Propofol as a Drug of Diversion: Changing Disposal Practices to Reduce Risk.

BACKGROUND: Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods. LOCAL PROBLEM: Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol's potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact. METHODS: The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses' workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention. RESULTS: Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward. CONCLUSION: Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

Surveillance: A Nursing Intervention for Improving Patient Safety in Critical Care Environment.

BACKGROUND: Nursing surveillance has been identified as a key intervention in early recognition and prevention of errors/adverse events. Nursing Intervention Classification (NIC) defines surveillance as "the purposeful and ongoing acquisition, interpretation, and synthesis of patient data for clinical decision making." Because nurses are the main staffing constant in the critical care environment, the importance of surveillance as an intervention is fundamental. OBJECTIVE: The aim of this study was to explore how surveillance is expressed by critical care nurses. METHODS: A descriptive exploratory research design was used. Think-aloud was used for data collection. Twenty-one registered nurses from 3 critical care units participated in the study. Participants were asked to say out loud whatever they were thinking as they performed patient care at 3 time points: during handoff, initial patient assessment, and after 4 hours of care. Think-aloud (saying aloud what one is thinking) represents the information (cues) that is attended to in short-term memory, before it has been processed and stored. Data were analyzed using content analysis with key concepts and themes identified. RESULTS: The expression of surveillance was through the main theme of finding meaning. Surveillance involved (a) knowing the patient, (b) shared understanding and decision making, and (c) thinking ahead. The outcomes of these activities were aimed at finding meaning in the cues that emerged as the overarching theme. DISCUSSION: Surveillance was expressed through nurses' gathering cues, reflecting on past knowledge, asking questions, verifying, and pulling it all together to find meaning. During handoff, surveillance involved collaborative cognitive work to find meaning in cues.

The Tele-ICU: a new dimension in critical care nursing education and practice.

As health care reform pushes for improved patient care outcomes and reduced costs, tele-intensive care units are increasingly included in the discussion of critical care delivery. Nursing must be involved in the implementation of and education for this transformative initiative.

Cholera in Haiti.

Prior to the 7.1 magnitude earthquake that struck on January 12, 2010, conditions were dire in Haiti. Now, nearly a year later and with the emergency phase long since over, a cholera epidemic has hit Haiti.

Nursing's role in disclosure and apology.

Although there is general agreement regarding disclosing adverse events to patients and their families, much of the focus in the literature has been on the physician-patient relationship. Nurses are intimately involved in the day-to-day care of patients and their families. This column explores the role of nurses in disclosure and apology.