June 30, 2008
Is the Joint Commission Really Necessary?
The declared mission of this private organization is "To continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." It is often believed (erroneously) that The Joint Commission is an American or even a worldwide public authority, which is not the case. This perception occurs because of the company's deeming power - "Under 42 U.S.C. §§ 1395bb(a),(b), a hospital that meets Joint Commission accreditation is deemed to meet the Medicare Conditions of Participation" (which is a requirement for Medicare reimbursement).
The Joint Commission is therefore virtually a monopoly, enjoying unique statutory protection in the USA and collecting $113 million in annual revenue, mainly from the fees it charges US hospitals for evaluating their compliance with federal regulations. From what I am hearing the Joint Commission has been making the rounds among NYC Hospitals -- the most recent survey taking place at Bellevue Hospital. Nursing administrators have been reviewing with all of us “what to say and not say to a surveyor.” It seems to me that the Joint Commission is more of a punitive agency than anything else. Right or wrong?
In my more than 20 years of nursing practice, I have never met or seen the Joint Commission within the medical facility reviewing charts or interviewing staff. I must be working the wrong shift (nights)! Not a single question has ever been asked of me by a surveyor. As for the surveyors, the Joint Commission utilizes full-time salaried individuals, people who generally used to work within healthcare services, but who now work 100% of their time for the accrediting Commission.
What are your thoughts about the mission of the Joint Commission? Are they doing what they are supposed to be doing?
Source : The Joint Commission
Change of Shift -- Nursing Specialties Edition
This edition of Change of Shift highlights all of the various nursing specialties, hosted by an ER nurse. It is not to be missed!
June 23, 2008
The MRSA Bug
I just watched the video Webcast Video Editorial : Spread of MRSA : Past Time for Action, and the letter written in response to this editorial. There are also a good number of interesting comments from a variety of health professionals about these topics.
I can’t argue against the fact that we have a rising threat of MRSA infection within US hospitals. How many times have you worked and not seen a soul from the Housekeeping Department for hours? Or cleaned a room yourself as the admitting patient waited in the hallway? Or seen overflowing garbage in your “open chest case room?” How often do you see physicians who don’t wash their hands after packing a wound or examining a patient? And do nurses always wash hands between every patient encounter?
What are the biggest culprits in the spread of MRSA and other superbugs within a medical facility today? Are healthcare workers the ones responsible for the spread of MRSA? I see plenty of blue and green scrubs walking down York Avenue. Where have those scrubs resided for the day?
What about basic hygiene -- the use of alcohol-based disinfectants and handwashing? Bathing patients? Should all patients being admitted to an ICU be placed on contact isolation? (Of course, eventually there is a low supply of isolation gowns by the week‘s end…)
I do think basic education and increased awareness would be of benefit – for those who work within the system and those receiving care from the system.
This resource is not brand new, but very helpful: Questions About MRSA and Answers From the Experts
What are your thoughts? Have you made changes in your workplace? What should we be doing better?
June 18, 2008
What Do Patients Really Want?
Have you ever thought about what your patient in Room 9 really wants most? What the retired police officer waiting for a heart transplant in Room 16 wants? How Bill, who has suffered with hemochromatosis for 11 years and just been readmitted for mild liver failure, wants?
The results of a study in the UK of 1000 patients tell us that the number one thing patients want is thoroughness. That actually surprised me. I'm thinking that perhaps what those who have a national healthcare system (as they do in Great Britain) want, and what we Americans who have a private system want may be two different things.
In order after thoroughness, here is what British patients report as most valuable:
* Seeing a doctor who knows them well
* Seeing a doctor with a warm and friendly manner
* Having a shorter waiting time for an appointment
* Having flexibility in selecting appointment times
Hmmm.... as a nurse, knowing what I know, and working in the environment I work in, my values are a bit different, as follows:
* I want a doctor (or other provider) who is competent and knows what she/he is doing
* I want a doctor who can explain to me what is going on in my body and what my options are for fixing it
* I want a doctor who will take enough time to oversee my treatment so that no mistakes are made: no drug errors, no surgical errors, and no infections acquired if I have to be in the hospital
* I want a doctor who will coordinate my care, follow up when I've been to see another doctor, and help me keep the big picture in mind so I'm not being treated by drive-by specialists.
For those of you who have had the experience of being a patient, what have you wanted? Specifically—what have you most wanted from your nurses? (Let’s skip the doc part!)
June 13, 2008
To Picket or Not?
Have any of you joined a nursing picket line? Our State Nurse’s Union called last week, informing all members that a picket was planned at the multiple campus sites in the city that make up the healthcare conglomerate of New York-Presbyterian.
The strike tactic has a very long history. Towards the end of the 20th dynasty, under Pharaoh Ramses III in ancient Egypt in the 12th century BC, the workers of the royal necropolis organized the first known strike or workers' uprising in history.
A strike is typically reserved as a threat of last resort during negotiations between the company and the union, which may occur just before, or immediately after, the contract expires. The nurses’ contract had expired in December 2007. Agreements about staffing levels apparently could not be resolved. Neither side felt like budging from their stance or attempting to compromise. It’s not like this was a new subject matter for either party. Were we all being sleeping giants when it came to taking a stance? Had we all become complacent about the work environment over time?
Picketing was the choice of action chosen by all. Picketing outside the workplace is intended to prevent or dissuade people from working in their place or conducting business with the medical center. A matter of disruption!
Personally I had never experienced a picket line, let alone a sit-down strike, when workers may occupy the actual workplace, but refuse either to do their jobs or to leave. Makes you wonder if the impact of a sit-down strike versus a picket line strike would have on a medical center? Wonder if all would agree on contract differences much more quickly with a bit less defiance from either side?
What are your experiences with the picket line? Were Union goals accomplished? How did your workplace’s administrative staff handle the picket line?
June 12, 2008
A Flash Back to the Past
You've got to check out this version of Change of Shift, if only to see the old photos of the nursing instructors many of us remember!
June 04, 2008
Do You Remember Your First Patient?
Her name was Alice and she was 98 years old. She had lived a long life. It was my first day of ICU orientation. Room 9 was the room where she was surrounded by her extensive family -- sons, daughters, grandchildren, nieces, and nephews. They all swarmed around the room, exchanging sit-times with her. I wondered how I was even going to get to her to assess her.
Alice was dying. DNR -- Do Not Resuscitate was the order. Morphine slowly infused into a tiny right hand vein. DNR- What was I supposed to do? As a new nurse, I had just learned ACLS and was ready to jump and give a pre-cordial thump on anyone. I knew it was going to be a long night.
I recall entering the room, introducing myself and then directly focusing on Alice. Mouth and skin care were given. The family wanted to help, in any way that they could. They helped me turn her, and a daughter gave a soothing backrub. And so, the routine began until the cardiac monitor began showing a dropping heart rate. Gently, I turned off the monitor and sat with the family holding a daughter’s hand as tears brimmed my own eyes. For eight hours I had listened to stories of Alice’s life -- of growing up in Nebraska, of meeting the love of her life, of joining the Peace Corps, of chopping wood, of her favorite flower - the rose, of cooking large Thanksgiving dinners, of vibrancy and life.
Life was now ending. A bleep from the monitor could be heard. Silencing it, I let the family sit and hold her before calling in the physician for the standard pronunciation of death. No HR, no BP, no respirations.
Yes, this was my first patient in ICU. It was eventful, emotional, and a true learning experience -- one that I will never forget. No longer am I afraid of death and dying.
Do you remember your first patient?