Posted Nov. 20, 2009

Cheryl Slagle, RN, CMCN, CCM, CCP, has been named the 2009 Managed Care Nursing Leader of the Year by the Leadership Institute of the American Association of Managed Care Nurses (AAMCN).   

Slagle, director of medical management at CareSource, a public sector managed-care company, was honored Nov. 11 at the AAMCN Fall Managed Care Forum in Las Vegas.

It is the third annual Managed Care Nursing Leadership Award given by the AAMCN Leadership Institute, which developed the national award to recognize AAMCN members who have made outstanding contributions as a leader in managed care nursing, their communities and toward patient advocacy. 

Specific criteria such as leadership skills, mentoring and coaching skills, dependability, and appropriate nursing and patient advocacy was reviewed by the award committee. In addition to her active involvement in the association, Slagle is an advocate on the value of membership and certification in managed-care nursing.  

"This well-deserved leadership recognition is a tribute to both Cheryl and her team for their outstanding commitment to the nursing profession and managed care," said Pamela Morris, CareSource president and CEO.

AAMCN is a nonprofit active membership association of NPs, RNs and LPNs associated with managed-care organizations across the country.  AAMCN is dedicated to helping nurses become successful in their local marketplace through resourceful, responsive leading-edge member services, education and communication.

Posted Nov. 20, 2009

Women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended, according to newly revised evidence-based guidelines issued by The American College of Obstetricians and Gynecologists (ACOG) Nov. 19, and published in the December issue of Obstetrics & Gynecology.

ACOG now recommends women ages 21-30 be screened every 2 years instead of annually, using either the standard Pap or liquid-based cytology. Women age 30 and older who have had three consecutive negative cervical cytology test results may be screened once every 3 years with either the Pap or liquid-based cytology.

Women with certain risk factors may need more frequent screening, including those who have HIV, are immunosuppressed, were exposed to diethylstilbestrol (DES) in utero, and have been treated for cervical intraepithelial neoplasia (CIN) 2, CIN 3, or cervical cancer.

"The tradition of doing a Pap test every year has not been supported by recent scientific evidence," says Alan G. Waxman, MD, University of New Mexico in Albuquerque, who headed the document developed by ACOG's Committee on Practice Bulletins-Gynecology. "A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful."

Moving the baseline cervical screening to age 21 is a conservative approach to avoid unnecessary treatment of adolescents which can have economic, emotional, and future childbearing implications, according to ACOG, which previously recommended cervical screening begin 3 years after first sexual intercourse or by age 21, whichever occurred first.

Although the rate of HPV infection is high among sexually-active adolescents, invasive cervical cancer is very rare in women under age 21. The immune system clears the HPV infection within 1-2 years in most adolescent women. Because the adolescent cervix is immature, there is a higher incidence of HPV-related precancerous lesions (called dysplasia). However, the large majority of cervical dysplasias in adolescents resolve on their own without treatment.

A significant increase in premature births has recently been documented among women who have been treated with excisional procedures for dysplasia. And because adolescents have most of their childbearing years ahead of them, so it's important to avoid unnecessary procedures that negatively affect the cervix, Waxman says. "Screening for cervical cancer in adolescents only serves to increase their anxiety and has led to overuse of follow-up procedures for something that usually resolves on its own," he says.

Routine cervical cytology testing should be discontinued in women (regardless of age) who have had a total hysterectomy (removal of the cervix along with the uterus) for noncancerous reasons, as long as they have no history of high-grade CIN.

ACOG's recommendations on the upper age limit for discontinuing cervical screening remain the same. It is reasonable to stop cervical cancer screening at age 65 or 70 among women who have three or more negative cytology results in a row and no abnormal test results in the past 10 years. ACOG also recommends women who have been vaccinated against HPV follow the same screening guidelines as unvaccinated women.

About ACOG
The American College of Obstetricians and Gynecologists (ACOG) is the nation's leading group of physicians providing healthcare for women. As a private, voluntary, nonprofit membership organization of approximately 53,000 members, ACOG strongly advocates for quality healthcare for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women's healthcare.

Posted Nov. 20, 2009

To raise awareness of the risks associated with poor hand hygiene and encourage best practices among nurses and other healthcare professionals, the Association of periOperative Registered Nurses (AORN) and 3M Infection Prevention announced an initiative to reduce the risk of healthcare-associated infections (HAI) in the surgical setting. 

The "It's In Your Hands" campaign spotlights AORN's recently updated Recommended Practices for Hand Hygiene in the Perioperative Setting, and through new and creative programs will engage and recognize nurses from around the country for exemplary hand hygiene compliance.

The campaign will include a YouTube video contest set to launch Dec. 1, in which nurses will demonstrate the updated hand hygiene protocols through short videos, as well as a recognition program for those who have gone above and beyond to lead their organizations in reducing HAIs through good hand hygiene practices.

Contestants will develop an original short video that visually demonstrates correct hand hygiene techniques for the perioperative setting in a creative, educational and informative way. The deadline for entry is January 18, 2010, and entrants will follow criteria that include clearly demonstrating compliance to the new practices including demonstration of correct technique, thoroughness, use of appropriate steps, compliance with AORN Recommended Practices and creativity.

