Monday, May 28, 2012

Safe Practices: Preventing Needlestick Injuries

Dr Mary Foley

I recently had the privilege to learn more about the Safe in Common campaign, an exciting healthcare initiative that is promoting safe work environments free from needlestick injuries from one of the leading health worker safety advocates, Dr. Mary Foley. Below is our interview. Please read and consider taking the pledge for preventing needlestick injuries and creating safe work environments.

(Kelly) What has been your experience with the general "culture" or perception by nurses and other healthcare professionals regarding needlestick safety?

(Dr Foley) In my experience, healthcare workers are focused on patient care.  They are aware of needlestick risks, but they keep their worries about occupational injury in the background, so they can focus on giving the best care they can.  That presents some danger to healthcare workers.  Doctors, nurses, aids, lab technicians, housekeeping, and maintenance personnel are all at risk when sharps devices and delivery systems are not designed for maximum protection.

(Kelly) Can you estimate the cost in lost wages or medical care annually related to needlestick injuries?  What is the emotional cost?

(Dr Foley) There is an emotional cost to the ever-present threat of an injury, which is there even if a healthcare worker manages to keep the concerns "controlled", so they can focus on patient care. 

When a worker is exposed to a contaminated device, there is an immediate sense of panic, since this could be an infected device.  In spite of that fear, or maybe because of it, almost half of all injured workers fail to report their injury—which puts them at risk for no coverage if they become ill.

Injured workers talk about the tension in their personal and family lives as they wait for test results which are conducted over 6 or more months to determine if the worker is infected.  Some healthcare personnel are encouraged to take prophylactic medications, some of which are difficult to tolerate.  

The preferred future: reduce accidental injuries with better devices, proper training, and a culture of safety.

(Kelly) Can individual nurses make a difference?

(Dr Foley) Individuals can make a difference. Care for the caregivers begins with self care—being as knowledgeable as possible about protecting patients and oneself.  But many of the improvements in health care settings will require collective action by policy makers, device makers, occupational health specialists, managers, and staff.

(Kelly) What can we all do to offer our support?

(Dr Foley) The Safe in Common campaign was launched in May, and we already have thousands of pledges of support.  Just as importantly, the subject of sharp injury prevention is active again, over 10 years after the passage of the Needlestick Safety and Prevention Act.  There have been some improvements in some rates of injuries, but there are still too many occupational injuries from sharps, and now, many of those occur when staff uses "safety" devices. Clearly, the devices in use are not adequately protecting staff, and more work must be done.

Spread the word (thank you for writing about this), share the pledge, advocate for educational content and conference programming that informs and advocates for better protection.

(Kelly) Can you provide any statistics / facts about the frequency and gravity of needlestick injuries?

(Dr Foley) Virtually all healthcare personnel are at risk of harm from occupational exposures such as needlestick injuries. The Center for Disease Control notes that nurses sustain approximately half of all needlestick injuries, while physicians, housekeeping and maintenance staff, technicians, and administrators are also harmed.
The U.S. Occupational Safety and Health Administration (OSHA) estimates 5.6 million workers in the U.S. healthcare industry are at risk of occupational exposure to bloodborne pathogens via needlestick injuries and other sharps-related injuries. OSHA further reports that each year 385,000 needlestick injuries and other sharps-related injuries are sustained by hospital-based healthcare personnel. This equates to an average of around 1,000 sharps injuries per day in U.S. hospitals.
Including other non-acute healthcare facilities, it is estimated that between 600,000-800,000 healthcare personnel incur a needlestick injury each year in the U.S.
Forty percent of injuries occur after use and before disposal of sharp devices, 41% of injuries occur during the use of sharp devices on patients, and 15% of injuries occur during or after disposal.

(Kelly) How did you get involved advocating for needlestick safety?

(Dr Foley) As a registered nurse for more than 35 years, I was one of the first healthcare workers to combat the emerging HIV-AIDS epidemic during my work at Saint Francis Memorial Hospital in San Francisco during the 1980s. I played a key role in securing the passage in California of the first state-based laws in the U.S. mandating the use of safety medical devices. Afterwards, I joined other nursing colleagues to campaign for the adoption of the Federal Needlestick Safety and Prevention Act. Elected President of the American Nursing Association (ANA) in 2000, I was in the Oval Office of the White House when President Bill Clinton enacted the Act into law. Since, I have continued to work to improve healthcare policy, including improving the workplace, and promoting safe care for workers and patients nationally and internationally. Given my passion and knowledge of the issues, Safe In Common asked me to lead their Needlestick Safety Advocacy Tour.

