Category: Clinical Corner

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Clinical Corner: The Wonderful World of Wasting Narcotics

Wasting Narcotics Nursing

Knowing how to properly waste narcotics at each new hospital will help you succeed as a Travel Nurse!

By Chris Vinton, Medical Solutions Quality Assurance Specialist

While “waste” isn’t always a good word to hear in the nursing field, it is when it comes to narcotics. The proper disposal and documentation of narcotics is very important when dealing with controlled substances. When disposing of excess narcotics, always be sure you have a witness and are properly documenting the amount wasted.

First and foremost, check with your manager to see if there are any specific hospital policies regarding wasting narcotics, because hospital policies on the way narcotics can be wasted do vary. Some hospitals require a witness at every step of giving and disposing of a narcotic. Other hospitals have electronic systems in place to ensure the proper amount is drawn and given to the patient. Most hospitals state that narcotics should be disposed of in secure containers, such as a sharps container. Others allow narcotics to be wasted down a sink or even flushed down a toilet. A few hospitals in Australia require nurses to cover their teeth in silver food spray and yell “WITNESS ME!” before wasting narcotics.***

Wasting Narcotics Witness Me

Witness Me: This is a scene from Mad Max and NOT an Australian hospital. BUT, you should always have a witness when wasting narcotics!

Excess narcotics should be wasted immediately. Keeping narcotics in unsecured locations increases the risk of them being lost or stolen and creating major issues in documentation. It is very important to have another nurse as a witness to the wasting of narcotics. You should never, under any circumstances, waste narcotics alone and should always have someone else sign off as a witness. On the other hand, you should never sign off as a witness for someone else if you didn’t watch the narcotics being properly wasted — doing so could implicate you as an accessory.

Wasting narcotics according to hospital protocol is especially critical for Travel Nurses. Trust is very important in the nursing field and building trust as a Traveler is essential to your success while on assignment. Properly wasting narcotics is an easy way to build trust and show to the hospital and your colleagues that you are trustworthy and 100% professional.

***This sentence is probably not true, but who doesn’t love a solid Mad Max reference?!

Sources:

Drug Enforcement Agency (9/2014) Disposal of Controlled Substances; Final Rule.

Environmental Protection Agency (8/2008) Unused Pharmaceuticals in the Health Care Industry.

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Flu Season 2015: Are You Vaccinated?

Flu Season 2015: Are You Vaccinated?

Bless You! It’s Flu Season 2015: Are You Vaccinated?

By Chris Ahl, Risk Manager at Medical Solutions

Yes, it is that time of year again. The official start of the flu season 2015 is fast approaching. As a Traveler, this impacts you in a couple of ways — in addition to seeing more sick patients with the flu.

First, you will need your flu vaccine for this season. It is Medical Solutions’ policy that each Traveler receive a flu vaccine. If you don’t already have a vaccine for this year, you can plan on needing one for your next assignment. We will also need documentation of the vaccine. This is also a requirement of Medical Solutions. Verbal confirmations are not allowed, so keep that paperwork.

If you want to decline the vaccine for medical or religious reasons, you must have the declination form signed by you PCP or clergy. These are the only acceptable reasons for declining the vaccine. We want to keep you safe and compliant with our policies and those of the hospitals you will be traveling to. Please communicate with your Career Consultant and we can help get you set up to receive the vaccine in a timely fashion to meet these requirements.

In the meantime, click here to view the CDC’s page on influenza. There is a lot of great information there, including a page dedicated to information for healthcare professionals.

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Clinical Corner: Requirements for Tuberculosis Testing and Flu Vaccine

Requirements for Travel Nurse

So many requirements, so little time!

By Lalah Landers, BSN, RN, Clinical Nurse Manager at Medical Solutions

We often receive questions from Travelers wondering why each staffing firm and each hospital has different requirements for traveling healthcare professionals. Commonly, we hear questions such as:

“Why do I have to get another TB skin test or Quantiferon Gold?”

“Why do I need documentation of my flu vaccine?”

“Why do I have to take a PBDS or Behavioral test?” 

In a nutshell, every Travel Nurse company has different minimum protocols for their Travelers, and every hospital has different requirements for their staff. At Medical Solutions, we pride ourselves on being one of the most reputable staffing firms in the industry. While our minimum standards may be more extensive than other companies, we think it’s in the best interest of our Clients to get quality staff who are healthy, qualified, and have been thoroughly screened for any criminal history, substance abuse, or license action. It’s also beneficial from a Traveler perspective, because it helps make sure that are placed in a job that’s a good fit, and thus, is more likely to pan out positively for you.