A panel of judges from the AORN Recommended Practices Committee will choose three video finalists during the week of Feb. 1, 2010. The three finalists will be displayed on AORN's Web site http://www.aorn.org/. AORN members and other visitors to the site will have the opportunity to vote for their top video though Feb. 22. The winning video will be announced at the AORN Annual Congress in Denver, March 13-18, and the creators of the winning video (up to three people) will receive an educational grant from 3M to cover the registration fee to attend an AORN conference of their choice.

More details regarding contest criteria, submission requirements and the public voting will be posted on the AORN Web site Dec. 1.

"Proper hand hygiene remains one of the most effective and least costly ways to prevent and control healthcare-associated infections," said Linda Groah, MSN, RN, CNOR, FAAN, executive director and CEO at AORN.  "This partnership with 3M reinforces hand hygiene standards by helping to creatively inform nurses who are on the frontlines of surgical care and give them tools to inform and engage their peer groups."

Posted Nov. 18, 2009

Women who experience preeclampsia, a serious complication of pregnancy, may have an increased risk for reduced thyroid functioning later in life, reports a team of researchers from the National Institutes of Health and other institutions.

Preeclampsia is a life-threatening complication that occurs in 3 to 5 percent of pregnancies. The condition results in high blood pressure and protein in the urine.

To read more from ADVANCE on Hypertension & Pregnancy click here. 

The analysis combined two separate studies suggesting a link between preeclampsia and reduced thyroid function. In the first study, women who developed preeclampsia were more likely to have slightly reduced thyroid functioning during the last weeks of their pregnancies.

The second study found women who had preeclampsia during their pregnancies were more likely to have reduced thyroid functioning more than 20 years after they had given birth, when compared to women who had not had preeclampsia during pregnancy.

The study authors advised physicians treating women with a history of preeclampsia to be aware that this group of patients may be at increased risk for reduced thyroid functioning.

Funding for the research was provided in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Heart Lung and Blood Institute, both of the NIH.

"The findings suggest that the possible development of hypothyroidism is a consideration in patients with a history of preeclampsia," said Susan B. Shurin, MD, acting director of the NICHD. "Reduced thyroid functioning is easy to diagnose when suspected, and inexpensive to treat. Replacement therapy substantially improves quality of life of affected persons."

The study appears in the November BMJ, the publication formerly known as the British Medical Journal. Its lead author is Richard J. Levine, MD, MPH, a senior investigator in NICHD's Division of Epidemiology, Statistics, and Prevention Research.

The thyroid gland, located in the front of the throat, makes hormones that help regulate heart rate, blood pressure, body temperature, and the conversion of food into energy. Reduced thyroid functioning, or hypothyroidism, results in overall weakness and fatigue and also increases the risk for cardiovascular disease.

Preeclampsia may begin with mild symptoms, then progress to severe preeclampsia and to eclampsia - dangerously high blood pressure and convulsions - which may result in disability or death. The only cure for preeclampsia is delivery of the baby. The causes of preeclampsia are not known.

Updated Nov. 19, 2009

Ostensibly to address confusion created by new U.S. Preventive Services Task Force (USPSTF) breast cancer screening recommendations that women under age 50 no longer receive annual mammograms, Health & Human Services Secretary Kathleen Sebelius issued a statement Nov. 18 encouraging women to continue to have the annual exams after age 40 if they and their physicians agree it is prudent.

The task force "is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don't determine what services are covered by the federal government," Sebelius said in part.

To read the Secretary's entire statement, click here.

To learn more about the new USPSTF recommendations published in the Nov. 17 issue of the Annals of Internal Medicine, see the report below.

Posted Nov. 17, 2009

In a departure from guidelines issued 7 years ago, the task force now says evidence does not support routine mammography screening for women before age 50 is beneficial and suggests screening end at age 74 years.The new guidelines update those published in 2002 and recommend changing the screening interval from 1 year to 2 years, but suggest women 40-49 who are at high risk for breast cancer consult with their provider about when to begin regular, biennial screening mammography.

Read an opinion piece by a women's health physician who is "shocked and appalled" at the task force's new recommendations. Discuss the issue further at the ADVANCE for Nurses blog Tales From an ED Nurse by Lorettajo Kapinos, BSN, RN. 

Six models using common data elements were used for the task force's study with sources including national data on age-specific incidence, competing mortality, mammography characteristics and treatment effects. Twenty screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome measures included number of mammograms, reduction in deaths from breast cancer or life-years gained (versus no screening), false-positive results, unnecessary biopsies, and overdiagnosis.

According to USPSTF, the 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81 percent (range across strategies and models, 67-99 percent) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5 percent (range, 15-23 percent) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (versus 50 years) reduced mortality by an additional 3 percent (range 1-6 percent), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 yielded some additional mortality reduction in all models, but over-diagnosis increased most substantially at older ages.

Specific recommendations of the USPSTF, and the accompanying strength of recommendations, were as follows:

• USPSTF recommends against routine screening mammography in women 40-49 years, but suggests those women at high risk for breast cancer consult their provider about when to begin regular, biennial screening mammography before age 50 (grade C recommendation).
• Women 50-74 years should undergo biennial screening mammography (grade B recommendation).
• Current evidence is insufficient to determine additional benefits and harms of screening mammography in women 75 or older (I statement).
• In women 40 or older, current evidence is insufficient to determine the additional benefits and harms of clinical breast exams beyond screening mammography (I statement).
• USPSTF recommends against clinicians teaching women the breast self-examine technique (grade D recommendation).
• Current evidence is insufficient to determine additional benefits and harms of either digital mammography or MRI versus film mammography as screening modalities for breast cancer (I statement).

