Notes on Nursing Sensitive Indicators

Nurse sensitive indicators are necessary measurement tools that help nursing teams monitor the elements of patient care that are directly affected by nursing care. Think of nursing sensitive indicators as your dashboard: a collection of rates and information that are necessary to monitor to ensure that you are moving in the right direction.

In a car our dashboard has only the necessary points worth monitoring: your speed, miles per gallon, gas level, etc. A nursing leader’s dashboard could contain various points worth monitoring: % of outpatient intravenous therapy unit-related centrally-inserted central line-associated blood stream infections or the patient satisfaction levels of a specific unit. Successful indicators measure either the Structural, Procedural, or Outcome related aspects of nursing care. What do those fancy terms mean?

Structure:

• These indicators measure the supply of nursing staff, the skill level of the nursing staff, and the education and certification levels of the nursing staff. (A potential dashboard nursing sensitive indicator could be the number of RN hours per patient day).

Process:

• This nurse sensitive indicator category measures various methods of patient assessment and nursing interventions. (Potential example could be the number of smoking cessation interventions).

Outcome:

• These nursing sensitive indicators measure specific patient outcomes that are nursing sensitive because they rely on the quantity or quality of nursing care. (Dashboard example could be a specific unit/departments patient satisfaction scores).

There is a famous quote from the business management world: “If you can’t measure something, then you can’t improve it”. This concept of measuring in order to improve is crucial to the success of healthcare organizations. As busy nurses, we often get caught up in the floor level action and forget about our larger quality improvement picture. Nursing sensitive indicators keep us constantly aware of the big picture efforts moving around us. Quality indicators are used in every large hospital in the United States and Western Europe. The Joint Commission considers them to be absolutely crucial to the progression of nursing and health care quality in general.

Continuing education directly addressing nurse sensitive indicators can be difficult to find. We have used CNE Explorer in the past for sensitive indicator related online continuing education. They tend to build courses for nursing leaders and are good at breaking tricky concepts down. Regardless of where you learn about nursing indicators, they will be crucial parts of our changing healthcare system. Successful nursing leaders will be the ones who understand the value of measurements as a driver for positive continuous improvement.

5 Tips for Reducing Errors at the Bedside During Blood Transfusions

Blood Transfusions are the most common hospital procedure performed in the United States. Over the course of the past ten years, the number of blood transfusions performed in US hospitals has increased by over 126%. In total, over 30 million blood components are transfused each year. It is estimated that IV complications and blood transfusion errors occur in every 1 out of 6,000 procedures. A 2009 international study found that 70% of all blood transfusion errors and complications can be linked to a failure to perform a final bedside patient check. In most cases, a nursing professional is the final checkpoint during the blood transfusion process.  Listed below are 5 international best practices for reducing errors at the bedside:

• Whenever possible the PATIENT should be asked to confirm their identity. Positive identification of the patient before any blood sampling and transfusion of blood and blood products occurs is crucial to patient safety.

• Have a process in place for identifying unconscious patients. This is often done with a unique hospital identification number which is assigned to a patient. Any assigned blood request forms and units should have matching identification numbers.

• Implement a policy of: No identification band, no blood transfusion.

• Ensure that the patient has an IV ready before retrieving any blood from the blood bank.

• Conduct a thorough physical inspection of the patient’s condition prior to a transfusion. Document your findings. This will help to be able to compare and identify any adverse reactions. Conduct a second physical inspection 15 minutes after the transfusion has begun and document your findings. Compare.

The above listed items are by no means all inclusive. Due to the amount of blood transfusions performed nationwide, it is absolutely crucial that health care provider teams monitor and continuously improve their blood transfusion processes. In most facilities these internal processes are complex, and involve different departments and various levels of qualified staff. Focusing on the small implementable measures, such as the final bedside checklist, can help have a positive impact on patient care and reduce the number of negative IV complications and errors.

The Myers’ Cocktail: What is it and why is Everyone Talking about It?

What is it?