This month, I’d like to discuss tuberculosis testing and the flu vaccine specifically.

“Another TB skin test?!”

With reference to questions about TB skin tests or Quantiferon Gold tests, both Medical Solutions and hospitals follow CDC guidelines when it comes to screening and treatment for tuberculosis. If you’ve had a past positive result, you will have to fill out a screening form annually, have a recent physical that is less than one year old, and also have a copy of your last CXR showing that you are free of any active tuberculosis.

If you have a positive TB skin test and this is the first positive test you’ve had, you will need a physical within 30 days of your start date, a new CXR, and a TB clearance form from your healthcare provider. Every positive gets reported to the local health department, and often you will have to visit the health department in your local area for clearance as well. So, please keep your CXR, skin test and Quantiferon Gold results handy so you can send them in with your other paperwork when starting an assignment!

“Why do I have to get a flu vaccine?”

Well, the answer is you don’t! But, if you choose not to, some hospitals won’t choose you! With the surge in numbers of annual flu cases in the U.S., most hospitals want to know that their healthcare providers have been vaccinated. If you aren’t vaccinated, then you may spread the flu virus to already ill patients. Some facilities take a firm stance on this — they will not allow you to work without proof of vaccination and make no exceptions. Other facilities will allow you to work, but you must wear a mask at all times while working. The choice is ultimately up to you whether or not to receive the flu vaccine. The reality though is that most hospitals won’t allow you to work in their facility without it. You are protecting your patients and most importantly yourself! Finally, please remember to keep documentation that you’ve received the flu vaccine on file, so that you can easily provide proof when necessary.

While the variance in requirements between companies and hospitals can be frustrating at times, we greatly appreciate our Travelers’ commitment to meeting all requirements and protecting the delivery of quality patient care. Thank you!

Click here if you want to learn more about Medical Solutions’ Traveler screening process.

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Clinical Corner: Online Certification Courses

online nurse certification

Find out why travel nurse companies and hospitals alike prefer — and sometimes require — certifications be earned with a hands-on skills evaluation component.

By Joe Bryowsky RN, Alumnus CCRN

There are numerous online agencies that offer both initial certification as well as renewal of various healthcare certifications, however not all courses and certification cards are acceptable by Medical Solutions standards. The majority of hospitals also do not accept online certifications either. The reasoning for this is that online courses lack the hands-on portion of what would be considered an acceptable course, as they are conducted totally online. Acceptable certification courses can be completed partially online, but will also have a mandatory skills evaluation in front of a qualified instructor.

Why is the hands-on skills analysis with a qualified instructor so important? An instructor is able to observe, assess, and, if needed, correct the candidate at the very same time that skills are being practiced and performed. The instructor is also able to answer any questions as they arise. Online courses do not offer any of these important steps. Online courses can only offer feedback in the form of right or wrong answer.

Lastly, hands-on skills practice and evaluations also teach and promote the concept of teamwork. It is rare, if ever, that a healthcare worker will face a code or any other emergent situation alone.

A few years ago I was speaking with the CNO of a large Level 1 Trauma Center, and I asked him why accepting only certifications from courses that required hands-on skills testing was important and required for his nurses. His answer was quite simple yet very thought-provoking:

“Imagine your teenager comes to you and says, ‘I just finished learning how to drive a car through a course I took online. I passed all the tests with flying colors and even earned this certificate. Can I take your car for a spin now?’”

Then he asked me, “Would you hand him the keys?”

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Flu Season 2014: Verify Your Vaccination Status to Protect Yourself and Others

flu season ahead

With fall comes the flu season … Be prepared and you can protect yourself and your patients!

By Lalah Landers, BSN, RN, Clinical Nurse Manager

So many happy sights and sounds signal the fall season — colorful leaves, cozy sweaters, the kickoff of football, pumpkin spice lattes, and the like. With all of this also comes flu season 2014. But, no need to worry, with a little effort on your part you can help keep yourself, your colleagues, families, and patients protected.

Medical Solutions requires that all Travelers read, complete, and submit our Flu Screening Form by October 15, 2014.  

Click here to view and complete the form, then return it by email to placementspecialists@medicalsolutions.com or by fax to 1.866.688.5929.

If you have a copy of your 2014-2015 vaccine (received August 2014 or later) we can alternately accept that in place of the Flu Screening Form.   