Click here for the Clinical Summary of the newly recommended guidelines from the task force. 

USPSTF is an independent, voluntary body supported by the Agency for Healthcare Research and Quality (AHRQ). Recommendations made by the USPSTF are independent of the U.S. government and should not be construed as an official position of the AHRQ or the U.S. Department of Health and Human Services.

Despite the recession, most hospital executives believe there are still too few physicians, nurses and allied healthcare professionals in the U.S., and that worker shortages will grow worse if access to healthcare becomes universal.

In a survey of 285 hospital CEOs conducted by AMN Healthcare, the nation's largest healthcare staffing company:

• 95 percent of respondents said there is a shortage of physicians in the U.S.;
• 91 percent said there is a shortage of nurses;
• 86 percent said there is a shortage of pharmacists; and
• 79 percent said there is a shortage of allied healthcare professionals.

Moreover, many CEOs believe there too few healthcare workers in their areas to meet the increased demand for medical services universal access to care would create, according to AMN healthcare president, Susan Nowakowski. Of those CEOs surveyed:

• 70 percent said there would not be enough doctors to meet demand if access becomes universal;
• 51 percent said there would not be enough nurses;
• 48 percent said there would not be enough allied healthcare professionals; and
• 45 percent said there would not be enough pharmacists.

"While the short-term economic environment may have temporarily eased the ability to recruit and retain clinical staff, the long-term dynamics of an aging population will drive the need for thousands of more healthcare professionals that don't exist today," notes Nowakowski. "Any plan to expand access to care would intensify an already anticipated critical shortage of clinicians. Healthcare reform should include robust efforts to train more doctors, nurses and other clinicians," she added.

While hospital CEOs indicated long-term healthcare worker shortages persist, some said the recession has masked the overall shortage and resulted in a temporary easing of their hospitals' recruitment of clinical workers during the past 6 months. More than 24 percent of CEOs said the economic downturn caused them to:

• decrease nurse recruiting efforts during the past 6 months;
• decrease allied healthcare professional recruiting efforts (16 percent);
• said the downturn had caused them to decrease pharmacist recruiting efforts. By contrast, more than 24 percent said the downturn had caused them to increase physician recruiting efforts during the past 6 months. The majority (at least 64 percent) said recruiting efforts at their hospitals during the past 6 months had not changed.

In the next 6 months, most hospital CEOs plan to maintain or even increase recruitment of healthcare professionals, the survey suggests.

• 93 percent expect to maintain or increase physician recruiting efforts;
• 89 percent expect to maintain or increase nurse recruiting efforts;
• 91 percent expect to maintain or increase allied healthcare professional recruiting efforts;
• and 93 percent expect to maintain or increase pharmacist recruiting efforts.

Up to 11 percent, however, expect to decrease their efforts to recruit clinical professionals in the next 6 months.

Shortages of healthcare professionals have compromised access to care in their areas, some CEOs report:

• 46 percent said access to care in their areas has been compromised by physician shortages;
• 10 percent said access has been compromised by allied healthcare professional shortages;
• 8 percent said access has been compromised by nurse shortages; and
• 3 percent said access has been compromised by pharmacist shortages.

Additionally, CEOs reported an average hospital vacancy rate of 11 percent for physicians; 6 percent for nurses; 5 percent for allied healthcare professionals; and 5 percent for pharmacists.

AMN Healthcare's 2009 Survey of Hospital Chief Executives Officers was conducted in partnership with the Council on Physician and Nurses Supply, a national group of healthcare experts dedicated to finding solutions to the shortage of doctors and nurses funded by AMN Healthcare. Complete survey results are available at http://www.amnhealthcare.com/PDF/09CEOSurvey.pdf and www.physiciannursesupply.com.

Posted Nov. 13, 2009

Data Advantage, LLC announced 75 hospitals received a Best in Value: Superior Quality Merit Award from the 2009-2010 Hospital Value Index, the first and only national study on U.S. hospitals and the value of care they provide. 

The index is an independent analysis of each hospital's performance in the categories of: quality, affordability and efficiency, and patient satisfaction. Out of the more than 4,500 hospitals analyzed, 75 received the Superior Quality Merit Award.  

The quality category is analyzed using data from the Centers for Medicare and Medicaid Services (CMS) Core Measures, AHRQ Patient Safety Indicators, CMS 30-day mortality scores and CMS reported hospital readmission rates.

To receive the award, hospitals were first considered as Best in Value or in the top 25 percent of all hospitals in the study. The top 10 percent of this group were then ranked in the quality category in order to receive the Superior Quality Merit Award.  

To view a list of the award recipients, click here. 

For more information about the Hospital Value Index, click here.

Posted Nov. 11, 2009

Amid growing concerns about racial, ethnic and language disparities in healthcare, the Joint Commission and the U.S. Department of Health and Human Services (HHS) Office for Civil Rights have released a video, Improving Patient-Provider Communication, which supports language access in healthcare organizations.

With many competing priorities in healthcare, the video explains why particular attention should be paid to federal civil rights standards and the Joint Commission's accreditation standards pertaining to effective communication and language access.