The Myers’ cocktail is one of the most recognizable forms of IV vitamin infusion therapies in the United States. Originally pioneered by the Baltimore, Maryland physician John Myers, MD, it was communicated to a national audience, in large part, due to the work of Alan R. Gaby, MD. The Myers’ is a formula of vitamins and minerals that is administered intravenously as a treatment for a wide range of clinical conditions. It can be classified as a form of Intravenous Micronutrient Therapy which falls under the general classification of Complementary and Alternative medicine (CAM).

 

Why all the Interest?

Popularized thanks in large part to recent celebrity (think Dr. Oz and Rhianna) promotions and endorsements of IV vitamin therapy; the Myers’ cocktail is one of the most commonly infused vitamin cocktails. Although its health benefits haven’t been formally confirmed in a traditional clinical trial, hundreds of doctors and thousands of patients have proclaimed the positive effects of regular infusions. IV Vitamin Therapy has received significant interest in the medical community due to the fact that the human body can absorb significantly higher levels (when compared to oral absorption) of vitamins and minerals (magnesium and vitamin c for example) intravenously.

 

What’s in it?

The Myers’ cocktail IV vitamin therapy typically consists of several key ingredients:

• Magnesium (Magnesium Chloride Hexahydrate)
• Calcium (Calcium Gluconate)
• Vitamin C
• Sterile Water

The above listed items are the main ingredients of the Myers’ IV vitamin infusion. It contains a variety of smaller amounts of various vitamins and nutrients. There are several published recipes, but many physicians and practitioners alter standard recipes as needed. Typically, the solution is 37ml and is administered slowly using a slow-push infusion over the course of 10-20 minutes through a 25G butterfly needle

 

What is it used for?

The Myers’ Cocktail has been found effective against:

• Acute Asthma
• Migraines
• Chronic Fatigue
• Fibromyalgia
• Acute Muscle Spasm
• Upper Respiratory Tract Infections
• Chronic Sinusitis
• Cardiovascular Disease
• Seasonal Allergic Rhinitis

Oftentimes patients will receive regular infusions (Daily, Weekly, Monthly, etc.) as needed. The typical costs can range from $30 – $200+ per infusion. The Myers’ IV vitamin therapy is considered by the FDA to be a dietary or nutritional supplement. As such, it is not regulated in the same way as traditional pharmaceuticals. Depending on local laws, local practitioners may not be regulated (in regards to sanitation and administration standards) in the same way as a traditional hospital setting. Double checking the compliance and qualifications of local practitioners is highly recommended. It is also recommended that patient’s check with their primary care physician before beginning any type of IV Vitamin Infusion.

Phlebitis Scales: A Practical Tool for Successful Documentation

Phlebitis, or inflammation of the vein, is a common IV infusion complication. It is estimated that phlebitis may occur anywhere from 20-80% of the time following peripheral infusions. Phlebitis is characterized by pain and tenderness along the internal vein, redness, swelling and warmth at the insertion site. Regular assessment of the IV site is necessary in order to identify possible signs and symptoms of phlebitis. Phlebitis scales can help nurses consistently rate and document signs of phlebitis.

Listed below is an example of the most commonly used Phlebitis Scale: (Courtesy of The Infusion Nurses Standards of Practice 2011 Update)

Grade	Clinical Criteria
0	No symptoms
1	Erythema at access site with or without pain
2	Pain at access site with erythema and or edema
3	Pain at access site with erythema and or  edema, streak formation and palpable venous cord
4	Pain at access site with erythema and or edema, streak formation, palpable venous cord > 1 inch and purulent drainage

The Phlebitis scale can be used to help the nurse performing an IV infusion to describe and document any signs of phlebitis. For more information about the above listed Phlebitis scale or the associated standards of practice visit the Infusion Nurses Society. For more information about the different types of phlebitis and using a phlebitis scale during iv therapy visit CNE Explorer for their practical continuing education course on the subject.

Welcome to the IV Infusion Blog for Nurses!

Welcome!

We are dedicated to learning and talking about all things related to IV Infusion. Our goal is to make this blog a resource for IV therapy nurses. We hope you enjoy!