Medication safety initiative in reducing medication errors.

The purpose of the study was to evaluate whether a Medication Pass Time Out initiative was effective and sustainable in reducing medication administration errors. A retrospective descriptive method was used for this research, where a structured Medication Pass Time Out program was implemented following staff and physician education. As a result, the rate of interruptions during the medication administration process decreased from 81% to 0. From the observations at baseline, 6 months, and 1 year after implementation, the percent of doses of medication administered without interruption improved from 81% to 99%. Medication doses administered without errors at baseline, 6 months, and 1 year improved from 98% to 100%.

Parental satisfaction with nurses' communication and pain management in a pediatric unit.

This article addresses the relationship between nurses' communication and pediatric parents' satisfaction. The study was conducted on a pediatric unit of a tertiary care teaching hospital. The design was pre-experimental, measuring satisfaction before and after two interventions, without a control group. One intervention was an informational handout about pain management provided to parents of each child at the time of admission; the other intervention was a staff inservice regarding communication with parents. Fifty parents/families of discharged patients were randomly chosen for a pre and post-telephone survey, routinely conducted each quarter. Parental responses on three items on the satisfaction survey were analyzed for significant changes. There were positive trends showing increased satisfaction ratings on all three items, but none of the increases was statistically significant per t-test (p = 0.05). The authors suggest that staff education and a parent informational handout might be useful interventions.

Coping strategies used by parents of children with autism.

PURPOSE: The purpose of this research was to determine (a) the level of family adaptation, as measured by the Family Crisis Oriented Personal Evaluation Scales (F-COPESs) instrument, among persons with a child diagnosed with autism spectrum disorder (ASD) aged 12 years and under, (b) if there was a difference in F-COPES scores based on family demographics, and (c) the time lag between parent's suspicion of ASD and the actual professional diagnosis of ASD. DATA SOURCES: A descriptive survey was used with a convenience sample derived from ASD treatment agencies and a parental support group in the California Bay Area that supports the children and parents of children with special needs. CONCLUSIONS: Overall, the level of adaptation was within the normal limits with coping scores similar to the norm scores of the F-COPES with males scoring slightly higher than females in the coping scale. Subscale scores of the F-COPES indicated that the parents sought encouragement and support from friends, informal support from other families who faced similar problems, and formal support from agencies and programs. Reframing revealed similar results as the norm with less use of spiritual support, and more passive appraisals were noted from the parents of children with ASD. Within internal comparisons, there were no statistical differences among gender and amount of time a member spent in coordination of services. Comparisons in ethnicity for Caucasians and Asian Americans revealed a higher coping score for reframing in Asian Americans and a higher passive appraisal score among Caucasians. Non-English speakers scored higher on spiritual support, while English speakers scored higher in passive appraisals. Because of insufficient statistical power, comparisons in education, income, marital status, and relocation of residence were deferred. The time from parents' suspicions of developmental delays or disability to a professional diagnosis of ASD was at least 6 months or greater. IMPLICATIONS FOR PRACTICE: It is imperative for nurse practitioners (NPs) to provide appropriate professional support and other social support systems to families with children with ASD. Educating parents to sound therapy approaches to provide them with the skills needed to directly address stressful events in order to increase the parent's confidence level as to avoid passive appraisals is also a crucial role of the NP. NPs may want to use the F-COPES as part of the assessment to ascertain the areas of needs of families. This study reveals the resiliency and highly adaptive nature of these parents who are under severe strain and stress of caring for a child with ASD. The effective ways they coped as a family were in the areas of informal and formal social support networks. Participants also used passive appraisal to cope. The study also supports the need for early recognition and diagnoses of ASD and referral for early intervention for better outcomes for the children and families affected by ASD.

Nurses' perceptions of causes of medication errors and barriers to reporting.

This study describes nurses' perceptions about medication errors and the effects of physician order entry and barcode medication administration on medication errors. A convenience sample of 61 medical-surgical nurses was surveyed. All nurses surveyed perceived that information technology decreases medication errors. However, medication errors continue to occur despite the availability of sophisticated information technology systems.

Upsetting the apple cart: a community anticoagulation clinic survey of life event factors that undermine safe therapy.

