Gary Morley and Lisa Cohen
Every time she competes in a race, she knows she'll collapse in a sobbing heap at the finish line.
Unable to feel her legs, she'll crumple into the arms of her athletics coaches. Ice-cold water will be applied to calm the misfiring nerve fibers blazing beneath her numb skin.
The teenager has gone through this post-race trauma for the past five years since being diagnosed with multiple sclerosis.
"Every day that I run, it might be my last day -- I could easily wake up tomorrow and not be able to move," the 19-year-old American tells CNN's Human to Hero series.
"My initial MS attack caused lesions and scarring on my brain and my spine that affects the areas that are in control of how I feel my legs. So when I am overheated the symptoms reappear because my neurones start misfiring more.
"You can never really get used to the lack of feeling and the change of sensation, no matter how long you go through it. Every time it is still a bit of a shock and it's scary -- it freaks me out a little bit."
After five to 10 minutes she's able to get back on her feet again and start walking around, albeit a little stiffly as feeling slowly returns to her lower body.
It sounds like a nightmare ordeal that would put anyone off an athletics career, but Montgomery is determined to pursue her running dream.
She's actually faster now than before her diagnosis -- which, she says, was a painfully long and uncertain process following an accident playing soccer, falling hard on her neck and tailbone.
"It was really scary. I was so young. Most people with MS aren't diagnosed until their mid to late 20s, 30s. There wasn't anybody my age to relate to and understand what I was going through," she recalls.
"It took so long to get back results and we were ruling things out and leaving MS as the last option. For a while they thought maybe it was cancer."
When the diagnosis finally came, it sent Montgomery into a spiral of anger, depression and denial.
She avoided confronting the issue with her parents -- Keith, a salesman, and mom Alysia, recently qualified as a nurse -- and younger sister Courtney.
"I tried to pretend I wasn't sick or anything -- I wanted to go on with life as normal as possible," Kayla says.
"Nobody at school knew, and we were not allowed to talk about it at home. I just avoided it at all costs, and that actually made it a lot harder.
"The first couple of years after my diagnosis were impossibly hard -- I was so alone and still really scared. It was definitely a darker time in my life."
Running has proved to be her salvation. After a short break, in which she received treatment that made the numbness temporary, Montgomery decided she was going to make use of her legs while she still could -- despite knowing that exertion would bring back the symptoms.
"I wasn't amazing by any means but I was eighth on the team, so if somebody got hurt then I was there! And I wanted to be there if they needed me, so I trained so hard all the time and that definitely helped to deal with the things I wouldn't talk about," she says.
Montgomery's determination to succeed won her the North Carolina high school state title in the 3,200 meters last year, as she ran the 21st fastest time in the U.S.
She was team captain at Mount Tabor High School, setting several age-group records, and also excelled off the track in cross-country.
Now a freshman on an athletics scholarship at Nashville's Lipscomb University, she is studying molecular biology and has dreams of becoming a forensic scientist.
But before a career in CSI beckons, Montgomery is making the most of her chance to run for the college team.
"Racing is one of the greatest feelings in the world. I love it," she says.
"Long-distance running is my favorite ... you have to have so much stamina, strength and determination. I like to push myself to my limits for as long as I can."
One of the big challenges is staying on her feet during a race. If she gets knocked over or falls, which sometimes happens, then it's difficult to get up again -- especially in the later stages.
"If it is a track meet you can't grab on to something, whereas cross country there might be a tree close by that you can pull yourself up on," Montgomery explains.
"It all depends on when I fall as to how it will affect the outcome of my race."
Montgomery trains three hours a day, six days a week, covering 60-75 miles.
Without being able to judge pace through her legs, she has learned a new way to run, by focusing on the movement of her arms.
The hard work is paying off. Lipscomb is a Division One university in NCAA competitions, giving her an elite platform on which to impress.
It's a long way from those early high-school days when she asked her coach, mentor and "second father" Patrick Cromwell about her chances of running at college level.
