Research: Continuous Surveillance of Sleep Apnea Patients in a Medical-Surgical Unit.

This report consists of two separate studies on the use of continuous capnography monitoring conducted in an effort to improve patient safety at Virtua Health System. The desire for improved patient safety is motivating continuous monitoring and improved surveillance in clinical areas not traditionally equipped for such monitoring. We explored the use of remote monitoring of capnography, using enterprise middleware, in patients recovering from surgery in a medical-surgical unit. Continuous monitoring traditionally has been used in higher-acuity settings, such as intensive care units. Patients diagnosed or suspected to have obstructive or central sleep apnea may benefit from the increased surveillance afforded by continuous monitoring. Pain management in this cohort of patients, recovering from bariatric, joint replacement, or other major surgery, often involves administration of opioids (e.g., hydromorphone, morphine sulfate), which are known to increase risk of respiratory depression. Continuous monitoring of these patients increases the likelihood of detecting adverse clinical events. Our goal was to implement continuous monitoring in order to identify alarm conditions caused by adverse clinical events requiring intervention (e.g., opioid-induced respiratory depression) and artifacts related to patient movement, suspect measurements, or other medical device-generated alarm signals.

Workplace violence in healthcare: strategies for advocacy.

The Occupational Safety and Health Administration (OSHA) reports that over 2 million American workers are victims of workplace violence each year. Violence can strike any workplace; no area is immune. But who may be more at risk? Commonly, violence occurs at work and refers to a broad spectrum of behaviors (e.g., violent acts by patients, visitors, and/or coworkers) that result in a concern for personal safety. This article provides a brief overview of workplace violence, and discusses the settings where it often occurs. The authors consider the direct and indirect financial impact of violent acts, such as jury awards for injuries; higher than average turnover; increased requests for medical leaves; unusually high time and attendance issues; and stress related illnesses. Advocacy strategies for nurses are offered to address workplace violence on several levels, such as legislative advocacy, workplace policy, and education.