Category Archives: Medical errors
What drives “decision regret,” the negative cognitive emotion that occurs when an actual outcome differs from the desired or expected outcome? For nurses, fatigue is a big factor, according to a study in the current issue of the American Journal of Critical Care.
The study found that nurses impaired by fatigue, loss of sleep, daytime sleepiness, and an inability to recover between shifts are more likely than well-rested nurses to report decision regret. And while decision regret reflects previous decisions and adverse outcomes, it may also contribute to work-related stress and compromise patient safety in the future, the researchers found.
“Registered nurses play a pivotal role as members of the health care team,” lead author Linda D. Scott, RN, PhD, NEA-BC, FAAN, associate dean for academic affairs and an associate professor at the University of Illinois at Chicago College of Nursing, said in a news release. “Proactive intervention is required to ensure that critical care nurses are fit for duty and can make decisions that are critical for patients’ safety.”
Karen A. Daley, PhD, RN, FAAN, is president of the American Nurses Association. This post kicks off the “Health Care in 2014” series, in which health leaders, as well as Robert Wood Johnson Foundation scholars, grantees, and alumni share their New Year’s resolutions for our health care system and their priorities for action this year.
With so much attention focused these days on our health care system, it may not have occurred to you that the health of your own caregivers could also help determine the quality and safety of the care you receive.
Paying attention to things like getting enough rest, managing fatigue and work/life stress, living tobacco-free, taking advantage of preventive immunizations and exams, eating nutritionally and maintaining an active lifestyle and healthy weight are important for everyone. Unfortunately, nurses are often so busy caring for others that they fail to care for themselves. It is for this reason the American Nurses Association, which represents the interests of the nation's 3.1 million registered nurses (RNs), recently launched a Healthy Nurse™ program to promote healthier lifestyles and behaviors among nurses.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts in 2013. Yesterday, we shared five of the ten most-read posts published on this Blog this year. Today, as we prepare to usher in a new year, we report on those that generated the most visits.
Alcohol and Life Expectancy: Unraveling the Mystery of Why Nondrinkers Have Higher Risk of Premature Death For years, experts have reported that people who drink in moderation live longer than those who do not consume alcohol at all. Patrick M. Krueger, PhD, an alumnus of the RWJF Health & Society Scholars program, blogged about his study examining the reasons. One answer, Krueger found, is that nondrinkers include adults who quit drinking because they had problems with alcohol—and that group has a relatively high rate of premature death. His post attracted the biggest audience on this Blog in 2013 with more than 23,000 visits.
It’s a Lil’ Colored Girl to See You This deeply personal post by RWJF Nurse Faculty Scholar alumna Angela Amar, PhD, RN, FAAN, recounts an experience that occurred when she was a young nurse, and a patient’s wife referred to her in that way. Amar, a professor, also notes that students sometimes comment that she is intelligent—a comment her majority faculty member colleagues tell her they do not hear. Amar’s blog is a salute to the benefits of diversity. She concludes: “Diversity is not a one-way glass that only directs light in one direction. ... Diversity benefits us individually and collectively and allows the light to shine everywhere.” Like Krueger’s blog, it generated a lively conversation among readers.
Amal Trivedi, MD, MPH, is an alumnus of the Robert Wood Johnson Foundation/U.S. Department of Veterans Affairs Physician Faculty Scholars program. He is an assistant professor of health services, policy and practice at Brown University and a hospitalist at the Providence VA Medical Center. His co-author, Danya Qato, PharmD, MPH, is a pharmacist and doctoral candidate in health services research at Brown University. They recently published a study that finds older patients are routinely prescribed potentially harmful drugs, particularly in the South.
Human Capital Blog: Why did you decide to look at this particular topic? And why are some drugs considered high-risk for elderly patients?
Danya Qato and Amal Trivedi: Adverse drug events are an important public health problem. For the elderly, such events are often precipitated by use of potentially inappropriate or high-risk medications. Over the past several decades, clinicians and researchers have sought to identify medications that should be used with caution in the elderly. These high-risk medications should be avoided among people 65 years of age or older because the associated adverse effects outweigh potential benefits or because safer alternatives are available. Elderly patients are susceptible to these medications because they have more chronic illness, greater frailty, and an altered ability to metabolize drugs. The Centers for Medicare and Medicaid Services now require all Medicare Advantage plans to report on the use of high-risk medications among their enrollees.
We undertook this study because successful efforts to reduce high-risk medication use in the elderly require knowledge of how prescribing of these agents varies geographically and the factors that predict their use. Half of persons aged 65 and older use three or more prescription medications a day. Therefore, potentially inappropriate use of medications in the elderly has important implications for health care spending and quality.
Tootsie’s Story, Continued: A Family Wonders Whether Nurse-Led Care Coordination Might Have Prolonged a Life
Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. Yesterday, she blogged about the death of her beloved grandmother, Tootsie, due to complications from medical error that began with an overdose of Synthroid. This is Part Two of Bellot’s blog post.
In 2010, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) joined resources and released The Future of Nursing: Leading Change, Advancing Health. This landmark report included many recommendations, and a full-scale Campaign for Action is in place that will transform nursing for years to come. Among the many themes advocated in this report is the tenet that nurses should be the very core of reinventing the American health care system. The report encourages the health care system to lean, and lean heavily, upon the skill set and resources of nurses to facilitate access to higher quality care at a lower cost.