(Kelly) What does Safe in Common do to protect healthcare personnel?

(Dr Foley) Safe in Common is a movement of healthcare personnel committed to making their working environment safe from the risk of needlestick injury. With the safest equipment, the best practices and the right culture, we believe all needlestick injuries can be prevented. The non-profit organization was established to enhance and save the lives of U.S. healthcare personnel at risk of harm from needlestick injuries.  First established in 2010 as an online community of healthcare professionals and other advocates committed to injection safety, Safe in Common is leading the Needlestick Safety Advocacy Tour across the U.S from March 2012 through March 2013 to engage with healthcare personnel to hear their concerns, raise their hopes and unite them together behind the creation of a workplace environment that is free from the risk of needlestick injury. 
The Tour will visit more U.S. hospitals and attend healthcare conferences across the nation during the first stage of the national campaign. At each location, Safe in Common representatives will advocate for needlestick safety, record real stories from healthcare personnel, and provide demonstrations of the latest safety-engineered medical devices that can help to deliver optimal protection to those at risk of harm.
(Kelly) What is the Safe in Common Pledge?

(Dr Foley) The pledge is the cornerstone of the NSAT:

Our goal is to have at least 100,000 healthcare personnel take the pledge as a show of support that more can be done to reduce needlestick injuries. The pledge, which can be taken online or in person wherever SIC is engaging healthcare personnel, says “A safe working environment is essential if I am to effectively serve the needs of my patients. Needlestick and sharps injuries represent one of the most serious threats to occupational safety within my facility.”

The pain and trauma that these injuries inflict upon healthcare personnel, and their loved ones, is unacceptable. The dollars lost each year in the testing and treatment of reported injuries is unacceptable. The continued use of medical equipment that fails to adequately address the safety and functional needs of healthcare workers and their patients is unacceptable.

Thank you Dr Foley for sharing this important topic with my readers. Patient safety causes often take priority over safety initiatives for ourselves. As nurses, other healthcare providers and ancillary services it is imperative to use caution and advocate for safe and healthy work environments.

Please follow the link and take the Safe in Common Pledge

Saturday, May 26, 2012

NTI 2012: A conference to remember

The week at NTI was an incredible one. It apparently had more of an impact than I even realized. And that is consciously recognizing that I am intellectually, emotionally and spiritually charged. But when I came home and began sharing my experiences with my significant other, the emotions just poured out of me. From the energizing opening by Sticks of Thunder, to the heartfelt stories of courage from Joplin, MO to the motivational keynote address by Robin Benincasa and all the moments in-between - the excitement and intensity, compassion and fatigue flowed out of me as I manically tried to convey a weeks worth of events in 20 minutes! As I showed him my drumsticks and Together. Stronger. Bolder. t-shirt and other goodies from the conference he remarked that he was so happy that there was an organization and conference that provided that level of professional learning and excitement for me. As I gave it more thought, I realized there is no other place that I can go and get the educational credits I need to maintain my three certifications, the relevant learning I desire, the celebration of nursing and accomplishment, the professional networking and camaraderie, the emotional nurturing, all in a spirit of fun. And oh did I mention, I get to experience all this is with thousands of my closest nurse friends?

Not that I could possibly list every detail or even quantify the conference, but some of my personal highlights of the conference include:

  • Opening Supersession on Monday - Sticks of Thunder, Mary Stahl, Pioneering Spirit Awards
  • Mastery Session on Break the readmission cycle by integrating Pallitiative care with life-saving therapies
  • Bertice Berry's Mastery Session - Becoming the highest version yourself 
  • President-elects new theme - Dare to
  • Robin Benincasa Keynote Address
  • Interactive lecture utilizing technology and the other amazing sessions
  • Networking with AACN board members 
  • Meeting up with classmates from graduate (CNS) & post-graduate (ACNP) schools
  • Nurses Night Out at Sea World
  • And so many other incredible moments
Thank you AACN and the numerous sponsors that make NTI possible. Having attended other conferences and professional organizations, NTI is of the highest quality and is very well organized. Not to mention fun!

This conference came for me at a important time as I embark on new path in nursing. Perhaps that is why it resonated so deeply with me. So as the post-conference journey begins how will I take the lessons learned and apply them to my practice, to my self as a leader, a healer, as mother and spouse? I leave you with the challenge Kathryn Roberts did...Dare To

Dare to Dream. Change. Lead. Act.   
What do you DARE TO do?

Monday, May 21, 2012

NTI 2012 Starts with a Bang...literally!