In addition to allowing you to easily communicate your vaccination status, the Flu Screening Form offers some important facts regarding influenza, so be sure to check that out. Here are some more important points regarding flu season 2014:

  • Some facilities may have specific flu requirements. In that case, Medical Solutions will send you a separate email detailing that information.
  • You have options for obtaining your flu vaccine. You can check to see if your current facility offers a free flu clinic for employees, visit a local chain pharmacy such as Walgreens or CVS, or visit your primary care provider.
  • Most insurance providers cover the cost of your flu vaccination at 100 percent. If your vaccination is not covered, Medical Solutions will reimburse you up to $42, with documentation and a receipt. If you are having trouble locating a flu vaccination site, just let your Career Consultant know. He or she is always here to help you with this or any other questions.
  • What about the flu mist? Click here to view the latest CDC guidelines for 2014-2015 flu vaccination. You’ll notice in the section on who should not be vaccinated with the nasal spray flu vaccine, it does indicate “People who care for severely immunocompromised persons who require a protective environment (or otherwise avoid contact with those persons for 7 days after getting the nasal spray vaccine).”

Essentially, this means that healthcare workers do fall into this category of those who should not get vaccinated via flu mist, as they often care for immunocompromised patients. However, because the flu mist is a live attenuated virus, you could still get vaccinated with the mist if you were able to wait seven days afterwards to care for patients. This could be an option for you if you’re in between travel assignments, for example.

In the end, a little preparation on your part goes a long way towards protecting yourself and those around you, and in stopping the spread of influenza. We appreciate your efforts — thank you, and we hope you enjoy a happy, healthy fall season.

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Personal Protective Equipment (PPE) Reminder

By Joe Bryowsky, CCRN, RN Clinical Nurse Manager

The use of personal protective equipment (PPE) is a strong component of any hospital’s safety and infection control plans. Besides frequent hand washing, the use of PPE is a major factor contributing to the safety of both healthcare workers and patients.

What is Personal Protective Equipment?

PPE is regarded as any equipment or clothing worn by the healthcare worker for protection against infectious materials. PPE aids in protection against coming into contact with infectious agents or body fluids, which may contain an infectious agent, by creating a barrier between the healthcare worker and the potentially infectious material.

Types of PPE commonly used include:

  • Gloves
  • Gowns
  • Masks (including N95)
  • Eye protection (goggles, face shields) *
  • Face protection
  • Shoe covers
  • Head covers

*Note: Prescription glasses do not provide adequate protection.

Types of PPE less commonly used include:

  • Powered Air Purifying Respirator (PAPR)
  • Plastic aprons
  • Cytotoxic PPE (for handling some cancer drugs)

Choosing the right PPE

All hospitals have written policies addressing which PPE to use in just about every circumstance. Always consult hospital policy and adhere to it strictly in order to protect yourself, patients, and co-workers.

Any healthcare worker also has the option to wear most types of PPE even if not required in a particular situation. There are many options as well as different circumstances for this. One example would be when hanging blood or blood products, or using a pressure bag with blood. Some nurses opt to not only wear gloves, but also add goggles and fluid resistant barrier gowns for further protection.

After using your PPE

Always be sure to safely remove and dispose of your PPE. This will prevent others from being exposed to any germs or toxins. Strictly follow your hospital’s policy on when to remove your PPE (inside the patient’s room versus outside, in a decontamination area, etc.) and put it in the proper place and receptacle. This information normally is also contained in the hospital’s policy.

For more information, visit the CDC website here.

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Smoked Out: How Recent Changes to State Marijuana Laws Affect Travel Nurses

Drug Test

How do new state marijuana laws affect your travel nurse employment?

By Lalah Landers, BSN, RN Clinical Nurse Manager

With the legalization of recreational marijuana in Washington State and Colorado, we’ve been getting more questions recently regarding the use of recreational marijuana and how it affects mandatory employer drug testing and your Travel Nursing job prospects. There is a common misconception that people can smoke marijuana anywhere in Colorado and Washington State without consequence.

Although it is now legal to recreationally use cannabis, commonly known as marijuana, in Washington and Colorado, a recent Denver Post article cautions that employers can still fire or elect not to hire employees who indulge in legal use.

According to the Post, “State law gives employers full authority to impose any drug prohibitions they wish, despite it being legal in Colorado for adults to possess and consume marijuana.

