNIPPETS
This snippet information is from JCAHO
Tubing misconnections-a persistent and potentially deadly occurrence
Tubing and catheter misconnection errors are an important and under-reported problem in
Tubing and catheter misconnection errors are an important and under-reported problem in
health care organizations. In addition, these errors are often caught and corrected before
any injury to the patient occurs. Given the reality of and potential for life threatening
consequences, increased awareness and analysis of these errors-including averted errors-
consequences, increased awareness and analysis of these errors-including averted errors-
can lead to dramatic improvement in patient safety.
To date, nine cases involving tubing misconnections have been reported to the Joint
To date, nine cases involving tubing misconnections have been reported to the Joint
Commission's Sentinel Event Database. These resulted in eight deaths and one instance of permanent loss of function, and affected seven adults and two infants. Reports in the media
and to organizations such as ECRI, the Food and Drug Administration (FDA), the Institute for
Safe Medication Practices (ISMP), and United States Pharmacopeia (USP) indicate that misconnection errors occur with significant frequency and, in a number of instances, lead to
deadly consequences.
Types of misconnections
The types of tubes and catheters involved in the cases reported to the Joint Commission
Safe Medication Practices (ISMP), and United States Pharmacopeia (USP) indicate that misconnection errors occur with significant frequency and, in a number of instances, lead to
deadly consequences.
Types of misconnections
The types of tubes and catheters involved in the cases reported to the Joint Commission
included central intravenous catheters, peripheral intravenous catheters, nasogastric feeding
tubes, percutaneous enteric feeding tubes, peritoneal dialysis catheters, tracheostomy cuff
inflation tubes, and automatic blood pressure cuff insufflation tubes. The specific misconnections involved an enteric tube feeding into an intravenous catheter (4 cases); injection of barium
inflation tubes, and automatic blood pressure cuff insufflation tubes. The specific misconnections involved an enteric tube feeding into an intravenous catheter (4 cases); injection of barium
sulfate (GI contrast medium) into a central venous catheter (1 case); an enteric tube feeding
into a peritoneal dialysis catheter (1 case); a blood pressure insufflator tube connected to an intravenous catheter (2 cases); and injection of intravenous fluid into a tracheostomy cuff
inflation tube (1 case).
A review by USP of more than 300 cases reported to its databases found misconnection errors involving the following:
a.. Intravenous infusions connected to epidural lines, and epidural solutions (intended for epidural administration) connected to peripheral or central IV catheters.
b.. Bladder irrigation solutions using primary intravenous tubing connected as secondary infusions to peripheral or central IV catheters.
c.. Infusions intended for IV administration connected to an indwelling bladder (foley) catheter.
d.. Infusions intended for IV administration connected to nasogastric (NG) tubes.
e.. Intravenous solutions administered with blood administration sets, and blood products transfused with primary intravenous tubing.
f.. Primary intravenous solutions administered through various other functionally dissimilar catheters, such as external dialysis catheters, a ventriculostomy drain, an amnio-infusion catheter, and the distal port of a pulmonary artery catheter.
Many of the misconnection cases involved luer connectors-small devices used in the connection
of many medical components and accessories.
There are two types of luer connectors-slips and locks. A luer slip connector consist of a
inflation tube (1 case).
A review by USP of more than 300 cases reported to its databases found misconnection errors involving the following:
a.. Intravenous infusions connected to epidural lines, and epidural solutions (intended for epidural administration) connected to peripheral or central IV catheters.
b.. Bladder irrigation solutions using primary intravenous tubing connected as secondary infusions to peripheral or central IV catheters.
c.. Infusions intended for IV administration connected to an indwelling bladder (foley) catheter.
d.. Infusions intended for IV administration connected to nasogastric (NG) tubes.
e.. Intravenous solutions administered with blood administration sets, and blood products transfused with primary intravenous tubing.
f.. Primary intravenous solutions administered through various other functionally dissimilar catheters, such as external dialysis catheters, a ventriculostomy drain, an amnio-infusion catheter, and the distal port of a pulmonary artery catheter.
Many of the misconnection cases involved luer connectors-small devices used in the connection
of many medical components and accessories.
There are two types of luer connectors-slips and locks. A luer slip connector consist of a
tapered "male" fitting that slips into a wider "female" fitting to create a secure connection.
The luer lock connector has a threaded collar on the "male" fitting and a flange on the
"female" fitting that screw together to create a more secure connection. Examples of
"female" fitting that screw together to create a more secure connection. Examples of
misconnections involving luer connectorsinclude the following:
a.. Capnography sampling tube to an intravenous cannula.
b.. Enteral feeding set to a central venous catheter.
c.. Enteral feeding set to a hemodialysis line.
d.. Noninvasive blood pressure (NIBP) insufflation tube to a needleless IV port.
e.. Oxygen tubing to a needleless IV port.
f.. Sequential compression device (SCD) hose to needleless "piggy-back" port of an IV administration set.
Root causes identified:
The basic lesson from these cases is that if it can happen, it will happen. Luer connectors are implicated in or contribute to many of these errors because they enable functionally dissimilar
tubes or catheters to be connected. Other identified causes include the routine use of tubes or catheters for unintended purposes, such as using IV extension tubing for epidurals, irrigation,
drains, and central lines, or to extend enteric feeding tubes; and the positioning of functionally
dissimilar tubes used in patient care in close proximity to one another. In the cases reported to
the Sentinel Event Database, contributing factors included movement of the patient from one
a.. Capnography sampling tube to an intravenous cannula.
b.. Enteral feeding set to a central venous catheter.
c.. Enteral feeding set to a hemodialysis line.
d.. Noninvasive blood pressure (NIBP) insufflation tube to a needleless IV port.
e.. Oxygen tubing to a needleless IV port.
f.. Sequential compression device (SCD) hose to needleless "piggy-back" port of an IV administration set.