The video also addresses the obligations of healthcare organizations with respect to the translation of written documents. It also clarifies that HHS and the Joint Commission do not endorse one specific approach to ensuring language access, but recommend using resources and modes of interpretation that are accessible, in working order, and are put into use when necessary to serve the needs of patients and their families.

This video streams from jhe Joint Commission's Hospitals, Language, and Culture Web site at http://www.jointcommission.org/PatientSafety/HLC/. The Web page also includes related resources from the Hospitals, Language and Culture: A Snapshot of the Nation study, a cross-sectional, qualitative study of how 60 hospitals across the country provide healthcare to culturally and linguistically diverse patient populations conducted by the Joint Commission with funding from The California Endowment. 

Posted Nov. 10, 2009

RNs employed in the U.S. are invited to participate in a study looking at work instability and intent to leave the profession.

Your participation will help researchers learn more about work instability, i.e., the mismatch between the ability to perform nursing work and the demands and expectations of the work among RNs.

You are eligible to participate if you are a licensed, employed RN able to read and write in English.

If you are interested in participating, contact Leslie Neal-Boylan, PhD, RN, associate professor, Yale University School of Nursing, at leslie.neal-boylan@yale.edu or 203-785-3337.

Posted Nov. 9, 2009

The Honor Society of Nursing, Sigma Theta Tau International (STTI) on Nov. 4 inducted board members for the 2009-11 biennium at its annual convention in Indianapolis. The new board members include:   

• President: Karen H. Morin, DSN, RN, ANEF, director of the nursing doctoral program at University of Wisconsin-Milwaukee.
• President-Elect: Suzanne S. Prevost, PhD, PhD, COI, associate dean for practice and engagement, University of Kentucky School of Nursing.
• Vice President: Gwen Sherwood, PhD, RN, FAAN, professor and associate dean for academic affairs, University of North Carolina at Chapel Hill School of Nursing.
• Secretary: Beverly Reigle, PhD, RN, assistant professor, University of Cincinnati College of Nursing.
• Treasurer: Col. Richard Ricciardi, PhD, RN, PhD, FAANP, chief of nursing research service, Walter Reed Army Medical Center, Washington, DC.
• Director: June Clark, PhD, RN, DBE, FRCN, Professor Emeritus of Community Nursing, at Swansea University in Wales, U.K.
• Director: Patrice K. Nicholas, DNSc, MPH, ANP, RN, FAAN, professor at the MGH Institute of Health Professions School of Nursing and Director, Global Health and Academic Partnerships at Brigham and Women's Hospital.
• Director: Hester Klopper, PhD, MBA, RN, RM, RPN, RNM, RCN, RNE, professor and director, North-West University, South Africa.   
• Director: Karen Pehrson, MS, APRN, BC, psychiatric clinical nurse specialist, Southcoast Hospitals Group; visiting lecturer, University of Massachusetts Dartmouth College of Nursing.
• Director: Beth Baldwin Tigges, PhD, RN, CPNP, BC, interim senior associate dean for research and clinical scholarship, associate professor, University of New Mexico College of Nursing.
• Regional Chapters Coordinating Committee Chair: Cathy Catrambone, PhD, RN, assistant professor, Adult Health and Gerontological Nursing at Rush University College of Nursing, Chicago.

Founded in 1922, STTI has inducted more than 400,000 members in 86 countries. Its members include practicing nurses, instructors, researchers, policymakers, entrepreneurs and others. The honor society's 469 chapters are located at 586 institutions of higher education throughout Australia, Botswana, Brazil, Canada, Colombia, Ghana, Hong Kong, Japan, Kenya, Malawi, Mexico, The Netherlands, Pakistan, Singapore, South Africa, South Korea, Swaziland, Sweden, Taiwan, Tanzania, the U.K. and U.S.

For more information, visit www.nursingsociety.org.  

Posted Nov. 6, 2009

Alex's Lemonade Stand Foundation (ALSF) announced the winners of its Nurse Researcher Grants for 2009.The grants, designed to improve the quality of care and life for young cancer patients and their families, will total nearly $250,000 over a 2-year period.

The grant categories, the winners, their facilities and their research projects include:

Mentored Nurse Researcher
Rita Secola, RN, MSN, CPON
Children's Hospital of Los Angeles
$26,300 over 2 years
Central venous catheter related bloodstream infections in pediatric cancer.
For the majority of children diagnosed with cancer every year, treatment will include the use of a central venous catheter (CVC). The CVC maintains reliable intravenous access for medications and treatments, but is also associated with a risk of infection. This risk is particularly important in children with cancer because their immune function remains decreased throughout the treatment period. This research study hopes to reduce CVC related infections in children with cancer.

Intermediate Nurse Researcher
Mary Nelson, MS, RN, CPNP
Children's Hospital of Los Angeles
$20,000 over 2 years
Neuronal damage, neurocognitive losses and quality of life following high-dose chemotherapy in children with brain tumors.
For those who survive brain tumors, neurocognitive deficits are common in the areas of memory, problem-solving and planning. These deficits have been linked not only to poor educational attainment, but also to behavioral and social difficulties, all of which may contribute to poor quality of life. There is some evidence chemotherapy alone may contribute to cognitive effects in patients, but there is little research in the area of these effects in children treated in this manner for brain tumors. The overall objective of this study is to determine whether children treated with high-dose chemotherapy for brain tumors will display key areas of white matter and gray matter injury due to this treatment, which results in deficits in cognitive functioning and decreased quality of life.