"He said, 'I don't know, you might be lucky if you can be a walk-on.' I was like, 'Well I'll show you, I'm going to run in college and not only that I'm going to run for a D1 school.' And I am!
"Lipscomb is one of the best, it's really awesome to achieve that once really far-fetched dream."
Montgomery was actively recruited by Lipscomb, the first school to contact her -- others also rang "but a lot of them never called back" after she explained her condition.
"They made me feel so welcome," she says of her first visit to Lipscomb's campus. "They all knew my situation and it didn't bother them, and they didn't acknowledge it or ignore it either. It was exactly what I was looking for."
Her debut collegiate cross-country season was a steep learning curve, but Montgomery helped Lipscomb win a fourth successive conference championship in November, placing 13th overall and seventh in her team in the 5 km race.
On the track, she was sixth in the 10,000 meters last weekend as Lipscomb's women's team finished third at the Atlantic Sun championships in Florida, its best result at the event -- and a continuation of its rapid improvement since Bill Taylor, who recruited Montgomery, took over the athletics program in 2007.
She says the coach has given her the confidence to keep pushing herself, having taken a chance on her even though he realizes she may not be able to fulfill the four years of her scholarship if her condition gets worse.
"I keep running because it makes me happy," Montgomery says. "It makes me feel whole and safe, just because I know as long as I am running and still moving, I am still OK."
By KAREN BARROW
Elisabeth Bing, who helped lead a natural childbirth movement that revolutionized how babies were born in the United States, died on Friday at her home in Manhattan. She was 100.
Her death was confirmed by her son, Peter.
Ms. Bing taught women and their spouses to make informed childbirth choices for more than 50 years. (“We don’t call it natural childbirth, but educated childbirth,” she once said.)
She began her crusade at a time when hospital rooms were often cold and impersonal, women in labor were heavily sedated and men were expected to remain in the waiting room, pacing.
Ms. Bing pushed for change. She worked directly with obstetricians, introducing them to the so-called natural childbirth methods developed by Dr. Fernand Lamaze, which incorporated relaxation techniques in lieu of anesthesia and enabled a mother to see her child coming into the world.
Along with Marjorie Karmel, Ms. Bing helped found Lamaze International, a nonprofit educational organization.
She became known as “the mother of Lamaze,” championing the technique in her book “Six Practical Lessons for an Easier Childbirth” (1967) and on the lecture and television talk-show circuits.
Today, Lamaze and other natural childbirth methods are commonplace in delivery rooms, and Lamaze classes, with their emphasis on breathing techniques, are attended by an estimated quarter of all mothers-to-be in the United States and their spouses each year.
For years Ms. Bing led classes in hospitals and in a studio in her apartment building on the Upper West Side of Manhattan, where she kept a collection of pre-Columbian and later Native American fertility figurines.
Ms. Bing preferred the term “prepared childbirth” to “natural childbirth” because, she said, her goal was not to eschew drugs altogether but to empower women to make informed decisions. Her mantra was “Awake and alert,” and she saw such a birth as a transformative event in a woman’s life.
“It’s an experience that never leaves you,” she told The New York Times in 2000. “It needs absolute concentration; it takes up your whole being. And you learn to use your body correctly in a situation of stress.”
There was one secret she seldom shared, however: Her own experience giving birth to her son, Peter, was decidedly unnatural. As Randi Hutter Epstein reported in her book “Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank” (2010), she continually asked her doctor, “Is my baby all right? Is my baby all right,” until the doctor said he could not concentrate with her chatter and gave her laughing gas and an epidural.
“I got everything I raged against,” Ms. Bing told Ms. Epstein. “I had the works.”
Elisabeth Dorothea Koenigsberger was born in a suburb of Berlin on July 8, 1914. Her parents, of Jewish descent, had converted to Protestantism years before her birth, but the family nevertheless felt the virulent anti-Semitism sweeping Germany before World War II. She was kicked out of a university two days into her freshman year, and two of her brothers — a historian and an architect — could not find work because of their Jewish background, she told The Journal of Perinatal Education in 2000.
