Patient early warning detection system reduces mortality rates by 35 percent

October 23, 2014

October 21, 2014 | By Katie Sullivan/Fierce Healthcare

Patient early warning detection system alerts staff to minor changes in a patient’s conditions and can help prevent more serious events down the line and reduce mortality rates.

St. Joseph Mercy Oakland hospital in Michigan implemented a detection system with the overall goal of reducing mortality rates, David Bobryk, clinical informatics project, said in a video interview with Suzanna Hoppszallern, senior editor of Hospitals & Health Networks.

Patients wear a monitor on their wrists that continually tracks their vital signs–blood pressure, respiratory rate, pulse rate, pulse oximetry and body temperature–and sends the information to an electronic health record. The stats then travel to monitors that calculate a wellness index measured from a 0 to 5 scale. If patients’ vitals rank from 0 to 2.9, they’re in the clear “green” zone, but if they jump to 3.0 or above, a dangerous “red” zone, nurses on the unit are alerted to check on the patients.

“This tool helps combine that into a single value and makes it really easy for the clinician–green 0 to 2.9 the patient is doing well–red, 3.0 to 5.0 you need some action on the patient,” Bobryk said during the interview.

While using the tool over the course of a four-year study, Bobryk said the hospital reduced mortality rates by 35 percent, while code blues were cut in half and the average length of stay were cut by 5.3 percent.

Clinicians and staff are sometimes skeptical of new technologies, but Bobryk said the hospital broke down those barriers and resistance by allowing nurses to take the tool home with them and monitor themselves at home. They also included staff and hospital leadership in the design meetings from the very beginning.

Ebola: CDC Tightens Protection Rules

October 22, 2014

Published: Oct 21, 2014/By Michael Smith, North American Correspondent, MedPage Today/Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Faced with dismay over the Ebola infection of two nurses, the CDC has tightened its guidance for personal protective equipment.

The major change in the new guidance is an insistence that no skin be exposed during the care of an Ebola patient.

But the CDC is also insisting that people likely to treat Ebola patients need to practice putting on and taking off the equipment safely, and that hospitals have a trained monitor to observe both procedures.

“There’s no alternative to hands-on training,” Frieden said, adding that “it’s an important message for healthcare workers that these are three comprehensive aspects.”

The CDC now says personal protective equipment should consist of:

  • Double gloves
  • Boot covers that are waterproof and go to at least mid-calf or leg covers
  • Single-use, fluid-resistant or impermeable gowns that extend to at least mid-calf or a coverall without integrated hood
  • Either N95 respirators or powered air purifying respirators
  • Disposable single-use full-face shield
  • Surgical hoods to ensure complete coverage of the head and neck
  • A waterproof apron that covers the torso to the level of the mid-calf in the event Ebola patients have vomiting or diarrhea

The guidance no longer recommends goggles, arguing they might leave skin exposed, are not disposable, and might fog up, tempting healthcare workers to manipulate them with gloved — and possibly contaminated — hands.

Screening and Triage

While a great deal of attention has been paid to protective equipment, it’s “just one aspect of infection control,” Frieden said, and such things as screening and triage are also “critically important.”

“Every healthcare worker needs to learn how to screen a patient who may have Ebola,” he said, including making sure to ask about a travel history.

For Full Article, see Medpage Today.

AHA Includes Depression as Risk Factor for Cardiac Disease

April 14, 2014

Depression is common after acute coronary syndrome (ACS), according to a brief review by the authors featured as part of the current American Heart Association (AHA) Scientific Statement. It is encountered in approximately 20% of patients hospitalized for ACS, compared with a prevalence of approximately 4% in the general population. Depression not only reduces quality of life among these patients but also might increase the risk for recurrent cardiac disease. Potential mechanisms by which depression can increase cardiovascular risk include neuroendocrine dysfunction, enhanced platelet activity, and endothelial dysfunction, as well as lifestyle factors (sedentary behavior, smoking, etc) noted to be worse in the presence of depression.

Depression should join the ranks of obesity, diabetes, hypertension, and smoking as an official heart disease risk factor, according to an expert panel convened by the AHA (American Heart Association).

The recommendation is based on an extensive literature review examining the risks for depression conducted by the panel, which included Robert M. Carney, PhD, professor of psychiatry at the Washington University School of Medicine in St. Louis, Missouri.

The AHA Scientific Statement notes that the combined findings support the call to formally “elevate depression to the status of a risk factor” for adverse outcomes, such as all-cause and cardiac mortality, in patients who have ACS.