Root causes identified:
The basic lesson from these cases is that if it can happen, it will happen. Luer connectors are implicated in or contribute to many of these errors because they enable functionally dissimilar
tubes or catheters to be connected. Other identified causes include the routine use of tubes or catheters for unintended purposes, such as using IV extension tubing for epidurals, irrigation,
drains, and central lines, or to extend enteric feeding tubes; and the positioning of functionally
dissimilar tubes used in patient care in close proximity to one another. In the cases reported to
the Sentinel Event Database, contributing factors included movement of the patient from one
setting or service to another, and staff fatigue associated with working consecutive shifts.
Risk reduction strategies:
There are currently no published standards that specifically restrict the use of luer connectors to certain medical devices. Consequently, a broad range of medical devices, which have different functions and access the body through different routes, are often outfitted with luer
fittings that can be easily misconnected. Organizations in Europe and the U.S. are now
Risk reduction strategies:
There are currently no published standards that specifically restrict the use of luer connectors to certain medical devices. Consequently, a broad range of medical devices, which have different functions and access the body through different routes, are often outfitted with luer
fittings that can be easily misconnected. Organizations in Europe and the U.S. are now
developing standards to restrict the types of devices that use luer fittings in an attempt to mitigate misconnection hazards.
According to Jim Keller, vice president, Health Technology Evaluation and Safety for ECRI,
According to Jim Keller, vice president, Health Technology Evaluation and Safety for ECRI,
and Stephanie Joseph, project engineer for ECRI, the solution to reducing-even
eliminating-misconnection errors lies in both engineering controls respecting how products and devices are designed ("incompatibility by design"), and in re-engineering work practices.
"A well-designed device should prevent misconnections and should prompt the user to take
eliminating-misconnection errors lies in both engineering controls respecting how products and devices are designed ("incompatibility by design"), and in re-engineering work practices.
"A well-designed device should prevent misconnections and should prompt the user to take
the correct action," explains Joseph, author of a guidance article published in the March 2006
issue of ECRI's Health Devices journal. As a first step in prevention, Joseph urges hospitals
to avoid buying non-intravenous equipment (such as nebulizers, NIBP devices, and enteral
to avoid buying non-intravenous equipment (such as nebulizers, NIBP devices, and enteral
feeding sets) that can mate with the luer connectors on patient IV lines. In addition, Joseph emphasizes that the single most important work practice solution for clinicians is to trace
all lines back to their origin before connecting or disconnecting any devices or infusions.
Other solutions include specific education and training regarding this problem for all clinicians
all lines back to their origin before connecting or disconnecting any devices or infusions.
Other solutions include specific education and training regarding this problem for all clinicians
and having practitioners take simple precautions such as turning on the light in a darkened room
before connecting or reconnecting tubes or devices. The risk of waking a sleeping patient is
minimal by comparison. Errors have also occurred when patients or family members attempt
before connecting or reconnecting tubes or devices. The risk of waking a sleeping patient is
minimal by comparison. Errors have also occurred when patients or family members attempt
to disconnect and reconnect equipment themselves. Staff should emphasize to all patients the
importance of contacting a clinical staff member for assistance when there is an identified need
importance of contacting a clinical staff member for assistance when there is an identified need
to disconnect or reconnect devices.
Other approaches to reducing the risk of misconnections that have been identified also have significant potential for unintended consequences.
These include:
a.. Labeling all tubes and catheters-This may not always be practical and may therefore lead
Other approaches to reducing the risk of misconnections that have been identified also have significant potential for unintended consequences.
These include:
a.. Labeling all tubes and catheters-This may not always be practical and may therefore lead
to inconsistent implementation. However, the labeling of certain high-risk catheters (epidural, intrathecal, arterial) should always be done.
b.. Color-coding tubes and catheters-This can lead users to rely on the color coding rather
b.. Color-coding tubes and catheters-This can lead users to rely on the color coding rather
than assuring a clear understanding of which tubes and catheters are connected correctly to
which body inlets. In addition, the training and educating of all staff (including temporary
agency and travel staff) about the institution's color-coding system requires continuing attention. Finally, color-coding schemes often vary across institutions in the same community, creating increased risk when agency and travel staff are used.
agency and travel staff) about the institution's color-coding system requires continuing attention. Finally, color-coding schemes often vary across institutions in the same community, creating increased risk when agency and travel staff are used.
Joint Commission recommendations:
The Joint Commission offers the following recommendations and strategies to health care organizations to reduce tubing misconnection errors:
1.. Do not purchase non-intravenous equipment that is equipped with connectors that can physically mate with a female luer IV line connector.
2.. Conduct acceptance testing (for performance, safety and usability) and, as appropriate,
The Joint Commission offers the following recommendations and strategies to health care organizations to reduce tubing misconnection errors:
1.. Do not purchase non-intravenous equipment that is equipped with connectors that can physically mate with a female luer IV line connector.
2.. Conduct acceptance testing (for performance, safety and usability) and, as appropriate,
risk assessment (e.g., failure mode and effect analysis) on new tubing and catheter purchases to identify the potential for misconnections and take appropriate preventive measures.
3.. Always trace a tube or catheter from the patient to the point of origin before connecting any new device or infusion.
4.. Recheck connections and trace all patient tubes and catheters to their sources upon the patient's arrival to a new setting or service as part of the hand-off process. Standardize this
3.. Always trace a tube or catheter from the patient to the point of origin before connecting any new device or infusion.
4.. Recheck connections and trace all patient tubes and catheters to their sources upon the patient's arrival to a new setting or service as part of the hand-off process. Standardize this
"line reconciliation" process.
5.. Route tubes and catheters having different purposes in different, standardized directions
(e.g., IV lines routed toward the head; enteric lines toward the feet). This is especially important
in the care of neonates.
6.. Inform non-clinical staff, patients and their families that they must get help from clinical staff whenever there is a real or perceived need to connect or disconnect devices or infusions.
