Solving the mystery: the role of competency assessment in OASIS documentation.

Having an effective ongoing competency assessment program allows regulatory compliance for competency assessment, OASIS data collection, and information management, while enhancing existing quality management efforts. This article provides an overview of the competency assessment process, its regulatory underpinnings, and describes how this process fits into the existing performance and quality measurements within a home care organization.

Enhancing effectiveness in assessing forensic nursing staff competency.

Assessing the competency of forensic nurses is an evolving area of management practice. This article presents a performance-based model for the assessment process. Examples of competency assessment activities that can measure psychomotor skills, critical thinking, and interpersonal skills are discussed, along with a sample competency for a selected skill. Evaluation strategies and their effectiveness are also analyzed.

An outbreak of neonatal deaths in Brazil associated with contaminated intravenous fluids.

A nursery outbreak of fever and clinical sepsis resulted in the deaths of 36 neonates in Roraima, Brazil. To determine the cause, epidemiologic studies were performed, along with culture and endotoxin analysis of intravenous (iv) fluids. Affected neonates were more likely to have lower birth weight (2.1 vs. 3.2 kg; P<.01), lower APGAR (activity, pulse, grimace, appearance, and respiration) score at 1 (7 vs. 8; P=.1) or 5 min (8 vs. 9; P=.03), lower gestational age (32 vs. 39 weeks; P=.001), or to receive iv medications (20/20 vs. 2/40; P<.0001). Fever occurred only after iv medication administration. Although culture results of unopened iv medications were negative, endotoxin levels of glucose and distilled water for injection were elevated (3.3 and 1.2 U/mL, respectively). Endotoxin-contaminated iv medications were distributed nationally and may have caused other outbreaks of unexplained death. These results highlight the importance of monitoring both pharmaceutical quality and postmarketing surveillance for adverse events.

Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma

The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with A and B blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.

Reversal of benzodiazepine sedation with flumazenil in a patient with tetanus

A 54-year-old female patient admitted with a diagnosis of tetanus had her sedation reversed with an infusion of flumazenil. Flumazenil appears to be of use in reversal of sedation in patients with accumulation of benzodiazepine after prolonged administration.