My Day 2 was the official start to NTI which meant the first Supersession - and boy was it super! We should have known something was up when they were handing out drumsticks as we walked in the door! The 2 hours were filled with excitement and inspiration and laughter and tears! From Bertice's beautiful voice and rendition of the national anthem to Sticks of Thunder jumpstarting the crowd. 

Mary Stahl sharing heartfelt stories of nurse heroes and nurses lifting each other up in laughter. Nurses reaching for what seems to be the impossible in clinical excellence to using their seemingly small voice to advocate for the patient no matter how new they are. 

It was a magical sight I'm sure watching thousands of nurse tapping drumsticks together in unison. Close your eyes. Imagine it. We are a community of strong nurses. Together we can accomplish many things. Together our voice is bold

We are powerful. 

Together. Stronger. Bolder. 

My Day 2 was the official start to NTI which meant the first Supersession - and boy was it super! We should have known something was up when they were handing out drumsticks as we walked in the door! The 2 hours were filled with excitement and inspiration and laughter and tears! From Bertice's beautiful voice and rendition of the national anthem to Sticks of Thunder jumpstarting the crowd. Cue the drums...

Mary Stahl sharing heartfelt stories of nurse heroes and nurses lifting each other up in laughter. Nurses reaching for what seems to be the impossible in clinical excellence to using their seemingly small voice to advocate for the patient no matter how new they are. Recognition of true pioneers in health care to everyday heroes - it was a time of celebrating what we do and doing it well. 

It was a magical sight I'm sure watching thousands of nurse tapping drumsticks together in unison. Close your eyes. Imagine it. We are a community of strong nurses. Together we can accomplish many things. Together our voice is bold

We are powerful. 

Together. Stronger. Bolder. 

Sunday, May 20, 2012

AACN NTI Orlando - Sunday

Today is my official start to the conference. Even as I type from the Orange County Convention Center, I am overwhelmed at the number of nurses, carrying the familiar blue tote (thank you AACN sponsors!) and badge holder around their necks. I see some faces I know and many I don't know, but yet there is a strong sense of kinship and knowing just who they are. They are me!

So I continue to pour over the session descriptions and schedules trying to figure out how I can squeeze in as many as possible in the next 4 days. I thought I had a well laid out plan before I left for Orlando, but now I am here, that has somehow all changed.  

The excitement is palpable. The networking has begun. I am looking forward to meeting up with classmates and colleagues both past and present. And of course the motivation and inspiration that is waiting for us in the supersessions from our president Mary Stahl and Dr Bertice Berry. 

I can't wait for the rest of the week. Not that I want to rush any of it - I want to savor every moment and recharge and reconnect to the profession I am committed to. 

So this is Day 1.

Saturday, May 12, 2012

Partnerships in care...More than lip service

There has been a lot of chatter lately about collaborative care and interdisciplinary teams and of course patient-centered care, yet little changes in the delivery and outcomes of care occur. These terms are more than catch-phrases and trendy terms, but important concepts in how we has health care providers impact the patient and family as being the center of that care.

Patient-centered care has never been new to me. It is what we were taught in nursing school; the patient comes first. It makes sense, but most delivery care processes are not designed with the patient at the center. We develop systems and processes that are convenient to us, that work around our schedules. This includes administering medications on 24 hour time intervals, restricting visiting hours and bathing patients at night in critical care just to name a few. How many people take baths at 0300 in the real world? This is perfect example of a care process that has evolved to accommodate nursing staff not the patient; hardly patient centered and one that certainly does not promote natural sleep/wake cycles and healing.

But patient-centered care is more than bathing patients during the day and administering medications at times that do not interrupt patients sleep schedules. It includes partnerships and decision-making...with the patient. Not all patients have the capacity for decision making but most have family or other appointed individual that does. Not all patients understand why their illness or disease process, the reason for hospitalization, but are willing to learn. They need us to educate them.

The key is active participation. Care that moves away from "disease-centered" where the disease and subsequent treatments dictate the courses of action towards "patient-centered" in which the patient and providers discuss and determine the best treatment options for the patient. This may mean invasive procedures or simple medication changes; or perhaps no treatment at all such as palliative or hospice care. 

Recently Dr Donald Berwick gave a commencement speech at his daughter's medical college graduation. His words were poignant and relevant in this era of cost containment and pay-for-performance and other phrases that pose as patient-centered care. I have provided a brief excerpt here as it is a great example of what we as providers ought to remember each day we interact with patients and their families.