Independent Nurse Researcher
Ki Moore, DNSc, RN, FAAN
University of Arizona
$100,000 over 2 years
Effects of CNS treatment on Hippocampus
Acute lymphoblastic leukemia (ALL) is the most common pediatric tumor among children and adolescents in the United States. Central nervous system (CNS) treatment has significantly contributed to the dramatic improvement in long-term disease-free survival of these patients by preventing disease relapse in the brain. Unfortunately, CNS treatment is frequently associated with long-term cognitive and academic problems. Despite problems associated with CNS treatment, little is known about the mechanisms of injury to the hippocampus and even less is known about changes in expression of genes involved in responses to brain injury and cognitive abilities. The purpose of this research is to investigate the effects of methotrexate on the hippocampus. Findings may be used to develop therapeutic strategies to protect the brain from injury, promote synaptic plasticity, and improve cognitive outcomes among the ever increasing numbers of children who are long-term survivors of ALL.

Independent Nurse Researcher
University of California San Francisco
$100,000 over 2 years
Tina Baggott, PhD
Pilot study of the feasibility and acceptability of an interactive computerized symptom assessment tool to assess the disease and treatment-related symptoms experienced by children with cancer.
The use of Patient Report Outcomes in research and clinical care has increased substantially in recent years. Multiple challenges exist when researchers and clinicians collect symptom data from children. One goal of this research is to determine the feasibility and usefulness of a novel interactive computerized symptom assessment tool (SiSom) to be used in both clinical practice and research. The number and type of symptoms reported by children and their parents using a standardized symptom checklist will be compared to the SiSom system. In addition, children's symptom reports will be compared to parent reports.

ALSF added the Nurse Researcher Grant program to an already successful and innovative pediatric research grant program in 2007. Plans are to expand upon this commitment to helping pediatric nurses in 2010 with the first ALSF Nurse Researcher Workshop. The free workshop, slated for April 26-27 in Philadelphia, will be designed to help nurses learn the mechanics of creating a research proposal, securing funds, carrying out research and disseminating findings. ALSF will also cover travel and lodging expenses for those eligible.

For more information on the Nurse Researcher Grant Program and the upcoming workshop, visit www.ALSFgrants.org

For more about the origins of Alex's Lemonade Stand Foundation which emerged from the front yard lemonade stand of cancer patient Alexandra "Alex" Scott (1996-2004) click here. 

Posted Nov. 5, 2009

The Institute for Safe Medication Practices (ISMP) recently released a set of interdisciplinary guidelines to help healthcare organizations safely implement and use smart infusion pumps.

Smart infusion pumps contain software that allows healthcare organizations to create internal medication libraries with dosing guidelines for drugs given intravenously. This helps prevent errors with the amount or rate of medication administered to patients. Users are alerted to potential errors before drug administration begins, and alerts will warn them to recheck the pump setting before proceeding.

In 2007, ISMP formed a steering committee to discuss how smart infusion pumps can best be used to help prevent intravenous drug errors. The committee identified three areas in which to provide assistance - implementation, drug library development, and best use of information provided by the pumps to help prevent future errors from occurring. A national summit was convened to develop a set of guidelines.

The summit, supported by Baxter, B. Braun, CareFusion (formerly Cardinal Health), Hospira and Smith's Medical, brought together healthcare professionals, biomedical engineers, vendors, and representatives from facilities with experience in using this technology. The group created guidelines that focus on a collaborative approach to implementing smart infusion pumps. They also address the limitations of smart pumps and considerations healthcare organizations should keep in mind when using these devices. 

To view a copy of ISMP's smart infusion pump summit proceedings and safe implementation and use guidelines, click here. 

The American Nurses Association has examined the Affordable Health Care for America Act, introduced in late October by the U.S. House of Representatives, and finds there's a lot in it pertaining to nurses.

For instance, the bill would create programs aimed at building the workforce and reimbursing more for services provided by nurse practitioners. Additionally, according to ANA, the bill would, among other things, do the following for nurses.

• Pour a lot of money into educating nurses - an additional $638 million over the next 5 years for various nursing programs to be appropriated from the Public Health Investment Fund. Currently the fund is worth $171 million.
• Increase loan repayment benefits for students and faculty.
• Increase Medicare payment rate by 5 percent for primary care services of primary care practitioners - including nurse practitioners. Eligible practitioners practicing in health professions shortage areas receive an additional 5 percent.
• Establish a demonstration program to reduce the student-to-school nurse ratio in public elementary and secondary schools.
• Authorize nurse practitioners to lead various new models of coordinated care, including the "medical home" and Independence at Home pilot program.
• Create transparency in nursing homes by detailing its staffing ratios, patient census and staff turnover rates on Centers for Medicare & Medicaid's Nursing Home Compare Web site. The bill would also include whistleblower protection for employees who complain in good faith about the quality of care or services at a skilled nursing facility.

Read ANA's full synopsis of the bill here.