After Ms. Bing’s father died in 1932, the family left the country; most members settled in England, while one sister moved to Illinois. In London, Ms. Bing studied to become a physical therapist and began work at a hospital. Mostly she helped patients with paralysis, multiple sclerosis and broken bones, but every morning she also visited the maternity ward, to give massages to new mothers and help them exercise. At the time, women were not allowed out of bed for as many as 10 days after giving birth.
She became interested in natural childbirth in 1942 when a patient handed her Dr. Grantly Dick-Read’s influential book “Revelation of Childbirth,” published that year (and later titled “Childbirth Without Fear”). Dick-Read proposed that pain during childbirth was caused by fear, and that a woman could avoid anesthesia by following a series of relaxation techniques aimed at reducing that fear.
Ms. Bing became intrigued and hoped to train with Dick-Read in the north of England, but with the war on and travel all but impossible, she began her own independent study. She read as much as she could and observed obstetricians and their patients — heavily anesthetized women who, she saw, had little control over the birth of their children.
“What I saw I disliked intensely,” she said in her interview with the perinatal journal. “I thought there must be better ways.”
Ms. Bing, who drove an ambulance during the war, began pursuing her interest in natural childbirth after 1949, when she moved to Jacksonville, Ill., to be with her sister, who had recently married. There, while working with handicapped children, Ms. Bing met an obstetrician who, she discovered, knew very little about natural childbirth. Resolving to champion the techniques, she began approaching obstetricians and having them send patients to her for one-on-one classes.
Ms. Bing had planned to return to England in about a year and was on her way back when she stopped in New York to visit friends. There she met Fred Max Bing, an exporter’s agent, and decided to stay. The two were married in 1951.
Besides her son, Ms. Bing is survived by a granddaughter. Her husband died in 1984.
In New York, Ms. Bing again started giving private childbirth education classes. They caught the attention of Dr. Alan Guttmacher, the chief of obstetrics at Mount Sinai Hospital, which had opened its first maternity ward in 1951. He asked her to teach a formal class there.
In her search for other childbirth alternatives, Ms. Bing began to learn about the psychoprophylactic method developed in the mid-1950s by Lamaze, a French obstetrician. Lamaze refined Dick-Read’s approach by incorporating breathing exercises he had observed in the Soviet Union, where anesthesia was a luxury poor women in labor could scarcely afford.
In 1960, Ms. Bing, by then a clinical assistant professor at New York Medical College, and Ms. Karmel founded the American Society for Psychoprophylaxis in Obstetrics, known today as Lamaze International.
Ms. Karmel, an American, had become a natural-childbirth crusader after seeking out Lamaze in Paris to help her deliver her first child, and her best-selling book, “Thank You, Dr. Lamaze” (1959), largely introduced the method to Americans and drew Ms. Bing’s attention.
(In the late 1950s, Ms. Bing had persuaded Ms. Karmel to smuggle into the United States an explicit French educational film, “Naissance,” depicting a woman giving natural birth. When New York City hospitals and the 92nd Street Y refused to show it in prenatal classes — they considered it obscene — the two women held a private screening at Ms. Karmel’s home on the Upper East Side. Ms. Karmel died of breast cancer in 1964.
At the heart of the methods the women promoted was the idea of family teamwork, with the father helping the mother by coaching her in responding to her contractions with breathing exercises and massaging her back, and being present during the delivery.
But in her book, Ms. Bing cautioned, “You certainly must not feel any guilt or sense of failure if you require some medication, or if you experience discomfort or pain.”
Some obstetricians were skeptical of the methods and thought Ms. Bing, not being a physician, was ill qualified to be instructing patients. But the natural-childbirth movement found a receptive public. Women coming of age in the 1960s embraced the idea of taking a more active role in childbirth and wanted fathers to participate more as well.
