Applying the American Nurses Association Credentialing Center Accreditation Program in the Setting of Registered Nurse Remediation.

The objective of this project was to use and evaluate the American Nurses Credentialing Center (ANCC) accreditation program in the context of registered nurse practice remediation using Just Culture. The quality improvement project intervention was aimed at educating nursing professional development educators about the accreditation program for registered nurse remedial education and implementing this program for remediation. It compared pre- and postintervention data for nurse educators using the nine key elements.

Innovative Varied-Fidelity Simulation Mobile Teaching Cart and Education Project.

The use of a varied-fidelity simulation mobile teaching cart is a teaching tool that offers unique advantages in the acute care setting. The cart is used to demonstrate the use of patient monitoring devices, and there are a variety of software tools available with the monitoring technology to ensure that the outputs, including electrocardiographic waves, are analyzed appropriately by nursing staff using this varied-fidelity simulation mobile teaching cart. Bringing varied-fidelity simulation to the nurses' work area is a unique application setting.

Intravenous smart pumps.

Intravenous (IV) smart pumps provide substantial safety features during infusion. However, nurses need to understand the requisite education necessary to fully benefit from and improve IV smart pump use and clinical integration. Failure to use IV smart pumps places the nurse and patient at increased risk.

Reducing blood culture contamination rates in the emergency department.

INTRODUCTION: Routine monthly monitoring of blood culture (BC) contamination rates detected a spike (>3%) in false-positive BCs drawn in the emergency department. This triggered an ad hoc quality-improvement team to develop and implement a corrective action plan in our 230-bed urban community hospital with 58,000 ED visits annually. METHODS: Both phlebotomists and nurses draw BCs in the emergency department; therefore all interventions were directed at both groups. These included private conversations with individual staff members associated with higher numbers of contaminated draws compared with peers, ensuring availability of necessary BC collection supplies, re-education of all phlebotomists and ED nursing staff surrounding BC collection best practices, monthly feedback to staff on BC contamination rates, and continuing private conversations as necessary, regardless of the contamination rate. RESULTS: Before the spike in the emergency department, the average rate of BC contamination for the hospital as a whole was 1.82% (January-July 2011). Excluding 3 months when ED contamination was greater than 3% and the hospital contamination rate was 2.65% (August-October 2011), the average rate of BC contamination for the hospital dropped to 1.01% after the interventions (November 2011-June 2012). This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. DISCUSSION: The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. The total hospital BC contamination rate never rose above the 3% benchmark, which illustrates the importance of tracking ED-specific data.

Lung cancer in the emergency department.

According to the World Health Organization lung cancer was the leading cause of cancer deaths in 2008. Patients with lung cancer present frequently to the emergency department. This article will outline Non-Small Cell Lung Cancer (NSCLC), patient presentation, and how to care for the patient with lung cancer in the emergency department (ED).

Remediation: a necessary function for employers to correct incompetence regarding clinical professional registered nurse practice.

Remediation for the professional licensed registered nurse is a topic sparsely written about in the nursing literature. The provision of remediation, however, is a common tool used to address registered nurse practice issues. This article seeks to describe the various stakeholders' roles in remediation and recommends that nurses in management roles should ensure the provision of remediation for registered nurses when warranted.

Increasing the use of 'smart' pump drug libraries by nurses: a continuous quality improvement project.

The use of infusion pumps that incorporate "smart" technology (smart pumps) can reduce the risks associated with receiving IV therapies. Smart pump technology incorporates safeguards such as a list of high-alert medications, soft and hard dosage limits, and a drug library that can be tailored to specific patient care areas. Its use can help to improve patient safety and to avoid potentially catastrophic harm associated with medication errors. But when one independent community hospital in Massachusetts switched from older mechanical pumps to smart pumps, it neglected to assign an "owner" to oversee the implementation process. One result was that nurses were using the smart pump library for only 37% of all infusions.To increase pump library usage percentage-thereby reducing the risks associated with infusion and improving patient safety-the hospital undertook a continuous quality improvement project over a four-month period in 2009. With the involvement of direct care nurses, and using quantitative data available from the smart pump software, the nursing quality and pharmacy quality teams identified ways to improve pump and pump library use. A secondary goal was to calculate the hospital's return on investment for the purchase of the smart pumps. Several interventions were developed and, on the first of each month, implemented. By the end of the project, pump library usage had nearly doubled; and the hospital had completely recouped its initial investment.

Nurses' risk without using smart pumps.

Intravenous smart pump devices hold specific medications in electronic libraries. These libraries contain predetermined volumes with corresponding administration rate limits. Smart pumps prevent nurses from engaging in calculations under high-pressure situations and ensure that only therapies available to the nurse are administered to patients. When this technology is available and not utilized, litigation could be successful in finding fault on the nurse. Therefore, nurses should use the available smart pump technology every time when administering intravenous therapy.