-Stacey Miller

Posted Nov. 3, 2009

Among the many honors and awards announced at the Emergency Nurses Association (ENA) annual conference in Baltimore Oct. 7-10 was the induction of eight nurses as fellows of the Academy of Emergency Nursing (AEN). Established in 2004, AEN honors emergency nurses who have made substantial and enduring contributions to the profession of emergency nursing. The 2009 AEN inductees include:

• Nancy Bonalumi, MSN, RN, CEN, past president of the ENA and current director of a national ED consulting company;
• Kathleen Carlson, MSN, RN, CEN, of Hampton, VA;
• Gordon Gillespie, PhD, RN, CEN, CCRN, CPEN, assistant professor at the University of Cincinnati College of Nursing;
• Denise Ramponi, MSN, RN, CEN, APRN-BC, DNP-S, nurse practitioner and physician assistant supervisor in the ED at Heritage Valley Health System in Beaver, PA;
• Ellen Ruja, MSN, RN, CEN, staff nurse at the Medical University of South Carolina, Charleston;
• S. Kay Dedlak, MS, RN, CEN, a nursing instructor at Western Nevada College in Carson City;
• Audrey Snyder, PhD, RN, ACNP-BC, CEN, FAANP, a professor in acute/specialty care in the Center for the Study of Complementary & Alternative Therapies at the University of Virginia School of Nursing; and
• Gayle Walker-Cillo, MSN/EdD, RN, CEN, CPEN, an ED clinician at Morristown Memorial Hospital in New Jersey.

The new AEN fellows join the 62 fellows inducted since 2005, and they will add FAEN to their credentials, indicating their fellow status.

Posted Nov. 2, 2009

To assist nurses desirous of participating as H1N1 vaccinators, the Office of Preparedness and Response (OP&R) of the Maryland Department of Health and Mental Hygiene (DHMH) requested development of an intramuscular refresher/training program.

The Institute for Johns Hopkins Nursing (IJHN) was chosen to design and implement the program. A grant provided by DHMH OP&R provides funding to educate nurses across the state on the knowledge and skills to effectively administer intra-muscular (IM) vaccine injections.

The Johns Hopkins University School of Nursing (JHUSON) and the IJHN quickly put together a program with two components:

1) a self-paced online continuing education activity that illustrates the skills of IM vaccine administration and child restraint; and
2) a skill-competency program provided in 4-hour "train the trainer" sessions.

Online training went live on Sept. 29, and will be available on the IJHN Web site http://www.nursing.jhu.edu the next 2 years. The "train-the-trainer" sessions were held Oct. 1-2.

Nurses who complete the online program and post-test through the IJHN Web site will receive contact hours and a downloadable certificate of completion of the online portion of the program.

Upon completion of the online theoretical portion, nurses are able to then take the hands-on certification portion of the course. The hands-on portion of the course provides nurses with additional validation of skills and competency in the actual administration of IM injections.

"These training sessions will prove to be an invaluable tool for nurses who have to administer vaccinations to a variety of patients," said IJHN executive director Jane Shivnan and a project planning committee member.

Others on the committee included Associate Dean for Academic Affairs Pamela Jeffries, DNS, RN, FAAN, ANEF; instructor Diane Aschenbrenner, APRN, MS, RN, CS; and instructional designer Emily Jones.

Posted Nov. 2, 2009

Clinical Inservices Solutions, LLC announced its CEO, Debra Braun, BS, RN, CEN, has been invited to join Sigma Theta Tau International, Nursing's Honor Society.   

Braun is recognized by the society as a nurse leader for her achievements in nursing, education, curriculum development and entrepreneurial success. The official induction ceremony is planned for Dec. 9.

"I am extremely proud to be included in this elite group of nursing professionals," says Braun. "As a nurse and an educator it is extremely fulfilling to work with patients, advocate for nurses and to offer solutions for adapting clinical workflow through the implementation of medical technologies. There are countless opportunities for nurses to practice safely while bringing the art of nursing to everything they touch."

Clinical Inservices Solutions provides implementation and training support to clinical end-users, as well as change management strategies and workflow efficiencies that aid in increasing adoption of medical technologies.

"We partner with technology vendors to provide experienced nurse educators who understand patient care and clinical workflow," Braun says. "Our peer-to-peer connections and knowledge of the clinical environment allow us to work more effectively with clinical ends users than sales-driven implementation solutions." 

Raleigh, NC-based Clinical Inservices Solutions is currently under contract with several national medical technology vendors who provide hospitals and healthcare systems with patient protection systems, EMR, voice-activated charting, nurse call systems and asset tracking systems.

Braun previously worked in emergency medicine and clinical education for more than 20 years. She has also worked in corporate IT, delivering medical technology implementation and training solutions. She is a member of the Healthcare Information & Management Systems Society (HIMSS) Nursing Informatics Group, the RFID in Healthcare Consortium, American Trauma Society, Emergency Nurses Association, and serves on the National Faculty for Trauma Nursing.

Founded in 1922, the Nursing Honor Society has inducted more than 400,000 members in 86 countries. Members include practicing nurses, instructors, researchers, policymakers, entrepreneurs and others. To learn more visit www.nursingsociety.org.

To learn more about Clinical Inservices Solutions, LLC, visit www.cis4training.com.   

Posted Oct. 30, 2009

In a letter to the CDC, the American Nurses Association has expressed deep concern about shortages of fitted N-95 respirators, the equipment CDC recommends as the minimum level of respiratory protection for healthcare workers who could be exposed to the H1N1 virus.