Colorado law prohibits employers from terminating employees for engaging in lawful activities (such as marijuana possession and use) off of the employer’s premises during nonworking hours. However, the Colorado law expressly states that marijuana legalization does not affect the right of employers to maintain a drug-free workplace. [1]

The Washington law is silent on this matter. But the state Supreme Court of Washington issued a decision in 2011 upholding the right of an employer to terminate an employee who violated the company’s drug policy through medical marijuana use that was lawful under state statute. [2] This has also been backed up by other states, such as California, Montana, and Oregon, with medical marijuana laws that allow for legal medical use.

It’s also important for employees to note that THC, the primary active element in marijuana, can linger in a user’s system for weeks or months after ingestion. This means that partaking of marijuana in a legal fashion may still show up in the results of an on-duty drug test, which could have consequences regarding your employability. The rights of employers to terminate employment or to not hire on the grounds of marijuana usage are not likely to undergo any change unless and until there is a federal law that legalizes marijuana use in all 50 states — much the same way that alcohol is currently controlled in employment situations.

We ask that Medical Solutions Travelers remember that we do maintain a drug-free workplace policy, and for their actions to remain consistent with this policy.

Footnotes

[1] Amendment 64 to Article 18 of the state constitution. Amendment 64 includes the following sentence: “Nothing in this section is intended to require an employer to permit or accommodate the use, consumption, possession, transfer, display, transportation, sale, or growing of marijuana in the workplace, or to affect the ability of employers to have policies restricting the use of marijuana by employees.”

[2] See Roe v. TeleTech Customer Care Mgmt. LLC, 257 P.3d 586 (Wash. 2011).

 

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Clinical Corner: How Healthcare Workers Can Prevent Slips, Trips, and Falls

By Lalah Landers BSN, RN Clinical Nurse Manager

A slip, trip, or fall while you’re on the job can often cause or lead to serious injury. Aside from the obvious cost of personal physical pain, such disabling injuries can also be detrimental in terms of a healthcare employee’s ability to do his or her job. This can lead to:

  • Missed hours and/or days on the job
  • Lower productivity
  • Expensive and/or diminished worker compensation claims
  • Worsened patient care

According to the CDC, “Slips, trips, and falls are the second most common cause of lost workday injuries in hospitals.”

In 2009 the U.S. Bureau of labor Statistics reported that the frequency of of lost workday injuries resulting from slips, trips, and falls in hospitals was 38.2 per 10,000 employees. At that rate the occurrence is 90% higher than the average rate for all other private industries combined. That’s a major jump!

So, what can you do help prevent slip, trip, and fall injuries and all of their related negative consequences?

  • Report and clean up spills immediately.
  • Keep a clean, orderly, sanitary work area.
  • Wear sturdy shoes with nonskid soles, especially in inclement weather like rain, and ice.
  • Keep halls, patient rooms, and stairs free of clutter and obstructions.
  • Watch for tripping hazards at nursing stations, in patient rooms, at computer, and in the OR. Watch for cords, tubing on the floor, multiple chairs, and cords stretched across pathways where you walk.
  • Nursing station counter tops or medication cards should be free of sharp, square corners.
  • Watch for indoor and outdoor irregular flooring surfaces. Watch for uneven sidewalk or floor tiles outside or in parking garages.
  • Make sure steps outside are free of ice and snow, and use handrails for support.

Should you as a Traveler, have a slip, trip or fall, you MUST notify Medical Solutions within 24 hours of the incident. 

You should also notify your hospital if you have a slip, trip or fall, and seek medical attention if necessary.

Plus, you’ll want to notify the nurse manager or supervisor if you notice any safety concerns that need to be addressed.

 

http://www.cdc.gov/niosh/docs/2011-123/

https://www.osha.gov/SLTC/etools/hospital/hazards/slips/slips.html

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Clinical Corner: Clinical Corner: COWs, and WOWs, and HIPAA! Oh My!

by Joe Bryowsky RN, CCRN Clinical Manager

Many hospitals are increasingly using COWs (computers on wheels) or WOWs (workstations on wheels) these days. (By the way, I’m told that use of the name COWs is considered politically incorrect these days, but we still call them that at the hospital I currently work at. Therefore I apologize in advance to any PCs out there on a wheeled work station that may take offense to this. J, but I digress … )

This is good for nurses in that we can spend less time (and energy) running back and forth to the nurses’ station to chart, and more time taking excellent care of our patients. There is a potential downside to this convenience, though. Having COWs or WOWs either in patient’s rooms or in the hallways also opens up a huge potential for theft of information as well as HIPAA violations. This can manifest in many different ways such as not logging off or “locking” the computer when leaving the area, people walking by, etc.

