Category: Clinical Corner


Joint Commission 2016 National Patient Safety Goals

Joint Commission 2016 National Patient Safety Goals

‘Tis the Season: The Joint Commission 2016 National Patient Safety Goals are here!

By Chris Vinton, Medical Solutions Quality Assurance Specialist

The end of the year is my favorite time of all, and it isn’t because of the pumpkin spice lattes, hearing “Rudolph the Red-Nosed Reindeer” a thousand times, or hanging out with family. It’s because this is the special time of year when The Joint Commission 2016 National Patient Safety Goals are released!

Why should you care about The Joint Commission’s National Patient Safety Goals? I’m glad you asked!

The Joint Commission is a non-profit organization that works with healthcare facilities throughout the United States to continually improve healthcare and patient safety. Many hospitals, clinics, and staffing companies (including Medical Solutions) strive to maintain their Joint Commission accreditation — and it is no small feat due to the tough standards The Joint Commission sets for hospitals, clinics, and staffing. But these strong standards are a good thing and they mean that every company with The Joint Commission’s stamp of approval is doing their absolute best.

As we share their commitment to quality patient care, Medical Solutions is proud to have been one of the very first healthcare staffing agencies in the nation to be awarded The Joint Commission’s Healthcare Staffing Services Gold Seal of Approval — and, we’ve been continuously certified since!

The Joint Commission’s National Patient Safety Goals are divided into several categories, depending on the facility or clinic, and highlight general problem areas throughout the healthcare field, offering professional, easy-to-implement solutions.

Categories include:

  • Ambulatory Health Care
  • Behavioral Health Care
  • Critical Access Hospital
  • Home Care
  • Hospital
  • Laboratory Services
  • Long Term Care (Medicare/Medicaid)
  • Nursing Care Center
  • Office-Based Surgery

Each category can be read as a full PDF chapter, going in depth about the rationale behind the new goals or more bits of detail about the goal. The “easy-to-read” version is a very basic outline of what the goals are, with each of them listed in a bullet point fashion then a small description is given.

Get in the Holiday spirit this season and check out the “easy-to-read” version of the goals. It’s a very useful guide and takes less than a minute to read. If you want to know the reasons why behind each of the goals, you can read the full chapter. Most chapters are only 10-20 pages and will probably take about 20 minutes to read.

Click here to check out the Joint Commission 2016 National Patient Safety Goals.


Clinical Corner: The Importance of Proper Documentation

Clinical Corner: The Importance of Proper Documentation

Clinical Corner: The Importance of Proper Documentation

By Chris Vinton, Medical Solutions Quality Assurance Specialist

One of the less exciting, yet most important parts of the nursing field is documentation. Documenting information properly is absolutely paramount to protecting you, your fellow nurses, the hospital, and your Travel Nursing company.

Having good documentation skills is essential to quality patient care, most importantly, because it protects your patients. Properly notating important information — such as medication administered or vital signs — will provide you with an overall picture of your patient’s health. Be sure to avoid general statements. Instead of writing “Administered 500 of saline” try writing “1100: Administered 500ml of normal saline using IV located at Median cubital vein.”

War and Peace

Your documentation needn’t be the length of a Tolstoy tome to be effective.

Granted, that entry is basically a novel when it comes to documentation terms and there are abbreviations. However, the second statement gave specific details and will give a much better view of the procedure or the patient’s health for you, the patient’s doctor and the nurse coming on shift after you! Even over-documenting small details that might seem meaningless could turn out to be significant and help uncover symptoms that may not have otherwise been caught.

In addition to patient protection, proper documentation protects you and your fellow staff! Even when the hospital staff does everything right, patients may not always respond to the care given. In which case, the patient’s hospital file and your documentation will go under a heavy amount of scrutiny. If things ever go really poorly, the patient’s medical record might be your first and only line of defense against a lawsuit.

Now, how to be thorough yet also brief? Each hospital does have approved abbreviations for medicine and many abbreviations are standardized across the industry. Be sure to check with your supervisor or preceptor and make sure you are using the correct abbreviation for the facility! You don’t want to be writing War and Peace every time you administer normal saline but at the same time, you do not want to under-document or incorrectly document treatment.

When going on a Travel Nursing assignment, be sure you are aware of what documentation system the hospital has. Some might have EMR and other hospitals might be old school and only use paper! Always be sure you make the time to document properly. As usual, documentation can’t be talked about without saying “If it wasn’t documented, it didn’t happen.” Always use good documentation to protect your patient and yourself!


Austin, Sally. “Stay out of Court with Proper Documentation: Nursing2015.” LWW. N.p., Apr. 2011. Web. 09 Nov. 2015.

Wang N., Hailey D. & Yu P. (2011) Quality of nursing documentation and approaches to its evaluation: a mixed-method systematic review. Journal of Advanced Nursing 67(9), 1858–1875.


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?!


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

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


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.


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.


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?”


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 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.


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.


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.


[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.

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