Several state nurses associations have told ANA nurses are indicating difficulties in obtaining the N-95 respirators on the job, and hospitals in their states are reporting shortages of the N-95s.

ANA also questioned a strategy outlined by CDC whereby N-95 respirator use would be prioritized for healthcare personnel where shortages exist, leaving other workers to use facemasks. ANA said it is widely acknowledged facemasks were not intended to be "personal protective equipment," calling facemasks merely a "better than nothing" device since they don't filter airborne particles and they do leak.

"Registered nurses want to come to work and do our jobs to take care of patients. We historically have put patients' needs ahead of our own," said ANA President Rebecca M. Patton, MSN, RN, CNOR. "So it's absolutely essential to have adequate protection from exposure to the H1N1 virus. If nurses get sick and can't come to work, who will take care of patients? It is reasonable to hold our employers accountable for providing necessary equipment to protect the safety of healthcare employees and our patients.

"Considering all the national planning that has taken place in the past few years to prepare to respond to a pandemic, it is inexcusable to be facing shortages of personal protective equipment at this stage," Patton continued. "Employers need to improve their commitment to support and protect RNs and all other direct healthcare workers so we can safely care for patients without putting ourselves and patients at undue risk and harm."

Posted Oct. 28, 2009

The Harvard Health Publications Division of Harvard Medical School has launched an iPhone application focused on the H1N1 flu pandemic.

The H1N1 iPhone application includes science-based information on the state of the pandemic's spread; practical steps people can take to mitigate their risk of infection; key symptoms to watch for; and how to act in case of a suspected infection.  

The application includes video content as well as text, animated illustrations and links to government databases.  In addition, the application provides businesses with specific information on how to best prepare their enterprises for managing through the pandemic, developed in collaboration with Harvard Business School Publishing.

Since the first outbreak of the H1N1 flu earlier this year there have been more than 180,000 cases of infection globally, according to the World Health Organization, and the White House has called 160 million infections, with 90,000 deaths this winter a plausible scenario for the U.S. 

The H1N1 iPhone application is the first of a series of such applications to be part of HMSMobile from Harvard Medical School and The Imagine Network. Over time, HMSMobile plans to expand its offerings to include content for additional platforms beyond the iPhone series as different mobile devices add similar functionality.

Posted Sept. 25, 2009

FDA has issued a Public Health Alert to notify prescribers and pharmacists about potential dosing errors with Tamiflu (oseltamivir) for Oral Suspension.

FDA has received reports of errors where dosing instructions for the patient do not match the dosing dispenser.

U.S. healthcare providers usually write prescriptions for liquid medicines in milliliters (mL) or teaspoons, while Tamiflu is dosed in milligrams (mg). The dosing dispenser packaged with Tamiflu manufactured by Roche Laboratories, Inc. has markings only in 30, 45 and 60 mg.

According to FDA, healthcare providers should write doses in mg if the dosing dispenser with the drug is in mg. Pharmacists should ensure that the units of measure on the prescription instructions match the dosing device provided with the drug.

Click here to read the complete FDA MedWatch 2009 Safety summary, including links to the FDA Public Health alert, the "Dear Healthcare Professional" letter from Roche and Information for Pharmacists from the CDC.

Posted Sept. 22, 2009 

Two innovative and highly successful models of care developed by nurses were the centerpiece of a recent briefing on healthcare reform in Washington, DC.

The event brought together women's health leaders and healthcare experts, and focused on the ways in which innovative healthcare models can help to improve efficiency, reduce costs and ensure quality care for patients and their families.
 
The briefing, On the Edge of Reform: Innovative Health Care Models, was sponsored by the American Academy of Nursing (AAN), which directs the Raise the Voice campaign. 

Raise the Voice showcases the ways in which nurses are leading the way in transforming the health care system and informs policy makers of these innovations and their success with an eye toward seeing those innovations replicated. The campaign is supported by a grant from the Robert Wood Johnson Foundation.

Among the presenters were Mary Naylor, PhD, RN, FAAN, architect of the Transitional Care Model for the Frail Elderly, University of Pennsylvania School of Nursing; and Katherine Kinsey, PhD, RN, FAAN, principal investigator and administrator of the National Nursing Centers Consortium's Philadelphia Nurse-Family Partnership Program.

In response to the need for expanded monitoring and reporting of healthcare-associated infections (HAIs), the Association for Professionals in Infection Control and Epidemiology (APIC) announced June 3 its support for the use of automated surveillance technologies in the healthcare setting as an essential part of infection prevention and control activities.

Surveillance technologies are computerized systems designed to collect infection data, thereby allowing infection preventionists to rapidly protect patients by identifying and investigating potential clusters of HAIs in real time.

Most healthcare facilities currently use a manual surveillance method that can be limited in scope and is labor intensive. Automated surveillance technologies streamline the review and collection of data, providing a larger amount of information and reducing staff time spent on surveillance and clerical tasks.

The recommendations are published in the APIC position paper, The Importance of Surveillance Technologies in the Prevention of Healthcare-Associated Infections (HAIs).

The APIC position paper outlines many benefits of automated surveillance, including efficient review of infection data, rapid identification of outbreaks, expanded and better-defined infection prevention activities, reduced infection prevention department time spent on surveillance and clerical tasks, improved response to public health issues, assistance with regulatory compliance, and enhanced antibiotic stewardship programs.