7.. For certain high-risk catheters (e.g., epidural, intrathecal, arterial), label the catheter and do
not use catheters that have injection ports.
8.. Never use a standard luer syringe for oral medications or enteric feedings.
9.. Emphasize the risk of tubing misconnections in orientation and training curricula.
10.. Identify and manage conditions and practices that may contribute to health care worker fatigue, and take appropriate action. In addition, the Joint Commission urges product
5.. Route tubes and catheters having different purposes in different, standardized directions
(e.g., IV lines routed toward the head; enteric lines toward the feet). This is especially important
in the care of neonates.
6.. Inform non-clinical staff, patients and their families that they must get help from clinical staff whenever there is a real or perceived need to connect or disconnect devices or infusions.
7.. For certain high-risk catheters (e.g., epidural, intrathecal, arterial), label the catheter and do
not use catheters that have injection ports.
8.. Never use a standard luer syringe for oral medications or enteric feedings.
9.. Emphasize the risk of tubing misconnections in orientation and training curricula.
10.. Identify and manage conditions and practices that may contribute to health care worker fatigue, and take appropriate action. In addition, the Joint Commission urges product
manufacturers to implement "designed incompatibility," as appropriate, to prevent dangerous
misconnections of tubes and catheters.
Resources
ISMP Medication Safety Alert, June 17, 2004, www.ismp.org/MSAarticles/tubingprint.htm
Nursing 2005, 35 (9), September 2005, pg. 73, by Melissa Eakle, R.N., MBA, MSN; Beverly Albrecht Gallauresi, R.N., B.S., MPH; and AudreyMorrison, R.N.
FDA Patient Safety News, Show #31, September 2004; Show #20, October 2003; Show
misconnections of tubes and catheters.
Resources
ISMP Medication Safety Alert, June 17, 2004, www.ismp.org/MSAarticles/tubingprint.htm
Nursing 2005, 35 (9), September 2005, pg. 73, by Melissa Eakle, R.N., MBA, MSN; Beverly Albrecht Gallauresi, R.N., B.S., MPH; and AudreyMorrison, R.N.
FDA Patient Safety News, Show #31, September 2004; Show #20, October 2003; Show
#46, December 2005
"Fatal Air Embolism Caused by the Misconnection of a Medical Device Hoses to Needleless
"Fatal Air Embolism Caused by the Misconnection of a Medical Device Hoses to Needleless
Luer Ports on IV Administration Sets" [hazard report], ECRI, Health Devices, June 2004;
33(6):223-5
"Misconnected Flowmeter Leads to Two Deaths" [special report], ECRI, Health Devices
"Misconnected Flowmeter Leads to Two Deaths" [special report], ECRI, Health Devices
Alerts, January 25, 2003
"Preventing Misconnections of Lines and Cables," ECRI, Health Devices,
March 2006; 35(3):81-95
"Safe Systems, Safe Patients: Common Connectors Pose a Threat to Safe Practice."
"Preventing Misconnections of Lines and Cables," ECRI, Health Devices,
March 2006; 35(3):81-95
"Safe Systems, Safe Patients: Common Connectors Pose a Threat to Safe Practice."
Texas Board of Nursing Bulletin, 37(2):6-7, April 2006
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MEDICAL NEWS
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MEDICAL NEWS
FDA Panel Okays Sanofi's Bird Flu Vaccine
Among fourteen FDA-commissioned outside panelists, thirteen voted today to recommend
that the agency approve a bird flu vaccine made by Sanofi-Aventis as an interim vaccine to
get the U.S. ready for unforeseeable pandemic bird flu worldwide.
The majority of the experts mostly on infectious disease and vaccines agreed that the vaccine
The majority of the experts mostly on infectious disease and vaccines agreed that the vaccine
may not be potent enough to have a protective effect against the H5N1 virus. But FDA officials
said that the protective response is real. In any case, the FDA stressed that this is an interim vaccine, suggesting that better future vaccines can replace the vaccine.
In a small bird flu vaccine trial of a couple of hundreds of people,only 45 percent of participants developed protective immune response after receiving a dose that was ten times higher than
In a small bird flu vaccine trial of a couple of hundreds of people,only 45 percent of participants developed protective immune response after receiving a dose that was ten times higher than
that of a seasonal flu vaccine, which in comparison yields a response in at least
75 percent of the vaccine recipients.
http://foodconsumer.org/7777/8888/Non-f_ood_Things_27/022704272007_FDA_panel_okays_Sanofi_s_bird_flu_vaccine.shtml
75 percent of the vaccine recipients.
http://foodconsumer.org/7777/8888/Non-f_ood_Things_27/022704272007_FDA_panel_okays_Sanofi_s_bird_flu_vaccine.shtml
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FROM THE MEMBERS
Best Doctors Associate Clinical Director-Boston (can work remotely from anywhere)
Best Doctors is a private, fast-growing company providing cutting- edge solutions to fragmented care and escalating healthcare costs. Our core business is connecting patients
with the best medical care. Best Doctors was founded in 1989 by physicians affiliated with the
renowned Harvard Medical School and currently serves over 10 million people in 30 countries. With relationships with over 50,000 doctors identified as the best in their specialties by their peers, Best Doctors represents an unparalleled resource. We are a unique combination of medical experience, skill and insight that our clients - employers, insurers and reinsurers -
can access to help them manage complex medical problems confidently. This dynamic team-oriented environment is ideal for a candidate who enjoys clinical challenges
without direct hands-on care and can bring creativity and flexibility to communicating with health professionals.
The Associate Clinical Director is responsible for obtaining information on patients with catastrophic and/or serious injuries, facilitating medical review/analysis, developing/implementing plan of care and coordinating/communicating with all stakeholders including but not limited to: insurer, field case manager, patient, treating physician, the Best Doctors' medical team and experts, etc. The ideal candidate possesses clinical strengths, organizational and leadership skills, and experience in the workers' compensation system.