So how can we protect patient information as well as ourselves from this threat? Below are some very simple steps to follow:

  • Create a strong password. (Check out our helpful hints for creating a strong password below.)
  • Do not share your password with anyone and always be aware if anybody is around you when keying in your password.
  • When using a COW or WOW, position yourself or the computer so the information is difficult to see, and minimize screens detailing a patient information system if someone walks up to you.
  • ALWAYS log off or lock your computer whenever leaving the computer even if only for a short time.

Using these methods will reduce the risk of information theft as well as the potential for HIPAA violations.

Helpful hints for strong passwords

“Strong” passwords are hard to guess … either by human or machine. Creating a strong password requires doing the following:

  • Do make them long, at least 8 characters, ideally longer
  • Do use at least four different characters (don’t just repeat the same ones)
  • Do include mixes of uppercase letters, lowercase letters, symbols like !@#&, and numbers.
  • Do change your passwords regularly (some systems force the user to do this)
  • Do use different passwords for different systems (ex. PYXIS vs COW password)

Creating strong passwords require NOT doing certain things too:

  • Don’t use words associated with personal characteristics that others may know (family names, pet names, addresses, etc.)
  • Don’t use consecutive letters or numbers (ex. 1234567 or abcdefg)
  • Don’t use your name or nickname
  • Don’t use adjacent characters on your keyboard. (ex. zxcvbnm)
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Clinical Corner: Patient Falls

By Lalah Landers BSN, RN Clinical Nurse Manager at Medical Solutions

Did you know: Falls are the most frequently reported incidents in adult inpatient units? Actually, 30-50% of falls result in some injury, varying from bruises to severe wounds or fractures.

Patients at Risk for Fall (and a few tips to help address the risk):

Patients with Altered Mental Status – This includes patients with delirium or at-risk for delirium (patients with hip fractures, advanced age, baseline dementia, medication).

Patients With Impaired Gait or Mobility – Such as patients who entered the hospital and already use an assistive device like a cane or walker (make sure they are in good repair or obtain one from the hospital), patients who have new fractures, DVTs, hip replacements, knee replacements, recent stroke, spinal stenosis, or osteoporosis. For these patients you may consider bedside commode use.

Patients With Frequent Toileting Needs – For example, patients with incompetent bladder/bowel and patients on diuretics. These patients should be taken to the toilet on a regular basis or pre-set schedule and may consider bedside commode use.

Visual Impairment – For these patients it helps to have corrective lenses within reach, assistance up to use the restroom, or bedside commode.

Patients High Risk Medications – For example, psychotropic medications may cause orthostatic hypotension; new anti-hypertensives may cause hypotension or dizziness.

Patients with a History of Frequent/Recent Falls – For these patients put side rails up and bed alarms on.  The only caveat here is that you MUST respond to bed alarms; they can’t be ignored. Notify your nursing aides and co-workers around you that you have a patient at risk for falls.  Ask them to please respond if you aren’t available.  Remember:  YOU ARE ULTIMATELY RESPONSIBLE FOR YOUR PATIENT’S SAFETY!!

How Can You Prevent Patient Falls?

  • Use your facilities Fall Risk Scale (MORSE, Stratify, etc.)
  • Use Falling Star Door Markers or your facilities method of alert
  • Ensure your patient has a yellow arm band, yellow socks, etc., to alert staff of their risk of fall
  • Make sure you communicate fall risk during your shift to shift report and ensure it is noted on the patients chart
  • Use bed alarms
  • Make hourly rounds on patients
  • Have family sit with patient if possible
  • If possible, move fall risk patients closer to nurses’ station
  • Ensure bed is in low position
  • Document and follow up on any patient status changes that may increase their risk of fall
  • Instruct patient and family to call nurse/staff for assistance when ambulating
  • Do not leave patient alone in bathroom
  • Make sure your patient has non-skid slippers or their own shoes.
  • Lock bed wheels, wheelchairs, stretchers and commodes
  • Keep water, personal items within reach
  • Physician intervention for sitter or  restraints as required ( refer to facility restraint policy)

References:

http://www.ahrq.gov/professionals/clinicians-providers/resources/nursing/resources/nurseshdbk/CurrieL_FIP.pdf

http://www.ncbi.nlm.nih.gov/pubmed/21939135

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