At present, we have a health care system that is technology and intervention heavy when we know our population demographics are rapidly changing and technological intervention is not always the right answer. We have a growing need for a system that instead focuses on addressing chronic disease management, prevention and wellness care. Nurses are well positioned to support a system with these foci, managing care of the older adult in the community before inpatient care becomes necessary. Specifically in the outpatient setting, nurse coordinated care that is, by definition, proactive, holistic and comprehensive will help shift the focus of care from acute and episodic to chronic and preventive.
Jennifer Bellot, PhD, RN, MHSA, is an assistant professor at Thomas Jefferson University and a Robert Wood Johnson Foundation Nurse Faculty Scholar. This is Part One of a two-part blog about the death of her beloved grandmother.
Just over a year ago, our family lost our beloved matriarch and my grandmother, “Tootsie,” to complications from a medical error. It’s hard to believe that it’s been over a year now and each day, we feel her loss—or presence—in different ways. I write about this remarkable woman in this month’s issue of Professional Case Management.
Tootsie was an amazing example of strength, generosity, and perhaps most characteristically, of someone who spent her life caring for others. She bore eight children in nine years, raised them almost single-handedly after her husband died prematurely, and managed a 160-acre farm—all without a high school degree. Tootsie and I had an especially close relationship, blossoming one summer when I lived with her as a preschooler while my mother pursued her graduate degree.
As I grew older, I would become involved in Tootsie’s medical management. She would regularly send me copies of her lab reports and medical records. Medical talk became our currency of love. We chatted about her latest cardiology consultation like others might chat about celebrity gossip. Following and safeguarding her health was how we shared our love best.
Human Capital News Roundup: 'Citizen science,' compensation for medical errors, gunshot wounds, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:
The New York Times Well blog reports on a study by RWJF Health & Society Scholar Jason Fletcher, PhD, MS, that finds that about half of smokers carry a specific genetic characteristic associated with susceptibility to tobacco taxes and other health policy approaches intended to deter smoking. The other half have a different genetic mix and are largely unaffected by such measures. Medical XPress also reported on the findings. Read more about the study.
A study led by RWJF Investigator Award in Health Policy Research recipient Michelle Mello, JD, PhD, MPhil, finds that “patients who are offered disclosure, explanations, apologies and monetary compensation for medical errors may be more likely to accept lower rather than maximum compensation, apparently due to distrust of the motives behind a full compensation offer,” Cardiovascular Business reports.
People who frequently use the Internet to get health or medical information are more likely to have a positive outlook on cancer prevention and diagnosis, a study co-authored by Health & Society Scholars alumnus Jeff Niederdeppe, PhD, MA, finds. United Press International reports on the findings.
Human Capital News Roundup: Babies born experiencing drug withdrawal, medication-dosing errors, permanent patients, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) scholars, fellows and grantees. Some recent examples:
A study led by Robert Wood Johnson Foundation (RWJF) Clinical Scholar Stephen W. Patrick, MD, MPH, MS, has received coverage in a number of major media outlets. The first-of-its-kind study examined the increasing trend of drug withdrawal in newborns and its impact on the U.S. health care system. The number of babies born experiencing drug withdrawal increased nearly three-fold between 2000 and 2009, the study finds, and the number of pregnant women using opiate drugs at the time of delivery increased nearly five-fold. During the same period, the cost of health care for these babies nearly quadrupled. Among the outlets to cover the findings: The New York Times, Wall Street Journal, U.S. News & World Report, USA Today, NPR, CNN’s The Chart blog, and Fox News. Read more about the study.
The Post-Standard (Syracuse, N.Y.) featured the work of RWJF Executive Nurse Fellows alumna Luvenia Cowart, EdD, RN, one of nine 2012 Post-Standard Achievement Award winners, for her efforts to eliminate health disparities experienced by Syracuse’s African American community. “Since 1999 Cowart has been using black barbershops and churches as her classroom to educate people about prostate cancer, diabetes and other diseases, and the importance of exercise and healthy eating,” the newspaper reports. The winners will be honored at a luncheon May 9.
A study co-authored by RWJF Physician Faculty Scholar H. Shonna Yin, MD, MS, finds parents with poor math and reading skills are more likely than others to give their children incorrect doses of medicine, Health Day reports. The researchers found that parents with math skills at the third-grade level were nearly five times more likely to make a medication-dosing error than those with math skills at the sixth-grade level or higher. “Dosing liquid medications correctly can be especially confusing, as parents may need to understand numerical concepts such as how to convert between different units of measurement, like milliliters, teaspoons and tablespoons,” Yin said.
Ten years ago, the Institute of Medicine (IOM) issued Crossing the Quality Chasm, a landmark report calling for major quality and safety improvements in the nation’s health care system. It came on the heels of the IOM’s 1999 To Err Is Human Report, which estimated that there are 44,000 to 98,000 error-induced hospital deaths each year. That report made an urgent and compelling case that improvement was needed.
In the years since, quality and safety have been top-of-the-agenda priorities for researchers, clinicians and policy-makers alike. With funding from the Robert Wood Johnson Foundation (RWJF), this April’s issue of Health Affairs takes a look at where things stand today, assessing a decade’s worth of progress toward safer, more effective, patient-centered health care. In a series of articles, several by RWJF scholars and alumni, the issue examines a range of related topics supporting the theme of the issue, “still crossing the quality chasm.” In an overview, Editor-in-Chief Susan Dentzer writes,
As a number of articles in the issue demonstrate, there’s no doubt we’ve made progress—but it’s also clear that making any headway has been agonizingly slow. If ever the state of high-quality health care appeared to be an achievable end point, we recognize now that—to paraphrase Ralph Waldo Emerson—quality, like life, is not a destination but a journey.