Other requirements include but are not limited to:
BACKGROUND REQUIREMENTS AND SKILLS:
BSN required, MSN preferred
Certification in Case Management (CCM); additional certification (CRRN, CLCP, CDMS, etc.) desirable
Solid direct care experience, preferably in critical care, emergency medicine, and/or rehabilitation, with strong clinical knowledge and skills
Proven excellent verbal and written communication ability, experience in editing technical material a plus
Superior organizational, analytical/problem-solving, research, and interpersonal skills
Self-starter who is also an effective team player
Persuasive style and personality with ability to communicate with patients and physicians
Patient and customer focus, with commitment to improving treatments and outcomes for patients
Facility with multiple forms of electronic communication
Ability to use Word, email, Internet search, etc.
Minimal travel
Please forward your cover letter and resume to me at whowland@bestdoctors.com
Wendie A Howland RN MN CRRN CCM
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INTERESTING READING
Please remember that the REUTERS' articles are good for 30 days only
Important information for all of us......from Laregis (Laura) @aol.com THANK YOU !
In case you haven't heard... Daylight Saving Time (DST) Changes Starting spring, 2007, the start and end dates for daylight-saving time will change in the United States . This change is part of the United States Energy Policy Act of 2005.
try this web site for clarification. time change 2nd Sunday in March and 1st Sunday in November NeoTicker Blog » Daylight Saving Time Schedule Change
try this web site for clarification. time change 2nd Sunday in March and 1st Sunday in November
Daylight saving time in United States and part of Canada will change to a new schedule this year. The implication of this schedule change can affect traders ...Would have been: April 1, 2007 Will now be: March 11, 2007 Would have been: October 28, 2007 Will now be: November 4, 2007
Note: DST is NOT observed in Hawaii, American Samoa, Guam, PuertoRico, the Virgin Islands, nor Arizona .
Daylight Saving Time and Computer Glitches Some people may forget to change their clocks for daylight saving time. But computers and other gadgets are usually programmed to change automatically. But this year, you could run into some hiccups. Why? Daylight saving time starts three weeks earlier and ends a week later. Programs that adjust automatically for daylight saving time may need patches. So start planning, especially if you own a business. Vista (tm) won't require a patch, although XP will. Microsoft plans to make the patch available in early March. For other programs and gadgets, check the manufacturers (tm) sites.
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This is from Kurt Ullman....... check out all his articles including this one on the following website.
Proper adherence to medication regimens is an important yet frequently overlooked aspect of treatment for many diseases. A recent article by P. Michael Ho and colleagues found that more than one in five patients were not taking their medications for diabetes properly. Nonadherence was associated with higher glycated hemoglobin (A1C), blood pressure, and LDL cholesterol levels. In addition, every 25% increase in medication adherence was associated with reductions in these three measures.1
"Adherence is when the patient is taking the medication in a way that is both beneficial and agreed to by both the patient and the prescriber," says Jill Crandall, MD, associate professor of clinical medicine at Albert Einstein College of Medicine in Bronx, New York. "I define it this way because often the process is more one-sided, with the physician making a decision and then considering it poor adherence when the patient doesn't do exactly what the physician said. I think we need to take this discussion out of the context of unilateral decision-making and make it more of an agreement between the two." http://docnews.diabetesjournals.org/cgi/content/full/4/3/8?ct
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Here's a formula for sensational skin: You heard right. When eaten, flavanol-rich cocoa, the main ingredient in dark chocolate, improvesskin's texture, thickness, hydration, and blood flow. It may even boostyour skin's defense against the sun by up to 25 percent! How? It packs serious antioxidant power. Just don't overdo it -- chocolate is high in fat and calories, too. And you still need to wear sunscreen every day..Chocolate's good for your skin? It's true! Antioxidant compounds incocoa, called flavanols, improve artery health by boosting blood flow,and that boost may be good for your skin, too.Researchers discovered this chocolate benefit in a study of women whoconsumed half a cup of cocoa (containing 329 milligrams of flavanolsper serving, the amount in a 3-½ ounce serving of dark chocolate) dailyfor 12 weeks. At the end of the study, the women experienced less skindryness, scaling, and roughness compared to the beginning of the study.Also, their skin was thicker, exhibited improved blood flow, and waseven more resistant to sun damage. Pretty amazing.Still, don't toss your sunscreen and indulge in mass quantities ofchocolate. Consume the sweet in moderation and apply sunscreen everyday when you'll be outdoors for 20 minutes or more. For more skin tips,take the RealAge Skin Care Assessment for personalized advice andrecommendations. Reference: Long-term ingestion of high flavanol cocoaprovides photoprotection against UV-induced erythema and improves skincondition in women. Heinrich, U., Neukam, K., Tronnier, H., Sies, H.,Stahl, W., Journal of Nutrition 2006 Jun;136(6):1565-1569.
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What's better than climbing 150 stairs or taking 997 steps? Watching the time. The best way to measure your walking workout is with a watch.The time you take to walk -- at least 30 minutes each day -- is much more important than how many miles, steps, or blocks you've walked.That's because monitoring time is convenient and can be measured anywhere, and you're less likely to under- or overdo it. Using a watch to measure your walking progress can help keep you from cheating. Thatis, if you measure by some other means -- distance, for example -- and have a lot of time on your hands, you may opt for a slower pace. If you walk for at least 30 minutes a day, you may find yourself getting farther and farther in that amount of time, and that feels like progress. So just put 30 minutes of walking on your schedule, and thendo it at a pace that feels good. Can't do it all in one stretch? Get a watch with a cumulative stopwatch function, and keep track throughout the day until you patch together at least 30 minutes. Reference: The RealAge Workout: Maximum Health, Minimum Work. Roizen,M. F., Hafen, T., New York: Harper -Collins, 2006.