“It was a tremendous cultural revolution that changed obstetrics entirely,” Ms. Bing said in an interview in 1988.
Ms. Bing was modest about her role in the movement. “It wasn’t really a movement by Lamaze or Read or me,” she told the Disney-owned website Family.com. “It was a consumer movement. The time was ripe. The public doubted everything their parents had done.”
But she rejoiced in the outcome. “We are not being tied down anymore,” she said in 2000. “We’re not lying flat on our backs with our legs in the air, shaved like a baby. You can give birth in any position you like. The father, or anybody else, can be there. We fought for years on end for that. And now it’s commonplace. We’ve got it all.”
Lamaze, himself, did not acknowledge Ms. Bing, never responding to her requests for an interview even though she had made his name part of the American vernacular. During their only meeting, at a lunch in New York, he directed all his comments to a male obstetrician at the table.
“I’ve never thought of myself as someone with a legacy of any kind,” Ms. Bing said in an interview at an Upper West Side cafe. “I hope I have made women aware that they have choices, they can get to know their body and trust their body.”
“If my ideas supported feminist ideas,” she continued, “well, that’s all right. But I’ve never been politically active.”
While studying to become a paralegal and working as a temp, Symphonie Dawson kept feeling sick. She found out it was because she was pregnant.
Living with her mom and two siblings near Dallas, Dawson, then 23, worried about what to expect during pregnancy and what giving birth would be like. She also didn't know how she would juggle having a baby with being in school.
At a prenatal visit she learned about a group that offers help for first-time mothers-to-be called the Nurse-Family Partnership. A registered nurse named Ashley Bradley began to visit Dawson at home every week to talk with her about her hopes and fears about pregnancy and parenthood.
Bradley helped Dawson sign up for the Women, Infants and Children Program, which provides nutritional assistance to low-income pregnant women and children. They talked about what to expect every month during pregnancy and watched videos about giving birth. After her son Andrew was born in December 2013, Bradley helped Dawson figure out how to manage her time so she wouldn't fall behind at school.
Dawson graduated with a bachelor's degree in early May. She's looking forward to spending time with Andrew and finding a paralegal job. She and Andrew's father recently became engaged.
Ashley Bradley will keep visiting Dawson until Andrew turns 2.
"Ashley's always been such a great help," Dawson says. "Whenever I have a question like what he should be doing at this age, she has the answers."
Home-visiting programs that help low-income, first-time mothers have been around for decades. Lately, however, they're attracting new fans. They appeal to people of all political stripes because the good ones manage to help families improve their lives and reduce government spending at the same time.
In 2010, the Affordable Care Act created the Maternal, Infant and Early Childhood Home Visiting program and provided $1.5 billion in funding for evidence-based home visits. As a result, there are now 17 home visiting models approved by the Department of Health and Human Services, and Congress reauthorized the program in April with $800 million for the next two years.
The Nurse-Family Partnership that helped Dawson is one of the largest and best-studied programs. Decades of research into how families fare after participating in it have documented reductions in the use of social programs such as Medicaid and food stamps, reductions in child abuse and neglect, better pregnancy outcomes for mothers and better language development and academic performance by their children.
"Seeing follow-up studies 15 years out with enduring outcomes, that's what really gave policymakers comfort," says Karen Howard, vice president for early childhood policy at First Focus, an advocacy group.
But others say the requirements for evidence-based programs are too lenient, and that only a handful of the approved models have as strong a track record as that of the Nurse-Family Partnership.
"If the evidence requirement stays as it is, almost any program will be able to qualify," says Jon Baron, vice president for of evidence-based policy at the Laura and John Arnold Foundation, which supports initiatives that encourage policymakers to make decisions based on data and other reliable evidence. "It threatens to derail the program."
Alexandra Wilson Pecci
Hospitals have a broader responsibility to elderly trauma patients than just the time spent within their walls, and should consider updating their strategies to ensure the best outcomes for these patients, research suggests.
