Nevada RN - May 2019

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Page 10 • Nevada RNformation May, June, July 2019 Antibiotic Stewardship Many nurses who read RNformation are not members of the Nevada Nurses Association (NNA) or the nationwide American Nurses Association (ANA) and, before I continue, the question at hand is: “What is your responsibility to prevent antimicrobial resistance?” ANA’s periodical, The American Nurse, published the article: “Strengthening nurses’ role in antibiotic stewardship” in October 2017. It begins; “The recent worldwide outbreak of Candida auris, a multidrugresistant fungus, underscores the criticality of robust institutional and community-based antibiotic stewardship programs. Improving antibiotic use is a patient safety issue.” The article focuses on what nurses can do to halt antimicrobial resistance. 1 The January 2019 edition of The American Nurse updated the ANA’s 2017 concerns and the cover photo/ text defines Candida auris as an emerging threat. The accompanying article: “Nurses’ response to an emerging threat” emphasizes the potential dangers of multidrug-resistant (MDR) Candida auris as a new world-wide peril. 2 Also, in January 2019 Lei Chen, Ph.D. Sr. Epidemiologist at the Washoe County Health District sent out a bulletin instructing: “If your healthcare facility is located in Washoe County, should you have any suspected case of Candida auris, please call us immediately at 775-328-2447.” A Nurse’s Responsibility By Norman Wright, RN, BSN, MS History Anyone who has followed this column since 2016 knows the problem of Antimicrobial Resistance (AR) is more extensive than the recent concerns with Candida auris, which is fungal not bacterial. Fungal Candida auris alarms go way beyond MRSA, VRE or other familiar MDR pathogens. Likewise, MDR organisms (meaning resistant to just three classes of antimicrobial agents) are now overshadowed by Carbapenemresistant Enterobacteriaceae (CRE) that can be PDRO (Pan Drug Resistant) meaning resistant to all classes of antibiotics. Recognizing AR is an ever-expanding global threat you may ask yourself - “What can one nurse do to avoid AR?” After all, you are a single person in a vast network of health care providers and, unless you are an APN, you cannot write an antibiotic order. You may feel powerless, so why try? Which brings us to one of the basic mandates of nursing – do no harm. The May, 2016 edition of ANA’s The American Nurse includes the article “Antibiotic stewardship for staff nurses” 3 which, under the heading of: “Role of the staff nurse” highlights these five actions: 1. Ensure pertinent information about antibiotics is available at the point of care 2. Question the antibiotic administration route 3. Reassess antibiotic therapy in two to three days 4. Review antibiotic therapy when your patient develops a new C. difficile infection 5. Reconcile antibiotics during all patient-care transitions To rephrase, the first action is: Obtain and communicate accurate information about your patient’s symptoms to the prescriber. I recommend using SBAR. Post-acute Care and Rehabilitation Options for Every Age and Stage of Recovery Our Facility in Reno NeuroRestorative’s facility in Reno features 19,000 square feet and 24 private beds in a natural healing environment to support individuals with: • Brain & Spinal Cord Injury • Complex Wounds and Burns • Pulmonary Issues • Congenital Disorders Now Hiring: Pediatric RN • LPN • CNA • Amputation • Neuromuscular Disorders • Medically and Orthopedically Complex Issues NeuroRestorative provides a continuum of high-quality, cost-effective post-acute care and rehabilitation options to people of all ages with brain, spinal cord and other life-altering injuries and medically-complex illnesses. With program locations throughout the Western United States, NeuroRestorative offers a unique service delivery model, merging an experienced and skilled health care and rehabilitation team with specialized technology in community-based program settings designed to meet the unique needs of those we serve at every stage of their recovery. For more information about our Reno location contact: Frank Bellinger, NHA Administrator NeuroRestorative Reno 3980 Lake Placid Dr., Reno, NV 89511 775-470-8260 • C: 702-266-7040 jobs.thementornetwork.com/search-jobs/Reno or Christina M. Lepore, RN, BSN Director of Nurses NeuroRestorative Reno 3980 Lake Placid Dr., Reno, NV 89511 775-470-8260 • C: 775-781-9085 www.neurorestorative.com The second step, you must re-evaluate and question the prescribers’ initial antibiotic order, then three review subsequent C&S reports to determine if the antibiotic/ antifungal is appropriate, or needed at all. Number 4 asks you to determine if an allergic reaction, or C-diff, develops. Finally, if the C&S report shows an antibiotic is not needed, or the bacteria is resistant, you must communicate this information to the prescriber and get the