Patient safety on the otolaryngology service: the role of an established rapid response system.

OBJECTIVE: To study the medical emergencies occurring on a tertiary otolaryngology service identified using a rapid response system (RRS). DESIGN: Retrospective chart review of RRS activations during 21 months. SETTING: Specialised otolaryngology care unit within the University of Pittsburgh Medical Center Presbyterian/Montefiore Hospital, a tertiary, academic, teaching hospital in the USA. INTERVENTION(S): None. RESULTS: 1171 unit admissions. Unit mortality was 5.1/1000 admissions. 53 patients were involved in 67 RRS activations (4/53 deaths). 32 of 67 events were due to respiratory derangements, most commonly pneumonia. 18 of 67 events were due to cardiovascular abnormalities, most commonly hypertension and myocardial infarction. 11 of 67 events were secondary to mental status changes, several of which were related to adverse drug events. 6 of 67 events were secondary to acute bleeding. 23 of 67 events occurred within 24 h of patient transfer/admission, 14 of those after operations. RRS activation was a marker for in-hospital death (RR 42.2, 95% CI 7.9 to 225.2) compared with that in patients not activating the RRS. CONCLUSIONS: Although otolaryngology care units attempt to prevent adverse events, emergencies still occur. RRSs identify deteriorating otolaryngology patients who are at increased risk for mortality. RRSs are an efficient mechanism of intervention during a medical emergency. RRSs provide a convenient method of identifying medical/system errors and educational opportunities.

Pyoderma gangrenosum: a case study for pain management in dermatology nursing.

The Joint Commission on Accreditation of Healthcare Organizations recently approved new standards for pain assessment and management. These standards will influence the practice of dermatology nursing in every setting. Nurses play a critical role in the care of patients with pain. Pyoderma gangrenosum is used as the basis for applying the new pain standards.

Pelvic fracture patient care. Reflections on the past, implications for the future.

Nursing care of patients with pelvic fractures has changed dramatically in the past two decades. Fracture care that necessitated long periods of immobility and consequent complications has been influenced by new classification systems, the use of external fixation, and the more recent use of internal fixation. The evolution of pelvic fracture patient care has greatly influenced nursing care of these patients.

Naloxone: a word of caution.

Naloxone (Narcan), a semisynthetic opioid antagonist, has approved therapeutic use for the treatment of opioid-induced central nervous system depression. With the implementation of epidural and intrathecal opioid analgesia, naloxone has been used for the treatment of side effects associated with these methods of analgesia. Consequently, there has been greater utility of naloxone for postoperative orthopaedic, noncritical patients. Naloxone was thought to be devoid of any intrinsic activity and, therefore, thought to have few side effects. There have been several reports of cardiovascular complications associated with naloxone administration that have disputed this view. Since use of naloxone is increasing in orthopaedic nursing practice, orthopaedic nurses need to understand the potential complications associated with its use.

Surgery on the hemophiliac patient. Special considerations.

Optimum care of patients with hemophilia requires cooperation among the hematologist, the surgeon, nurses, and blood bank personnel. Relatively normal hemostasis can be achieved and maintained in factor-deficient individuals in the perioperative period. Surgical procedures in patients with hemophilia can be accomplished safely with careful monitoring of coagulation factor levels and appropriate replacement therapy.