Elderly trauma patients are increasingly likely to be discharged to skilled nursing facilities, rather than inpatient rehabilitation facilities (IRF), finds a study in The Journal of Trauma and Acute Care Surgery published in the April issue.
Discharge to skilled nursing facilities for trauma patients has, however, been associated with higher mortality compared with discharge to inpatient rehabilitation facilities or home.
Researchers wanted to "better characterize trends in trauma discharges and compare them with a population that is equally dependent on post-discharge rehabilitation." They not only examined trauma discharges, but also discharges of stroke patients, who have been taking up more inpatient rehabilitation facility beds.
Using data from 2003–2009 data from the National Trauma Data Bank and National Inpatient Sample, the retrospective cohort study found that elderly trauma patients were 34% more likely to be discharged to a skilled nursing facility and 36% less likely to be discharged to an inpatient rehabilitation facility. By comparison, stroke patients were 78% more likely to be discharged to an inpatient rehabilitation facility.
This is despite the findings of a 2011 JAMA study of patients in Washington State showing that "Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality."
The Journal of Trauma and Acute Care Surgery study notes that "elderly trauma patients are the fastest-growing trauma population," which leads to the question: Where should hospitals be investing their money and time to ensure the best outcomes for these patients?
"I think hospitals should be investing in post-acute care discharge planning," says Patricia Ayoung-Chee, MD, MPH, Assistant Professor, Surgery, NYU School of Medicine, and lead author of the study. "What's the best post-acute care facility for patients? And it may end up needing to be individualized."
She says reimbursement and insurance factors have "played more of a role than anybody sort of thought about" in discharges, rather than what is always necessarily best for patients.
For example, to be classified for payment under Medicare's IRF prospective payment system, at least 60% of all cases at inpatient rehab facilities must have at least one of 13 conditions that CMS has determined typically require intensive rehabilitation therapy, such as stroke and hip fracture.
"I think the unintended consequence is that we may be discharging patients to the best post-acute care setting, but we also may not be," Ayoung-Chee said by email, and that question "is only now being looked at in-depth."
She says hospitals should think about truly appropriate discharge planning upfront.
For instance, at admission, hospitals can find out who the patient lives with, or what their social support system is like. If they have a broken dominant hand after a fall, will they be able to get help with their groceries? Do they live alone? Will they be able to use the bathroom?
Caring for patients also doesn't end when patients leave the hospital, she adds. Hence the study's title: "Beyond the Hospital Doors: Improving Long-term Outcomes for Elderly Trauma Patients."
Ayoung-Chee says the next step in her research is to look at a more longitudinal picture, following individual patients to see what factors play into their function or lack of function.
But hospitals can do some of that work on a smaller scale, with internal audits to determine which facilities have the best post-acute care outcomes. For instance, they could spend time examining which facilities had fewer readmissions compared to others, as well as how long it took patients to get home and their how satisfied they were with their care.
Other research is also trying to determine which facilities are best for elderly trauma patients. For instance, a second study, also published in The Journal of Trauma and Acute Care Surgery, shows that geriatric trauma patients have improved outcomes when they are treated at centers that manage a higher proportion of older patients.
One of the overarching takeaways from Ayoung-Chee's research is the idea that hospitals have a broader responsibility to patients than just the time spent within their walls.
"What we do doesn't just end upon patient discharge. If we truly want to get the biggest bang from our buck, we're going to have to think about the entire continuum," she says.
That could range from working to prevent falls that can cause elderly trauma, to seeing patients through all of the appropriate care needed to expect a good functional outcome. Good healthcare for elderly trauma patients should extend beyond the parameters of morbidity and mortality, and toward returning patients to their original functional status and, ultimately, independence, says Ayoung-Chee.
"Our long-lasting effect as healthcare providers isn't just what we do in the hospital," she says. "And we have to start thinking outside."
BY SEAN DENT
Pens that don’t work? Socks that cut off your circulation? Cheap key chains? Yep, those sound like some Nurses Week gift failures to me!