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Patient elopement is the patient's departure without permission beyond the facility, which places the patient at risk of injury or death.Those at risk for elopement include patients with dementia, youngpatients with persistent mental illness, individuals with a familyhistory of abuse, those exhibiting or having a history of violentbehavior, and those who have been involuntarily hospitalized.A comprehensive initial assessment by qualified professionals canidentify problems that could lead to elopement due to an individual'sbehavioral disorder, cognitive impairment, fear, poor judgment, or lackof insight. Because of these problems, the individual is at greaterrisk of harm if he or she leaves the facility's protective environment. http://www.doody.com/s8.asp?ID=1013-88139-JRM39455
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It should come as little surprise that Social Security numbers are posted on the Internet. But, says Betty Ostergren, a former insuranceclaims supervisor in suburban Richmond, Va., who has spent years trolling for them, "people are always astounded" to learn that theirs is one of them. Mrs. Ostergren, 57, has made a name for herself as a gadfly as she took on a lonely and sometimes frustrating mission to draw attention to the situation. With addresses, dates of birth and maiden names often associated with Social Security numbers, she said, they are a gift to data thieves. But in the last few weeks, Mrs. Ostergren's Web site, The VirginiaWatchdog - with the help of lobbying from an unexpected ally, America's farm bureaus - is having an effect. One by one, states and counties have started removing images of documents that contain Social Security numbers, or they are blocking out the numbers. Four states, including New York, have removed links to images of public documents containing SSNs.
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An online report card is scheduled to be unveiled today in an ambitious attempt to compare more than 200 California hospitals on more than 50 quality measures ranging from maternity care to cardiac treatment and patient satisfaction. While a dizzying array of hospital report cards already exists, the developers of the Web site CalHospitalCompare.org (www.calhospitalcompare.org) say it's the most comprehensive site
for people to use when making decisions about where to receive health services.
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/06/BUG9DOFRLF1.DTL
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FRIDAY, Feb. 23 (HealthDay News) -- About one in three American adults is trying to lose weight at any given time, and while their track record for trying is good, their track record for succeeding is not.Within five years, most dieters will regain the weight they lost. And,after five years, they may even weigh more than when they started theoriginal weight-loss effort, some studies have found.
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022301611.html
http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022301611.html
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Eye Movements May help Diagnose Fetal Alcohol D/Os.
Friday, February 23, 2007; 12:00 AM FRIDAY, Feb. 23 (Health Day News) -- A simple test may be able to diagnose children with fetal alcohol spectrum disorders, Canadian researchers say.Fetal alcohol spectrum disorders (FASD) are a wide array of adverse developmental outcomes in children caused by prenatal alcohol exposure.FASD is more widespread and less severe than fetal alcohol syndrome, but FASD is harder to diagnose because of a lack of objective diagnostic tools. In a study published in the March issue ofAlcoholism: Clinical & Experimental Research, James Reynolds and Doug Munoz of Queen'sUniversity in Kingston, Ontario, collaborated with colleagues to find out if eye movement, oroculomotor, tasks could be used to assess FASD in children. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022300587.html
Friday, February 23, 2007; 12:00 AM FRIDAY, Feb. 23 (Health Day News) -- A simple test may be able to diagnose children with fetal alcohol spectrum disorders, Canadian researchers say.Fetal alcohol spectrum disorders (FASD) are a wide array of adverse developmental outcomes in children caused by prenatal alcohol exposure.FASD is more widespread and less severe than fetal alcohol syndrome, but FASD is harder to diagnose because of a lack of objective diagnostic tools. In a study published in the March issue ofAlcoholism: Clinical & Experimental Research, James Reynolds and Doug Munoz of Queen'sUniversity in Kingston, Ontario, collaborated with colleagues to find out if eye movement, oroculomotor, tasks could be used to assess FASD in children. http://www.washingtonpost.com/wp-dyn/content/article/2007/02/23/AR2007022300587.html
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Geriatric Populations and Patient Safety The elderly are a high-risk group in any
setting because of their potentially numerous physical limitations. Poor eyesight and coordination, as well as a lack of muscle strength and dizziness causedby multiple medications and/or medical conditions, make falls a common area of concern for this population. Patients who always need help with ambulation should have call buttons within easy reach. Staff must also be available to monitor these patients and provide assistance in atimely fashion. Patients who can walk on their own still need an environment that reduces the risks of falls. Areas should be well lit,and the path from the patient's bed to the bathroom should be free ofequipment and furniture.
setting because of their potentially numerous physical limitations. Poor eyesight and coordination, as well as a lack of muscle strength and dizziness causedby multiple medications and/or medical conditions, make falls a common area of concern for this population. Patients who always need help with ambulation should have call buttons within easy reach. Staff must also be available to monitor these patients and provide assistance in atimely fashion. Patients who can walk on their own still need an environment that reduces the risks of falls. Areas should be well lit,and the path from the patient's bed to the bathroom should be free ofequipment and furniture.
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Don't play favorites with this pair. Invite them both to your supplement party. When calcium and vitamin D get together, their powers multiply. Not only do they help build your bones and boost your immunesystem function, but, according to new research, they also help ward off type 2 diabetes. Research shows you'll be a whopping 33 percent less likely to develop the condition if you get at least 1,200 milligrams (mg) of calcium and 800 international units (IU) of vitamin D per day compared to an intake of only 600 mg of calcium and less than 400 IU of vitamin D daily. Although it's best to get many nutrients from food, the study showed that getting vitamin D and calcium from supplements -- not dietary sources -- was associated with a lower diabetes risk. It's difficult to get enough vitamin D and calcium from food, anyway -- especially vitamin D -- so make sure your supplement includes both. It's particularly important during the shorter winterdays when you may get little sunlight, which helps your body manufacture vitamin D.The RealAge Optimum (RAO) dose of vitamin D is 400 IU per day forpeople under age 70 and 600 IU per day for people over age 70. But the upper intake level is 2,000 IU -- meaning anything up to that level is generally considered safe. References: Vitamin D and calcium intake in relation to type 2 diabetes in women. Pittas, A. G., Dawson-Hughes,B., Li, T., Van Dam, R. M., Willett, W. C., Manson, J. E., Hu, F. B.,Diabetes Care 2006 Mar;29(3):650-656.