“It was very gratifying to see this recommendation at this time and know that the potential risks are appreciated,” Dr. Carney, who is also a member of the AHA Statistics Committee of the Council on Epidemiology and Prevention and the Council on Cardiovascular and Stroke Nursing, told Medscape Medical News.

“We’re hoping that eventually we’ll be able to show that treating depression will improve survival and heart health. Although that story remains to be done, I’m happy we’ve come this far,” Dr. Carney added.

The Scientific Statement was published online February 24 in Circulation.

Lowe’s and Walmart: Surgery’s On Us

January 11, 2014

Outpatient Surgery/Daniel Cook/Published October 15, 2013

The retail giants offer employees and their families free joint replacements.

Lowe’s and Walmart have partnered with 4 hospital systems to offer complimentary hip and knee replacements to employees and their families. 

The retail giants combined forces with the San Francisco, Calif.-based Pacific Business Group on Health Negotiating Alliance to launch a national Employers Centers of Excellence Network, which aims to provide workers of large employers with quality, affordable health care. 

Individuals who opt for the free surgery must travel to one of the following partner facilities to have it done:

-Johns Hopkins Bayview Medical Center in Baltimore, Md.

-Kaiser Permanente Orange County Irvine Medical Center in Irvine, Calif.

-Mercy Hospital in Springfield, Mo.

-Virginia Mason Medical Center in Seattle, Wash.

Safety: 4 Ways to Stop DVT in Its Tracks

November 15, 2013

September 2013/Cheryl Marsh, BS, RN, CNOR/Outpatient Surgery

The stakes are high when it comes to preventing deep vein thrombosis and pulmonary emboli. Between 300,000 and 600,000 people suffer DVT and PE each year, with 60,000 to 100,000 ultimately dying from the complications. When it’s not fatal, DVT can cause post-op morbidity, prolonged hospitalization and increased healthcare costs. An essential part of caring for surgical patients is to understand your role and responsibilities in preventing clots from forming. 

1. Know the facts. 

DVT commonly occurs when blood flow changes, which could cause clots to form in deep veins, often in the calf or thigh and less commonly in the chest or arm. Pulmonary emboli develop when clots break free from veins and travel to the lungs. The condition can prove fatal within minutes or hours.

Who’s at risk? Anyone who undergoes surgery, because injuries to vessels when surgeons operate and changes in blood chemistry caused by dehydration or general anesthetics increase the likelihood of clots forming. That said, the more invasive procedures in the abdomen or lower extremities put patients at increased risk. 

Other factors that heighten DVT possibilities include advanced age, obesity, recent physical trauma, varicose veins, personal or family history of circulation problems, surgeries lasting longer than 45 minutes and hip or knee replacement surgery. 

2. Pick the prophylaxis.

Muscles in prone, anesthetized patients aren’t working as they normally would; even sleeping individuals move slightly every few minutes to keep blood flowing properly. 

Two effective preventative measures against DVT:

  • Sequential compression devices. SCDs combat venous stasis and coagulation changes by squeezing legs to stimulate muscles and move blood through the veins.
  • Anti-embolism stockings. Stockings protect against venous stasis and vessel wall damage by keeping leg muscles tight and firm, which reduces pooling of blood in the veins.

Using both in combination therefore protects patients against all 3 risk factors of DVT. The stimulation and constriction combine to regulate the blood’s chemistry and break down any blood clots that might form. 


Case Report: Chronic Marijuana Use Potential Cause For Hypopituitarism

September 3, 2013

By Naseem S. Miller, Internal Medicine News Digital Network/Clinician Reviews

Phoenix — Chronic marijuana use can be a potential cause for hypopituitarism, according to an unpublished case report, which relied on existing data about the effect of cannabis on the hypothalamic-pituitary-gonadal axis.

The case hints at a largely underrepresented problem, researchers said, especially as various states contemplate legalizing marijuana, which is currently the most commonly used illicit drug in the nation, said Dr. Richard Pinsker at the annual meeting of the American Association of Clinical Endocrinologists.

The case describes a 37 year old man who was medically worked up and found to have hypopituitarism due to chronic marijuana use.

Dr. Pinsker said that the finding calls for further research on the effect of marijuana on the endocrine system.