"Automated surveillance eases the burden of data management for infection preventionists and allows them to focus on the activities that protect patients, like walking rounds, observing procedures and educating healthcare personnel," said Linda R. Greene, MPS, RN, CIC, lead author of APIC's position paper and director of infection prevention and control at Rochester General Health System. "In addition, it can help hospitals save money by targeting areas for tailored elimination strategies that reduce infections and excess cost."

In a recent survey of APIC members, only one in five had electronic data-mining technology.

"Surveillance of [HAIs] is the cornerstone of effective infection prevention programs, but without automation it consumes a considerable amount of an infection preventionist's time. This limits time spent on what is value-added to the patient - education of healthcare personnel and performance improvement activities," Greene said. "Automated surveillance offers a more efficient and accurate means of obtaining HAI data, provides the opportunity to expand surveillance beyond typical high-risk areas within the healthcare facility and allows infection preventionists to improve prevention practices."

Visit the APIC Web site for more information on Surveillance Technology Resources.

More than two-thirds of adult Americans agree the U.S. healthcare system needs to put more emphasis on chronic disease preventive care than on treatment, and they are willing to pay higher taxes to fund those programs, according to a new survey by the National Association of Chronic Disease Directors (NACDD).

The survey also found Americans across all income groups believe congress needs to do more to pay for prevention programs.

More than two-thirds (68 percent) don't think congress is doing enough to fund these programs, and 43 percent say they are more likely to vote for candidates who support increased public health spending, the survey found. More than four in five Americans (84 percent) favor public funding for programs to help prevent chronic disease.

According to CDC, chronic diseases are the leading cause of death and disability in the U.S., affecting 133 million Americans, or 45 percent of the population. They are responsible for seven out of every 10 deaths, killing more than 1.6 million Americans every year. In the U.S., 75 cents of every $1 spent on healthcare goes toward the treatment of chronic disease, according to CDC.

"This survey shows Americans believe prevention is the cornerstone to good health, but more funding is needed to achieve a healthy America," said John Robitscher, MPH, NACDD executive director. "More than 50 percent of Americans are not satisfied with the quality of their healthcare, and believe more funding should be allocated to preventive care."

Other NACDD survey findings: 

• 67 percent of Americans are worried about being able to afford necessary healthcare.
• 92 percent of Americans say lack of health insurance is a problem in the U.S.
• 95 percent of Americans say the greater incidence of health problems among Americans with lower incomes is a big problem.
• 83 percent of Americans believe that healthy workers have a strong impact on economic productivity.

The survey, Americans and Public Health: Attitudes Toward Public Funding for Public Health and Chronic Disease, was conducted for NACDD by TSC, a division of Yankelovich, Inc. 

The survey was conducted by telephone within the U.S. between Aug. 21 and 24, 2008, among 1,000 adults (aged 18 and over).  Figures for age, sex, race/ethnicity and region were weighted to ensure reliable and accurate representation of the total U.S. adult population. The margin of error for this study was +/- 3.1 percent.

NACDD was founded in 1988 to link the chronic disease program directors of each state and U.S. territory to provide a national forum. It provides state-based leadership and expertise for chronic disease prevention and control at the state and national level. Further information about NACDD is available at http://www.chronicdisease.org/.

The American Association of Critical-Care Nurses (AACN) launched a major upgrade to the Essentials of Critical Care Orientation (ECCO), dubbed EECO 2.0.

The proprietary e-learning program is a comprehensive introduction to the fundamentals of critical care nursing, providing the theoretical foundation necessary to care for critically ill patients, according to AACN.

Like all AACN e-learning courses, ECCO 2.0 is an easy-to-navigate, interactive Internet-based program. Experts in nursing and nursing education designed the content utilizing the most current adult learning theories.

ECCO provides a total of 69 hours of CE credit and is composed of 10 learning modules, organized using a body systems approach:

• Introduction to Care of the Critically Ill
• Care of the Patient with Cardiovascular Disorders
• Care of the Patient with Pulmonary Disorders
• Basic Hemodynamic Monitoring
• Care of the Patient with Neurological Disorders
• Care of the Patient with Gastrointestinal Disorders
• Care of the Patient with Renal Disorders
• Care of the Patient with Endocrine Disorders
• Care of the Patient with Hematological Disorders
• Care of the Patient with Multisystem Disorders

Modules are comprised of multiple lessons that provide in-depth, interactive content with rich graphics and illustrations that keep learners engaged. Each module addresses the anatomy and physiology of the body system, relevant diagnostic information, and the clinical presentation and management of common disorders for each of the body systems.

"Since its inception in 2002, learners and learning administrators have given us valuable feedback about the content of ECCO and what improvements were needed," said AACN CEO Wanda Johanson, MN, RN.

"For this highly anticipated upgrade, we have responded to these comments by including more interactivity, more case studies and more critical thinking exercises," Johanson continued. "In ECCO 2.0, nurses will find the content they have come to count on, as well as new content we believe makes ECCO a more exceptional orientation program."

For more information on ECCO 2.0 and other AACN e-learning products, call 800-899-2226 or visit www.aacn.org/e-learning.

AACN is the largest specialty nursing organization in the world, representing the interests of more than 500,000 acute and critical care nurses. Its international headquarters are located in Aliso Viejo, CA.  Founded in 1969, the association has more than 240 chapters worldwide. For more information, visit www.aacn.org.