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Imagine this: You're on a beach, with a cold drink in one hand and the latest best-selling novel in the other.The salty beach breeze kisses your face while the ocean tickles your toes.
You hear gulls talking, waves crashing, and the steel-drum band jamming. Feel like paradise? Great. That quick mental picture just improved your brain function. Keep your brain flexible
by setting aside time each day to daydream about whatever you like. Daydreaming keeps your mind flexible. By stirring up the part of your brain that handles imagination, you keep your brain running outside of its normal thought process, which helps your cognitive function at the highest levels.Consider daydreaming an important part of your mental-health action plan.
References: YOU: The Owner's Manual. Roizen, M. F., Oz, M. C., NewYork: HarperCollins, 2005.
You hear gulls talking, waves crashing, and the steel-drum band jamming. Feel like paradise? Great. That quick mental picture just improved your brain function. Keep your brain flexible
by setting aside time each day to daydream about whatever you like. Daydreaming keeps your mind flexible. By stirring up the part of your brain that handles imagination, you keep your brain running outside of its normal thought process, which helps your cognitive function at the highest levels.Consider daydreaming an important part of your mental-health action plan.
References: YOU: The Owner's Manual. Roizen, M. F., Oz, M. C., NewYork: HarperCollins, 2005.
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This is also a CME/CE article....for Nurses : 0.3 hrs November 20, 2006 - The target calcium intake for most postmenopausal women is 1200 mg/day, according to the North American Menopause Society's (NAMS) updated position statement reported in the November issue of Menopause. The new guidelines update an earlier consensus opinion published by NAMS in 2001."Calcium, an essential nutrient for the human body, has received substantial attention in both the medical literature and lay press regarding its role in osteoporosis and several other chronic diseases,"write Robert P. Heaney, MD, of Creighton University in Omaha, Nebraska,
and colleagues. "In response to the need to define standards of clinical practice in North America as they relate to menopause-associated health conditions, The North American Menopause Society (NAMS) has updated this evidence-based position statement. The objective of this position statement is to provide guidance on the roleof calcium in peri- and postmenopausal women to health professionals caring for this population.
http://www.medscape.com/viewarticle/548054?src=mp
and colleagues. "In response to the need to define standards of clinical practice in North America as they relate to menopause-associated health conditions, The North American Menopause Society (NAMS) has updated this evidence-based position statement. The objective of this position statement is to provide guidance on the roleof calcium in peri- and postmenopausal women to health professionals caring for this population.
http://www.medscape.com/viewarticle/548054?src=mp
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Here's a quick, easy, and inexpensive way to send your vitamin levels soaring. Hang out at a salad bar. Seems regular salad eaters have higher blood levels of lycopene, alpha and beta carotene, folate, and vitamins C, E,and B6 than people who shun "rabbit food." So step right up to the salad bar and get your fill of these cancer fighters, bone builders,and stroke stoppers. Here's to the green buffet! Although public-health campaigns have increased the average number of fruits and vegetables Americans eat daily, new research shows that more than half of us still aren't reaching the 5-A-Day goal set by the National Cancer Institute. And that means even fewer people are getting the daily four servings of fruit and five of veggies that RealAge recommends for optimum health, youth, and wellness.If at least one salad isn't already on your daily menu, add it now. Two cups of fresh veggies a day will significantly boost your chances of meeting the recommendations for vitamins A, E, B6, and folate -- which can make a big difference in your health. References: Salad and raw vegetable consumption and nutritional status in the adult USpopulation: results from the Third National Health and Nutrition Examination Survey. Su, L. J., Arab, L., Journal of the AmericanDietetic Association 2006 Sep;106(9):1394-1404.
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In a growing number of small and large hospitals across the country, including ones in Florida and North Carolina, nurses involved in a results-driven rounding protocol are finding their shifts less stressful, their time more productive, and patient safety and satisfaction scores at all-time highs.The new interest in rounding comes after research results from 27 nursing units in 14 hospitals showed that a consistent strategy of checking on patient needs effectively reduces monthly call light use by 38%, patient falls by 50%, and cases of skin breakdown 14%, while satisfaction scores move upward."The response has been amazing," says Christine Meade, executivedirector/chief researcher of the Studer Group's Alliance for HealthCare Research,
Gulf Breeze. "Nurses know rounding works, especially those who have been practicing for 20 years. But nobody's ever done a study to prove it."Meade says she gets about 10 e-mails a
day about the research results and is part of a team of coaches who present the rounding protocol to hospital units, including several in the southeastern states. An interactive training video toolkit is also available for $1,495 that shows study data and demonstrates how recommended behaviors and actions by nurses on hourly rounds can improve efficiency and satisfaction rates and give nurses more free time.
http://www2.nurseweek.com/Articles/article.cfm?AID=24895
Gulf Breeze. "Nurses know rounding works, especially those who have been practicing for 20 years. But nobody's ever done a study to prove it."Meade says she gets about 10 e-mails a
day about the research results and is part of a team of coaches who present the rounding protocol to hospital units, including several in the southeastern states. An interactive training video toolkit is also available for $1,495 that shows study data and demonstrates how recommended behaviors and actions by nurses on hourly rounds can improve efficiency and satisfaction rates and give nurses more free time.
http://www2.nurseweek.com/Articles/article.cfm?AID=24895
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Agitation in the Elderly Psychiatric Times - New York,NY,USA Consensus statement of
the American Association for GeriatricPsychiatry, the Alzheimer's Association and the
American Geriatrics Society. ...