initial order changed. Let’s get real Reality is some prescribers do not want to be questioned and any nurse who questions them gets bullied. When confronted by this type of behavior you have a decision to make, do you say, “I am sorry I will never question your order again,” or do you stand up and continue questioning? If you adhere to the premise of “Do No Harm” it is your responsibility to continue questioning, which admittedly may be difficult. Depending on the politics of the institution you work at, raising concerns have been known to place a nurse’s job in jeopardy. But this is a topic for another day. Back to basics Each time you neglect to perform proper hand hygiene you potentially cause harm. Likewise, if you observe someone failing to use proper transmissionbased precautions (isolation), it does not matter if they are a nurse, visitor, RT, PT, CNA, or a physician, call them out because they place your patient at risk for infection. Preventing an infection achieves two goals. Your patient was not harmed, and, if there is no infection there is no need to order an antibiotic. Be observant, explore your environment and find items harboring germs. For example, let’s look at privacy curtains. The American Journal of Infection Prevention published a study on how quickly a bedside curtain gets contaminated. The study found that 14 days after freshly laundered hospital curtains were hung five of eight curtains were contaminated with MRSA. 4 Now ask yourself - during patient care, did you ever realize the curtain was not providing enough privacy and you quickly close it with your soiled gloved hand? If yes you just contaminated the curtain. Later, before tending to the patient in the next bed you wash your hands, put new gloves on and again close the curtain! You have just contaminated your clean gloves with pathogens from the patient you previously cared for!!! Cross-contamination happens that quickly. Explore your environment for other similar scenarios to resolve. For additional information on preventing antimicrobial resistance go to www.nvasp.net – The website of the Nevada Antimicrobial Stewardship Program. We must preserve the power of antibiotics for future generations. Become involved and join the American Nurses Association, which enrolls you in Nevada Nurses Association. These organizations provide resources that will promote your nursing career, and antimicrobial stewardship. Citations: 1) https://www.americannursetoday.com/nurse-roleantibiotic-stewardship/ 2) https://www.americannursetoday.com/candida-aurisemerging-threat/ 3) https://www.americannursetoday.com/antibioticstewardship-staff-nurses/ 4) https://www.ajicjournal.org/article/S0196- 6553(18)30155-X/fulltext PERSHING GENERAL HOSPITAL Lovelock, NV Career Opportunities for Nurses FULL TIME / PART TIME POSITIONS- ED/ACUTE RN & LTC RN/LPN Per Diem RNs needed in the ER/Acute – must have experience. RNs or LPNs needed in Long Term Care. Application and information for all opportunities available: www.pershinghospital.org 855 6th St., Lovelock NV 89419 • 775-273-2621 x202 EOE/Drug & Alcohol Free Workplace
May, June, July 2019 Nevada RNformation • Page 11 Bicycle Safety CDC RECOMMENDS HELMETS The CDC recommends the use of a properly fitted helmet, when riding a bicycle, for all ages, to prevent head and brain injury in case of a crash (2017). Helmets not only protect against head and brain (TBI) injuries, which are the leading cause of morbidity and mortality, but other facial, ocular and dental injuries as well. Those wearing helmets during a wreck were found to have a 51% lower risk of TBI, 31% lower risk of facial fracture and 27% decrease in facial contusions and lacerations (Joseph et al. 2017). Lisa McKinney, BSN, RN Cycling can be a fun form of recreation, exercise and transportation for the whole family to enjoy. However, cycling is not without risks. There were 840 bicyclists killed, in the United States, in 2016, (National Highway Traffic Safety Administration, NHTSA). Seven of these fatalities were in Nevada and accounted for 1.8% of total traffic fatalities (NHTSA, 2018). The Nevada Department of Transportation shows 58% of these accidents were in the roadway, 13% on sidewalks and another 13% in intersections (2017). The majority of bicycle related deaths and one-third of non-fatal injuries are related to traumatic brain injuries (TBIs). TBIs tripled when injuries happened to riders not wearing helmets. In 2012, over 80,000 bicycle related head injuries were treated in emergency departments across the US. Helmets have been shown to decrease the risk of severe head and brain injury by 63-88% (Graves et al. 2014). AGE & GENDER RELATED STATISTICS While one might think children are the ones to most benefit from helmet use, children accounted for only 7% of bicyclists killed in traffic collisions in 2016. In this same time frame, men accounted for 84% of bicycle fatalities. The largest group of men