I have some suggestions for gifts I think every nurse would appreciate for Nurses Week. Here are two major ones (you can thank me later!):
A real lunch break
- You know, the kind of lunch break that involves leaving the nursing unit, or even leaving the premises all together. The kind where you actually taste your meal instead of inhaling it on the go. Maybe even a full hour-long lunch so we could enjoy the food we eat and take our time getting back on shift.
IOU: A time out
- A certificate that allows you the ability to just call a time out. I’m talking stopping everything, putting your hands in the air and taking a “Calgon moment.” No explanation necessary, just produce the IOU. We should be able to use this IOU whenever the need arises. You could even put an expiration date on it, although I doubt it would take long to use this one up.
Here are a few more random ideas for gifts:
- A valet ticket for parking
- A free lunch (or more than one)
- IOU: One time you get to leave work early
- IOU: One time you get to come to work late
- IOU: One request for a new pot of coffee be made (when the pot is empty)
- IOU: One admission paperwork completion
- IOU: A free breakfast
Don’t get me wrong, I’m always appreciative of the recognition, but I think if we’re going to celebrate all things nursing, then the gifts should be worth the year-long wait!!
Any other suggestions? What would be a great gift for you this Nurses Week?
The award-winning documentary “The American Nurse” (DigiNext Films) will be shown at special screening engagements May 6 in honor of National Nurses Week. The film highlights the work and lives of five American nurses from diverse specialties and explores topics such as aging, war, poverty and prisons.
“At some point in our life each of us will encounter a nurse, whether it’s as a patient or as a loved one,” Carolyn Jones, director and executive producer of the film, said in a news release. “And that one encounter can mean the difference between suffering and peace; between chaos and order. Nurses matter.”
The American Academy of Nursing recognized Jones, an award-winning filmmaker and photographer, as the winner of its annual Johnson & Johnson Excellence in Media Award for the documentary. The award recognizes exemplary healthcare journalism that incorporates accurate inclusion of nurses’ contributions and perspectives. “I intended to make a film that celebrated nursing,” Jones said in the release. “I ended up gaining deeper insights into some of the social issues we face as a country, through the eyes of American nurses. I’ve grown to believe that nurses are a truly untapped and under-appreciated national resource.”
The documentary also was awarded a Christopher Award in the feature film category, alongside films “Selma” and “St. Vincent.”
The film, which was made possible by a grant from Fresenius Kabi, is being presented locally through sponsorship by the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation and AARP, together with the American Nurses Foundation and Carmike Cinemas.
The campaign’s state action coalitions and other campaign partners are expected to host at least 50 screenings of the film. Ten percent of the proceeds will go to help local efforts to advance nursing. A portion of all proceeds from the film will benefit the American Nurse Scholarship Fund.
To find a screening near you or to learn how to host a screening, go to http://americannurseproject.com/national-nurses-day-screenings.
If you ever needed any evidence that nurses care vastly about every single patient they encounter, this is it.
A video posted last week on Facebook shows a nurse reacting as one of her patients stands up for the first time in 11 days.
The story as, posted by Texas mom Becky Miller:
“Our daughter, Bailey, had complete paralysis from the waist down for 11 days with no explanation as to why. This video is one of her favorite nurses coming onto her shift and not knowing that Bailey had started walking this day.”
The nurse immediately bursts into tears upon seeing Bailey, screaming, “Thank you, Lord.”
Miller said Bailey had no feeling or movement in her legs the day before. Doctors did not know what caused Bailey to lose feeling in her legs.
Commenters on Reddit immediately took the opportunity to commend nurses, and all of the work and long hours they put in daily.
“Nurses are great people,” one commenter wrote. “You’d have to be humanitarian to be a nurse.”
The Giles family is celebrating two miracles after the 20 year-old mom opened her eyes and saw a picture of her newborn child.
Sharista Giles awakened this week from a four month coma that doctors had feared would be permanent and learned that she had given birth to a baby boy.