http://www.psychiatrictimes.com/showArticle.jhtml?articleID=192300161
the American Association for GeriatricPsychiatry, the Alzheimer's Association and the
American Geriatrics Society. ...
http://www.psychiatrictimes.com/showArticle.jhtml?articleID=192300161
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Bradenton Herald, Sat, 17 Feb 2007 0:14 AM PST Nasty Noroviruses get jump on flu
The flu may be getting a late start this year, but we haven't escaped virus-induced misery. Noroviruses, which cause gastrointestinal illness, appear to be more widespread and severe
than usual this winter, federal health officials say.
http://www.bradenton.com/mld/bradenton/living/health/16705799.htm?source=rss&channel=bradenton_health
The flu may be getting a late start this year, but we haven't escaped virus-induced misery. Noroviruses, which cause gastrointestinal illness, appear to be more widespread and severe
than usual this winter, federal health officials say.
http://www.bradenton.com/mld/bradenton/living/health/16705799.htm?source=rss&channel=bradenton_health
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Under development by Sanofi-Aventis, Acomplia (rimonabant) is a selective CB1 endocannabinoid receptor antagonist indicated for the treatment of obesity. It works by blocking endogenous cannabinoid binding to neuronal CB1receptors. Activation of these receptors by endoegenous cannabinoids,such as anadamide, increases appetite. It is the most advanced endocannabinoid receptor antagonist in clinical development and offers a novel therapeutic approach to appetite control and weight reduction.The drug also has potential as a treatment for smoking cessation because the endocannabinoid system is involved in the body's response to tobacco dependence.Sanofi-Aventis filed for regulatory approval with the US FDA andEuropean EMEA in April 2005. In February 2006, however, the FDA declined to issue final approval until a number of (unspecified) issueswere resolved.The use of Acomplia as a treatment to aid weight loss received a letter of approval from the FDA but its use to aid smoking cessation was considered 'not approvable'. Despite this setback, analysts remain optimistic that Acomplia will eventually be approved in the US as an aid to weight loss.http://www.drug development-technology.com/projects/rimonabant/September 4, 2006
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Judy Foreman's "Health Sense" column, published today in the Boston Globe and syndicated nationwide, focused on ways to prevent medication errors. "Be sure those pills you're given are the right ones" contains valuable information about how patients and healthworkers can work to reduce errors. The piece refers in passing to the fact that nurses give and can help to explain medications to patients.But it cites no nursing experts, relying instead on four different physician sources. And it misses the key role nurses play in catching most medication errors--a role that calls upon nurses to be critical thinkers and advocates, not just people who mechanically implement the plans of others, as the piece's description implies. The piece also ignores the extent to which the nursing shortage and the generalundervaluation of nursing hampers efforts to reduce drug errors. Short-staffed nurses are less able to catch the errors, detect changesin patient conditions, and provide other care that enables drugs towork safely
and well. Underpowered nurses have a harder time advocating for changes in medication plans and medication administration systems. And the piece repeatedly suggests that only "doctors" prescribe drugs,even though most of the over 200,000 U.S. advanced practice nurses regularly do so as well. http://www.nursingadvocacy.org/news/2006/sep/04_foreman.html
and well. Underpowered nurses have a harder time advocating for changes in medication plans and medication administration systems. And the piece repeatedly suggests that only "doctors" prescribe drugs,even though most of the over 200,000 U.S. advanced practice nurses regularly do so as well. http://www.nursingadvocacy.org/news/2006/sep/04_foreman.html
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CEU/CME
Those that are free and otherwise
Nursing Spectrum CE was changed on January 1 to: www.nurse.com A website offering free CEUs: http://www.medscape.com/cmecenterdirectory/nurses
This site is loaded with CE/CME offerings.......check it out.
A huge offering of CEUs for LPNs and RNs.......for$24.99 https://nursing.advanceweb.com/Common/CE/Main.aspx
Asthma Pathogenesis and Management Contact hrs for NPs...4.0/2.5 $32.95Kathleen Conboy-Ellis ARNP, PhD, AE-C, - Effective patient education involves a partnership between the patient and healthcare provider.Nurse practitioners have a major role in asthma education programs. http://www.nursingcenter.com/prodev/ce_article.asp?tid=679464
Postmenopausal Osteoporosis: Putting the Risk for Osteonecrosis of the Jaw into Perspective CME/CE 02/26/2007 Experts provide the latest information aboutincidence, risk factors, and approach to ONJ in patients treated forosteoporosis with bisphosphonate. http://www.medscape.com/viewprogram/6720?sssdmh=dm1.250304&src=nlcmealert
Cases From AHRQ WebM&M: Crossing the Borderline CME/CE02/27/2007 A 24-year-old woman with borderline personality disorderwas admitted to an inpatientpsychiatry unit following a failed suicide attempt.http://www.medscape.com/viewprogram/6680?
sssdmh=dm1.250618&src=nlcmealert
Medical Adherence: America's "Other Drug Problem". Introduction: The Challenge of Adherence http://www.medscape.com/viewprogram/6450?src=mp 0.75 ceu s
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Medical Adherence: America's "Other Drug Problem". Introduction: The Challenge of Adherence http://www.medscape.com/viewprogram/6450?src=mp 0.75 ceu s
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WEBSITES/ LINKS
Always on the lookout for interesting websites / links.
Please send them to: RNFrankie@bellsouth.net
A - Z Guide on HealthTopicshttp://www.webmd.com/a_to_z_guide/health_topics.htm
Rozalfaro's website (Roz) http://www.alfaroteachsmart.com/
Raconte's website (Geneviève) http://www.solutionsoutsidethebox.net,
I am not certain...but probably most of us and all our information is at this website. "Believe it" !!!
I am not certain...but probably most of us and all our information is at this website. "Believe it" !!!