Jury Awards $2 M to Plaintiff, Finds Bard’s Vaginal Mesh Device Defective

September 3, 2013

Posted August 16th, 2013 by Jennifer Mesko/ by Doug Allen

Charleston, W.Va. — A jury here awarded $2 million on Thursday to a plaintiff who claimed a transvaginal mesh device permanently injured her, causing constant pain and requiring several surgeries to remove. The four men and four women deliberated about 12 hours before reaching a unanimous decision in the first mesh trial in federal court.

“I feel this trial represented me and all the other ladies affected by this product,” Donna Cisson told Drugwatch in an exclusive interview after the verdict. “I hope this trial set a precedent for all the other women who have this product in their bodies…Please continue to pray for me and all the other ladies who have been affected.”

The verdict comes a year after a jury in California found in favor of Christine Scott and ordered Bard to pay $3.6 million.

Tracing Germs Through the Aisles

July 30, 2013

By Sabrina Tavernise/July 29, 2013/New York Times

Twice a month for a year, Lance Price, a microbiologist at George Washington University, sent his researchers out to buy every brand of chicken, turkey and pork on sale in each of the major grocery stores in Flagstaff, Arizona. As scientists pushed carts heaped with meat through the aisles, curious shoppers sometimes asked if they were on the Atkins diet. 

In fact, Professor Price and his team are trying to answer worrisome questions about the spread of antibiotic-resistant germs to people from farm animals raised on industrial farms. Specifically, they are trying to figure out how many people in one American city are getting urinary tract infections from meat from the grocery store. 

Researchers have been warning for years that antibiotics – miracle drugs that changed the course of human health in the 20th century – are losing their power. Some warn that if the trend isn’t halted, there could be a return to the time before antibiotics when people died from ordinary infections and children did not survive strep throat. Currently, drug resistant bacteria cause about 100,000 deaths a year, but mostly among patients with weakened immune systems, children and elderly. 

Governments have begun to acknowledge the danger. The United States recently promised $40 million to a major drug company, GlaxoSmithKline, to help it develop medication to combat antibiotic resistance. But Dr. Price says that new drugs are only a partial solution. 

For full report see NY Times/July 29, 2013

University Hospital Administrators Trade Suits For Scrubs

May 24, 2013

Hospital leaders shadow nurses to experience direct patient care

May 22, 2013 | By 
A dozen administrators at San Antonio’s University Hospital found out first-hand today what it’s like to be a nurse on its Level I trauma center. The leadership team, which typically spends its day attending meetings and pushing paperwork, shadowed nurses instead and watched them deliver care to the region’s most sick and injured patients, the San Antonio Business Journal reported.

The event, “Walk in My Shoes,” is an opportunity for health system leaders to see direct patient care in action and better understand the role nurses play at the hospital, says Julie Wiley, spokeswoman for University Hospital, which is part of the University Health System. The hospital leaders trading in their business suits for scrubs included the CEO, vice president and chairman of the board.

While nurses are busy helping to save lives and care for patients, hospital leaders are busy focused on budgets, strategic planning and other administrative work. They rarely get to see what goes on behind-the scenes of healthcare, Wiley explained. The administration team met in the morning for their assignments and will discuss their experiences later today with the group.

“It has been an eye opening experience so far,” A.J. Sandoval, chief of police for the health system, told FierceHealthcare after spending part of his morning paired with a nurse in the inpatient dialysis unit. “The nurses are so professional, skilled and knowledgeable. But what is remarkable to see is the compassion they have for their patients. And I don’t think it was because I was there watching. They are genuinely compassionate people.”

Wiley said the hospital first launched the program in 2008. The event coincides with National Nurses Week, typically held in May.

Read more: University Hospital administrators trade suits for scrubs – FierceHealthcare 
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Clinical Notes: FDA Turns Up Heat On Compounders

April 15, 2013

By John Greer, Deputy Managing Editor, Medpage Today/April 14, 2013

FDA inspectors found all but one of 29 compounding pharmacies making sterile products to be violating federal standards. 

FDA Finds Fault With 28 Compounding Pharmacies

FDA inspectors issued violation notices to 28 compounding pharmacies after surprise inspections – that is, nearly every pharmacy they visited that was producing supposedly sterile drugs. 

Among the deficiencies:

“Unidentified black particles floating in vials of supposedly sterile medicine.”

Mold in clean rooms.

Workers handling sterile products with their bare hands and wearing nonsterile lab coats.

Following the inspections, several of the pharmacies issued voluntary recalls and others stopped production in order to correct problems, according to FDA Commissioner Margaret Hamburg, MD. 

For full story, see Medpage Today’s website. 


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