Sharista was four-months pregnant when she was involved in a car crash near Nashville, Tennessee. Doctors told her family she had a 10% chance of coming out of the coma.
"The doctors were telling us there was nothing else they could do," her aunt Beverly Giles, 49, told ABC News. "They already gave up hope. We never gave up. She's fought this hard."
The infant, who is being called "Baby L" until his mom is able to give him a proper name, weighed just over 1 pound when he was welcomed into the world a month after the accident.
But now he's healthy, weighing 6 pounds and 4 ounces, and proving he's as strong as his mother - who still hasn't spoken yet.
Sharista's father held up a picture of "Baby L" when she woke up, and she never took her eyes off the image, her aunt told ABC News. "When he turned around to put it back on the bulletin board, she turned her neck, her whole head trying to follow and find the picture again."
By Tracey Boyd
Informatics programs that allow med/surg nurses to cut down on documentation and increase patient safety at the touch of a button are becoming more essential in today’s fast-paced healthcare environment.
“Most all nurses use the electronic health record in their daily practice,” said Jill Arzouman, MSN, RN, ACNS-BC, CMSRN, president of the Academy of Medical-Surgical Nurses and clinical nurse specialist in surgical oncology at the University of Arizona Medical Center, Tucson. The university has computer stations inside each patient room for access to charting, she said, and some hospitals are investing in iPads to facilitate charting. Arzouman is a DNP candidate.
Med/surg nurses at New York’s Montefiore Health System in the Bronx use informatics throughout the day to document patients’ electronic medical records and provide direct care to patients, said Maureen Scanlan, MSN, RN-BC, vice president, nursing and patient care services and former director of informatics for the health system. “Electronic documentation has provided us the ability to track and trend patient outcomes data in a more efficient manner. We have the added benefit of decision support alerts to guide practice and documentation. We then can leverage information collected from the records to streamline workflows and improve patient safety.”
According to a HealthIt.gov study “Benefits of EHRs,” (www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes), having quick, up-to-date access to patients’ information can also reduce errors and support better patient outcomes by keeping a record of a patient’s medications or allergies, checking for problems whenever a new medication is prescribed and alerting the clinician to potential conflicts.
“The ability to clearly read a medication order printed from a computer is vastly different than trying to decipher a handwritten order,” said Arzouman.
In addition, staff can revisit patient information at any time.
“Many of the systems are very intuitive and allow the entire interdisciplinary team to document and communicate with precision and ease,” she said “A medical/surgical nurse may be busy with another patient but she or he can go back and read documentation from the dietitian who may have visited the patient at the same time.“
A reduction in medication errors was the catalyst for a project using computerized EHRs at Abington (Penn.) Health. When staff realized that patients with heart failure were being readmitted largely because of incorrect medication lists upon discharge, Diane Humbrecht, MSN, RN-BC, chief nursing informatics officer, devised a plan to evaluate the accuracy of such lists.
Humbrecht, a DNP candidate who is also a chapter director for the American Nursing Informatics Association, has worked in both cardiac and home care during her career and said she had experienced heart failure patients going home with medication lists that were either incorrect or missing information.
“It was very frustrating for both the patient and the nurse who is trying to follow up,” she said.
As part of her DNP program, Humbrecht decided to focus on transitions of care for this vulnerable population to help correct their discharge medication instructions and reduce their risk for readmission.
“As I began researching, I saw medication errors on medication discharge lists were the main reasons patients were readmitted to the hospital,” she said. •
Her findings were validated, she said, when the transition nurses who were involved in the postop discharge process informed her of problems with patients going home with incorrect medication lists. “Medication reconciliation and discharge instructions are done by the physician, but the nurses are the ones who review them and they were finding these errors after discharge,” she said.
Humbrecht implemented three changes to remedy the situation. The first step was to bring the pharmacists in on the front end. Pharmacists already performed patient rounding on units, but they were not involved in medication reconciliation at all, she said. The new protocol called for pharmacists to come in within 24 hours of a patient’s admittance to review the co-medications. The input from the pharmacists on the front end was crucial. “The pharmacists had to change about 80% of the lists,” Humbrecht said.