Zabasearch: http://www.zabasearch.com/
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HUMOR
A dentist noticed that his next patient, an elderly lady, was looking very nervous so he decided to tell her a little joke as he put on his gloves."Do you know how they make these gloves?" he asked."No, I don't" she replied."Well," he spoofed, "there's a building in China with a big tank of latex. Workers of all hand sizes walk up to the tank, dip in theirhands, let them dry, then peel off the gloves and throw them into boxes of the right size."She didn't crack a smile. "Oh well, I tried," he thought.
But five minutes later, during a delicate portion of the dental procedure, she burst out laughing.
"What's so funny?" he asked. "I was just picturing how condoms are made!" she said. Gotta watch those little old ladies! Their minds are always working!
But five minutes later, during a delicate portion of the dental procedure, she burst out laughing.
"What's so funny?" he asked. "I was just picturing how condoms are made!" she said. Gotta watch those little old ladies! Their minds are always working!
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MEDICAL RECALLS
Baxter and FDA notified healthcare professionals of the potential forlife threatening medication errors involving two Heparin products, Heparin Sodium Injection 10,000 units/mL, and HEP-LOCK U/P 10 units/mL. Baxter is aware of fatal medication errors that have occurred when two Heparin products with shades of blue labeling were mistaken for each other. Three infant deaths resulted when the higher dosage HeparinSodium Injection 10,000 units/mL was inadvertently administered instead of the lower dosage of HEP-LOCK U/P 10 units/mL. The currently marketed 1 mL vials of both Heparin products use blue as the prominent backgroundcolor on their labels.
Heparin Nerve Agent Treatment Approved for Emergency Use
Alert on Counterfeit "One Touch" Glucose Test Strips http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#2
New Labeling Stresses Bleeding Risk from Coumadin http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#3
Possible Association between Lamictal and Cleft lip /Palate
Roche Diagnostics Recalls CoaguChek PT Test Strips http://www.accessdata.fda.gov/psn/transcript.cfm?show=58#5
Severe Tissue Injury with IV Promethazine
Preventing Fatal Heparin Overdoses
FDA notified healthcare professionals that the manufacturers of all drug products approved
for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) have been directed to develop Patient Medication Guides to alert patients to possible cardiovascular risks and risks of adverse psychiatric symptoms associated with the medicines and to advise them of precautions that can be taken. An FDA review of reports of serious cardiovascular adverse events inpatients taking usual doses of ADHD products revealed reports of sudden death in patients with underlying serious heart problems or defects, and reports of stroke and heart attack in adults with certain risk factors. FDA recommends that children, adolescents, or adults who are beingconsidered for treatment with ADHD drug products work with their physician or other health careprofessional to develop a treatment plan that includes a careful health history and evaluation of current status,particularly for cardiovascular and psychiatric problems (including assessment for a family history of such problems).
http://www.fda.gov/medwatch/safety/2007/safety07.htm#ADHD
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NURSING HINTS
When it pumps, it pours Some of our patients lack the strength and coordination to pour water or juice from a pitcher into a cup. To make sure they get their required bluids, we give each of them a "pump pot"--a small picnic jug with a spout that dispenses liquid when you push down on the lid. Usually, patients can fill their cups themselves with this device, so they're encouraged to take more fluids. We like the pots, too: they save us the time of refilling cups... Since they're insulated, we don't have to refill the pots with ice.
Jeanne Sorrell, RN
Jeanne Sorrell, RN
Used with permission from 1,001 Nursing Tips & Timesavers, Third Edition, 1997, p. 49, Springhouse Corporation/www.springnetcom
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ADVERTISEMENTS from the members
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http://www.delightful greeting cakes.com/worlds greatest.php
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NEW MEMBERS
No new members with this issue. Please send the prospective members' screen names with first names to me: RNFrankie@bellsouth.net ~^~^~^~^~^~^~^~^~^~^~^~
ADDRESS CHANGES
NOTICE: I attempt to send newsletters to your current email addresses on file and if the newsletters are rejected THREE consecutive times, I must then delete the e-mail address until you contact me with an updated e-mail address; I have no way to reach you without a correct e-mail address....Remember most ISPs do not send the updated e-mail address.You could always send me your home number.......lol
So please send your new name/address to rnfrankie@bellsouth.net
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EDITORIAL STAFF:
GingerMyst @AOL.com (Anne),GALLO RN @AOL.com (Sue),HSears9868 @AOL.com (Bonnie), Laregis @AOL.com (Laura), Mrwrn @AOL.com(Miriam), and Schulthe @AOL.com (Susan)
Membership BIO Committee...(if you haven't sent in your BIO....Please send it to the appropriate section below) : Check by your screen name's first letter.........If you have any questions...feel free to write either the Bio/Profile person or myself. Be very glad to help you.
BCK131 @AOL.com (Chris) A thru B section,
Dick515 @AOL.com (Eileen) C thru D section,
GALLO RN @AOL.com (Sue) E thru I section,
rnfrankie @bellsouth.net (Frankie) J thru K section,
Jntcln @AOL.com(Janet) L thru M section,
GALLO RN @AOL.com (Sue) N thru Q section,
Schulthe @AOL.com (Susan) R thru T section,
Sandy1956 @AOL.com (Sandy) U thru Z section.
Paradigm 97 Co-Founders:
MarGerlach@AOL.com (Marlene) and rnfrankie@bellsouth.net (Frankie)
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DISCLAIMER: The intent of this PARADIGM BYTES Newsletter is to provide communication and information for our members. Please research the links and information provided by our members.The articles and websites are not personally endorsed by the editors, nor do the articles necessarily reflect our opinions.
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THOUGHT FOR THE DAY
Life may not be the party we hoped for:
But while we are here, we might as well dance.
But while we are here, we might as well dance.
Gingermax @AOL.com
Write me.....offer suggestions for the Newsletter/ share articles, etc.
Frankie (rnfrankie @bellsouth.net)