 'Dr. Berwick,

'My husband was Dr. William Paul Gruzenski, a psychiatrist for 39 years. He was admitted to after developing a cerebral bleed with a hypertensive crisis. My issue is that I was denied access to my husband except for very strict visiting, four times a day for 30 minutes, and that my husband was hospitalized behind a locked door. My husband and I were rarely separated except for work,' she wrote. 'He wanted me present in the ICU, and he challenged the ICU nurse and MD saying ... 'She is not a visitor, she is my wife.' But, it made no difference. My husband was in the ICU for eight days out of his last 16 days alive, and there were a lot of missed opportunities for us.'

 'I am advocating to the hospital administration that visiting hours have to be open especially for spouses... I do not feel that his care was individualized to meet his needs; he wanted me there more than I was allowed. I feel it was a very cruel thing that was done to us...'

Listen, again, to the words of Dr. Gruzenski: 'She is not a visitor; she is my wife.' Hear, again, Mrs. Gruzenski: 'I feel that it was a very cruel thing that was done to us.'

'Cruel' is a powerful word for Mrs. Gruzenski to use, isn't it? Her email and the emails that followed that first one are without exception dignified, respectful, tempered. Why does she say, 'cruel'?

We will have to imagine ourselves there. 'My husband and I loved each other very deeply,' she writes to me, 'and we wanted to share our last days and moments together. We both knew the gravity of his illness, and my husband wanted quality of life, not quantity.'

What might a husband and wife of 19 years, aware of the short time left together, wish to talk about - wish to do - in the last days? I don't know for Dr. and Mrs. Gruzenski. But, I do know for me.

Someone stole all of that from Dr. and Mrs. Gruzenski ... Someone who did not understand who was at home and who was the guest - who was the intruder ...

Of course, it isn't really 'someone' at all. We don't even know who, or what it is. Its voice sounds rational. Its words are these: 'It is our policy,' 'It's against the rule,' 'It would be a problem,' and even, incredibly, 'It is in your own best interest.' What is irrational is not those phrases; they seem to make sense. What is irrational is what follows those phrases, in ellipsis, unsaid: 'It is our policy ... that you cannot hold your husband's hand.' 'It is against the rules ... to let you see this or to let you know this.' 'It would be a problem ... if we treated you on your own terms not ours.' 'It is in your own best interest ... to miss your daughter's moment of birth.' This is the voice of power; and power does not always think the whole thing through. Even when it has no name and no locus, power can be, to borrow Mrs. Gruzenski's word, 'cruel.'

What is at stake here may seem a small thing in the face of the enormous health care world you have joined. It is as a nickel to the $2.6 trillion industry. But that small thing is what matters. I will tell you: it is all that matters. All that matters is the person. The person. The individual. The patient. The poet. The lover. The adventurer. The frightened soul. The wondering mind. The learned mind. The Husband. The Wife. The Son. The Daughter. In the moment.

We as providers at every level, have the privilege to enter patients lives and help them navigate a very complicated health care system. It is our duty to educate them and comfort them and respect the decisions they make regarding the care they wish to receive. Even if it means we step out of our comfort zone.

To read the full speech follow this link: Yale Medical School Graduation

To learn more on Patient/Family-centered Care: Remaking American Medicine

Monday, May 7, 2012

Moments in nursing

Moving away from my normal format, I agreed to post this link to share the video of great nursing moments...enjoy!

Happy National Nurses Week from! (May 6th-12th)

In honor of all of the veteran, new and aspiring nurses out there, we've put together a list of some of our favorite nursing videos. We hope you enjoy this collection of inspirational, funny and moving clips. Thank you for choosing nursing!

Saturday, May 5, 2012

Being a Nurse

According to a nurse is "a person formally educated and trained in the care of the sick or infirm." For those of us that are nurses, we know that being a nurse is so much more. It may be ushering a new life or be holding the hand of a life that's ending. It may be teaching a patient with a new diagnosis how to manage treatment at home or it may be teaching a new graduate nurse how to manage taking care of patients on their own. 

Being a nurse may require being a referee, a translator, a mentor, a counselor, or just being present. 

Being a nurse, is who we are. 

Often it interrupts lunch and bathroom breaks. It does not stop with the end of the shift. It may wake us at 0300 in the morning or with a bloody knee or on the side of the road or at a school function. A nurse is a 24/7 job. And we do it proudly.

May 6th through 12th is National Nurses Week. Thank you to all of my fellow nurses and for all of those who aspire to be a nurse, thank you. 

This week remember why you became a nurse and honor each other. And be proud for being a nurse.