Anticoagulation therapy is a life-enhancing therapy for patients who are at risk for embolic events secondary to atrial fibrillation, valve replacement, and other comorbidities. Clinicians are motivated to decrease the amount of time that patients are either under- or over-anticoagulated, common conditions that decrease patient safety at either extreme. The primary purpose of this descriptive study was to examine the relationship between personal life event factors as measured by Norbeck's Life Events Questionnaire, core demographics such as age and income, and anticoagulation regulation. Although many factors affect anticoagulation therapy, the precise impact of life events, positive or negative, is unknown. The salient findings of this study (n = 202) showed a small, though statistically significant, inverse relationship (r = -0.184, P < .01) between negative life events and decreased time within therapeutic international normalized ratio. Total Life Event scores showed a statistically significant inverse relationship (r = -0.159, P < .05) to international normalized ratio time within therapeutic level. Lower income was inversely associated with higher negative Life Event scores (r = -0.192, P < .01). The findings demonstrate the need for strategies that address the potential impact of life events in conjunction with coexisting screening measures used in anticoagulation clinics. Implications for this study are limited by lack of methodology documenting concurrent social support factors and limitations of the research tool to reflect life event issues specific to outpatient seniors.

Forensic nurses' views regarding medications for inmates.

1. High arrest rates among people with mental illnesses may suggest that the illness is a factor in their arrests. 2. The increased number of individuals with severe and persistent mental illnesses in the criminal justice system reflects deficient community-based mental health services. 3. Jails and prisons act as revolving-door treatment facilities and are a poor substitute for proper community-based mental health care. 4. Mandatory discharge medication and follow-up treatment for ex-inmates with mental illnesses may lower the rate of recidivism.

Outcomes of inpatient geropsychiatric treatment: the value of assessment protocols.

The purpose of this evaluative study was to determine if elderly patients' mental health assessment scores improved after receiving specialized inpatient treatment. A random sample of 106 cases was drawn from existing medical records of patients treated during a 2-year time period in a comprehensive geropsychiatric inpatient clinical outcome assessment program. The clinical assessments included measures of cognitive, affective, and functional levels and used scores from the Mini-Mental State Exam, the Geriatric Depression Scale, the Allen Cognitive and Level of Care Assessment, and the Global Assessment of Function on admission and at discharge. Comparisons of these scores revealed a statistical significance between admission and discharge scores, and the mean assessment scores did improve during the average 12-day hospital stay. Although specific treatment efficacy cannot be inferred from these results, at least the overall efficacy of such treatment was supported by this study's findings.

Nursing care makes a difference. Application of the Omaha System.

Nursing classification systems enable practitioners to describe their contributions to client care. The results of this study indicated an improvement in the outcome ratings, using the Omaha System, as a result of nursing interventions for 47 clients with chronic mental illness receiving services in three academic nurse-managed centers. The Omaha System was found to be a valid and reliable nursing documentation tool for outcome and quality of care measurement for clients with mental illness. This study describes how the Omaha System was used by undergraduate nursing students who were caring for adults with mental illness in nurse-managed centers.

Measuring patient satisfaction as an outcome of nursing care at a teaching hospital of southern Taiwan.

Patient satisfaction has become an important indicator to measure the quality of care. Nursing has long used outcome measures to evaluate health care. The study assessed the patient satisfaction of patients from medical and surgical units at a teaching hospital of southern Taiwan. Of the 806 near-discharge patients from medical or surgical units approached to participate in the study, a total of 477 patients returned questionnaires for a response rate of 59%. The total mean score for all the patients' satisfaction score was 4.28 (SD = 0.53). In general it reflected that the patients were satisfied. There was no significant difference between the patient demographic variables, primary nurse's age, marriage, and total working experience on any of the subscales. Results of this study provided evidence that primary nurse's unit working experience can influence patient satisfaction (P value < .05).

Bulimia nervosa: knowledge, awareness, and skill levels among advanced practice nurses.

PURPOSE: To examine the knowledge, awareness, and self-perceived skill levels regarding bulimia nervosa (BN) among advance practice nurses (APNs) caring for young female patients. DATA SOURCES: Two hundred APNs of various nurse practitioner (NP) specialties were surveyed with a mailed questionnaire. One hundred and twenty-one (61%) surveys were returned and analyzed. CONCLUSIONS: Results demonstrated that APNs are knowledgeable and aware about BN. There were several statistically significant relationships among awareness and self-perceived skill levels. Pediatric NPs were found to be the most aware of BN in their young female patients. IMPLICATIONS FOR PRACTICE: The incidence of eating disorders is on the rise. Bulimia nervosa, a common secretive illness, poses a significant challenge for APNs potentially leading to missed diagnosis. There is a paucity of research exploring this issue. Study findings provide evidence to enhance curricula on eating disorders in academic and continuing education programs and guidance for future research.