Category Archives: Nursing

Report details errors in waiting-room death

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Philadelphia Inquirer‘s Tom Avril reports on how hospital errors led to the death of a 63-year-old north Philadelphia guidance counselor. Avril opens his story by painting a picture of hospital operations, one based on documents released after a state investigation.

electronic medical recordsPhoto by exvertebrate via Flickr

Twice, when an emergency-room nurse called out the name of Joaquin Rivera and he did not respond, she had no idea he’d already suffered a massive heart attack.

The reason: The nurse did not venture beyond the waiting-room doorway and simply did not see him where he sat, unattended, for nearly an hour.

Avril reported that the hospital has already taken steps to prevent a similar occurrence in the future, including:

  • Increasing security by more than 30 percent
  • Creating new training for registration staff, with an emphasis on communication with nurses
  • Instituting a policy of calling patient names every 10 minutes if they don’t answer at first
  • Identifying a location on the waiting-room floor from which all parts of the room can be seen and marking it with tape so that triage nurses know where to stand when calling out names
  • Hiring an architectural firm to see if further improvements can be made

Temp agencies a haven for problem nurses

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Calling it a “free-wheeling, $4-billion industry” fueled by the nation’s chronic nursing shortage, ProPublica reporters Tracy Weber and Charles Ornstein take on the firms that supply temporary nurses to American hospitals (Los Angeles Times version here). In the story, the reporters say they “found dozens of instances in which staffing agencies skimped on background checks or ignored warnings from hospitals about sub-par nurses on their payrolls. Some hired nurses sight unseen, without even conducting an interview.”

iv
Photo by timsamoff via Flickr.

Although the healthcare system as a whole is increasingly regulated, the nurse staffing industry remains a Wild West. No one knows how many agencies exist nationwide; estimates range from 3,000 to 6,000.

Ornstein, AHCJ’s president, and Weber found plenty of cases to back up that ‘Wild West’ impression. In some cases, firms shift problem nurses from hospital to hospital as trouble arose and, even when a nurse was tossed from one temp firm, he or she usually had no problem finding work at another. Nurses were hired with criminal backgrounds and licenses that were revoked in other states. They often allow employees to prove their “competency” through online tests, and are sometimes fly-by-night operations run by people with no prior nursing experience.

In the end, the reporters found that while there is a clear divide between the best and worst temporary nurse staffing organizations, it’s not always easy or possible for hospitals to figure out which is which.

Nursing blog marks anniversary of landmark report

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

In a two-week series of posts, the INQRI blog – the blog of the Interdisciplinary Nursing Quality Research Initiative – is recognizing the 10th anniversary of “To Err is Human,” the groundbreaking report that found that as many as 98,000 people die each year from medical errors in hospitals.

A nurse vaccinates a child in this CDC photo.

A nurse vaccinates a child in this CDC photo.

The latest post, written by Barbara Olson of Florence dot com, looks at the building blocks of better health care. She says that ten years of studying how to make health care reliable has revealed that “things like speaking clearly, repeating words to be certain they have been understood; taking turns; using “inside” voices; and getting plenty of rest matter when individuals rely on complex processes to deliver intended outcomes. (Even “time-outs” have made a comeback!)”

Earlier posts include a Q&A with Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston; one that warns that we may not have made much progress in the area of patient safety; and a post about a nurse researcher who has found that a positive work environment helps nurses catch errors before they harm patients.

Slip of the needle brings fallout, tough decisions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for The New York Times, AHCJ member Sibyl Shalo Wilmont shares the chain of events that followed when she accidentally injected herself with a drop of a patient’s blood.

needle
Photo by hitthatswitch via Flickr.

A quick test showed the patient was likely negative for HIV, but Wilmont still had to decide whether or not to undergo post-exposure prophylaxis, a grueling cycle of treatment that would continue for at least a month. Wilmont had covered post-exposure prophylaxis as a journalist and her knowledge for that helped guide her decision.

Feds take Columbia to task over decade-old study

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The run of intriguing health journalism from the Huffington Post Investigative Fund continues this week, as Jeanne Lenzer and Shannon Brownlee look at the federal government’s entrance into an internal conflict at Columbia University’s medical center over the legality and morality of a heart-related study that took place from 1999 to 2001, one in which some experts say it was “virtually guaranteed” that some patients would suffer hemorrhaging.

milsteinhospital
Milstein Hospital Building at Columbia Presbyterian Medical Center, photo by Samat Jain via Flickr.

Columbia has already conducted three internal investigations on the matter. Now, the federal government has asked for a full account of what happened to the study’s participants and ordered that Columbia write a letter to the study’s participants and disclose the “true nature” of what some contend was a deceptive study.

NOTE: In addition to the story itself, the reporters have posted a selection of key documents online.

Lenzer and Brownlee explain that the study went wrong when participants (some of whom were “Spanish-speaking patients who lived in low-income neighborhoods near the hospital”) “were not told that they could be given high doses of the fluids or that they faced a risk of serious bleeding.” Then, despite protests from hospital doctors that patients hadn’t been informed of what were serious possible health risks, the local Institutional Review Board allowed the study to continue. This was followed by years of internal fighting, and finally capped by the HHS’ Office of Human Research Protections entrance into the fray.

Access to list of disciplined health workers in limbo

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

NPR’s Joseph Shapiro looked into the status of the Healthcare Integrity and Protection Data Bank, a database of nurses, nurse aides, pharmacists and pharmacy assistants who have been disciplined by state boards.red-tape

The 22-year-old database was supposed to be open to hospitals and nursing homes for background check purposes, but has been tied up in layers of bureaucracy. A policy for opening it up was written during the later years of the Bush administration, but the president decided to defer the decision to his successor.

Shapiro writes that the plan for opening the database is now under review by the Obama administration: “A spokeswoman for the Department of Health and Human Services says things are on track. And that maybe by early next year, the department will open the registry of disciplined nurses, aides and pharmacists.”

Related

Public Citizen has posted an open letter to HHS Secretary Kathleen Sebelius requesting that the proposals to open the database be put into effect “immediately.” The letter explains why the database is important, and details the consequences of keeping it under wraps.