Next, upon discharge, the nurses perform a thorough review of the co-medications list that was corrected by the pharmacist. “If anything needed to be corrected, the nurse then called the physician to tell them they need to change a medication,” Humbrecht said. “Once that was done, it caused the physician to perform medication reconciliation again, automatically updating the entire medication list.”
The transition nurses were the final piece to the puzzle. Prior to the new protocol, upon calling the discharged patient and finding any errors, the nurse would make notations on paper. If the patient was readmitted, and the change was not transferred onto the patient’s EHR, the incorrect information was still in the system. Now, using the computerized medication list, any errors are updated immediately in the system.
The changes worked. Since implementation last fall, the transition nurses have found one error on the medication list of a discharged patient, Humbrecht said.
“We figured if we can get the home medication list correct on the front end by using the pharmacists and double-checked and changed as needed by the nurses on the back end, then the transition nurses should find less errors,” she said.
Besides documentation and patient safety, med/surg nurses are using informatics to enhance patient care. “Our staff nurses provide expert advice when we are defining a new process for delivering patient care,” said Scanlan, who holds board certification in nursing informatics. “A recent implementation of a new lab system that changed the way specimens are collected was successful due to workflow and hardware recommendations from the frontline staff.”
Scanlan said staff nurses recently have contributed to revising the electronic skin assessment template as well.
“Although not a clear time saver,” she said, “it has significantly improved the ability to track, trend and communicate hospital-acquired pressure ulcers [and] has supported performance improvement efforts that are led by the nursing staff.”
Arzouman also noted innovative uses. “For a postoperative patient who needs to continue to ambulate and exercise while at home, a medical/surgical nurse can teach the patient how to track his activity using a smart phone app,” she said. “I have had the opportunity to trial an app on my smart phone that translates basic medical information into many different languages without needing to use a translator. For something simple like ‘Hi, my name is Jill and I will be the nurse coordinating your care today,’ it is a very helpful tool.”
Surgeons are no longer removing most of the lymph nodes in the underarm area when a biopsy near the area shows cancer, a major change in breast cancer management, according to a study published in the Journal of the American College of Surgeons.
Researchers evaluated data from 2.7 million patients with breast cancer in the U.S. and learned to what extent surgeons were following recommendations from the American College of Surgeons Oncology Group Z0011, or ACOSOG Z-11 trial, published four years ago.
They reported that most early-stage breast cancer patients with tumors in their sentinel lymph node who undergo lumpectomy do not benefit from surgical removal of the remaining lymph nodes in the underarm area, called completion axillary lymph node dissection or ALND, according to a news release. They found no difference in cancer recurrence and five-year survival between patients who underwent ALND and those who did not.
Researchers found a dramatic increase in the proportion of lumpectomy patients who underwent only a sentinel lymph node biopsy — SNB — without an ALND. The SNB-alone rate more than doubled — from 23% in 2009 to 56% in 2011, according to the study.
“As far as I know, our study is the first to show that the findings from the ACOSOG Z-11 trial have changed clinical practice for breast cancer patients nationwide,” lead author Katharine Yao, MD, FACS, director of the Breast Surgical Program at NorthShore University HealthSystem in Evanston, Ill., and clinical associate professor of surgery at the University of Chicago Pritzker School of Medicine, said in the release. “The Z-11 trial has had a huge impact because of the lower risks for patients who undergo SNB alone.”
Investigators found that 74,309 patients (of the 2.72 million cases diagnosed between 1998 and 2011) met criteria for having SNB alone but underwent lumpectomy and radiation therapy to the whole breast, according to the press release.
The rate of SNB alone cases reportedly increased from 6.1% in 1998 to 56% in 2011.
Yao said findings suggest that some practitioners may feel uncomfortable not performing ALND in high-risk patients, and called for more education for surgeons.