were 50 to 54 years old and 12% were 55 to 59. Men’s bicycle fatalities were 5.6 times higher than women’s (NHTSA, 2018). A study conducted between 1997-2013 reported 3.8 million bicycle injuries not ending in death. These numbers are thought to be just an estimate as only a fraction of accidents causing injuries are ever reported. The costs to society related to these statistics include medical costs, loss of work as well as life or quality of life. This study found the cost of non-fatal injuries to be $209 billion and fatalities $28 billion (Science Daily, 2017). Joseph et al. (2017) found that over $2 billion US healthcare dollars are spent on TBI’s annually. BE SAFE • Wear a Proper Fit Helmet • Wear Light Reflective Clothing • Be Aware of Your Surroundings • Know the Law (NRS 484B.760-783) Bicyclists have the same rights and responsibilities as other drivers. HELMET SAFETY & FIT For helmets to be effective in protection, they must be a Consumer Product Safety Commission (CPSC) approved helmet. The CPSC is the standard required by law, in the United States, for bicycle helmets. This standard was put in place by the government in 1994 and covers all helmets produced for the US, since 1999 (Bicycle Helmets, 2017). The CPSC helmet must be properly fit and adjusted. If the helmet is not properly adjusted it is unstable and may wobble or rotate. Helmets are made with adjustable straps, many with an adjustment at the nape of the neck as well as under the chin affecting stability. Poor stability compromises the efficacy of the helmet on impact. In one particular study, children and adolescents were found to more often wear helmets incorrectly. The correct size, adjustments, angle or tilt and width of the helmet worn, was found to be detrimental in its effectiveness. The helmet should be adjusted to take out the instability, with straps fastened securely under the jaw. It is worth seeking fit guidance from a bicycle technician, in one of the many sports or bicycle shops in the area. Sufficient helmet fitting was found in less than half of retail stores (Thai, McIntosh & Pang, 2015). NURSES GET INVOLVED Nurses may get involved in one of the many school bicycle programs or create bicycle safety programs where they do not exist. Nurses have a wide range of outreach to educate patients, families and schools within our communities. For example, one trauma center was instrumental in developing a program to keep kids healthy and safe in their community. The program consists of bicycle safety books, DVD’s, video games, classroom educational programs as well as organizing an interactive bicycle safety rodeo. The safety program provided patients presenting to the emergency department after crashing, safety awards for wearing helmets. The positive recognition reinforces safe behavior (Elwell, Kulp & McCue, 2014). Nurses may provide printable education brochures available at Nevada’s Source for Bicycling Information, BicycleNevada.com (n.d.): Kids Bicycling Guide https://www.nevadadot.com/home/ showdocument?id=3684 Kids Bicycling Guide in Spanish https://www.nevadadot.com/home/ showdocument?id=3686 A Guide to Frequently Asked Questions https://www.nevadadot.com/home/ showdocument?id=3682 A Guide to Frequently Asked Questions https://www.nevadadot.com/home/ showdocument?id=3692 Grab your helmet, friends and family and get out there and ride Nevada! Reference Bicycle Helmet Standards. (2017). Retrieved from https:// helmets.org/standard.htm#CPSC BicycleNevada.com (n.d.). Nevada’s Source for Bicycling Information. Retrieved from https://www.nevadadot. com/mobility/bicycle Centers for Disease Control and Prevention. (2017). Bicycle safety. Retrieved from https://www.cdc.gov/ motorvehiclesafety/bicycle/index.html Elwell, S., Kulp, H. & McCue, J. (2014). Creating a comprehensive bicycle safety program. Journal of Trauma Nursing, 21(6), 309-313. Graves, J., Pless, B., Moore, L., Nathens, A., Hunte, G., & Rivara,F. (2014). Public bicycle share programs and head injuries. American Journal of Public Health, 104(8), 106-111. Joseph, B., Azim, A., Haider, A., Kulvatunyou, N., O’Keefe, T. Hassan, A., Gries. L. Tran, E., Latifi, R. & Rhee, P. (2017). Bicycle helmets work when it matters the most. The American Journal of Surgery, 213(2), 413-417. National Highway Traffic Safety Administration. (2018). Bicyclists and other cyclists (DOT HS 812 507). Retrieved from https://crashstats.nhtsa.dot.gov Nevada Department of Transportation. (2016). Public safety. Retrieved from https://www.nhtsa.gov/sites/nhtsa.dot. gov/files/documents/nevada_fy2017_ar.pdf Science Daily. (2017). Soaring medical costs from bicycle accidents. Retrieved from https:www.sciencedaily.com/ releases/2017/06/170601082236.htm Thai, K., McIntosh, A. & Pang, T. (2015). Bicycle helmet size, adjustment and stability. Traffic Injury Prevention,16, 268-275. NNA EHC Answers puzzle on page 7
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