I began the topic with the link below and probably titled it wrong. So I am checking to see if there is any comment, ludicrous or otherwise, on a subject that is now the object of a huge investigative report being done presently. I found it online yesterday in the Houston Chronicle and a friend from Washington says it is being reprinted in the Seattle Post-Intelligencer newspaper. It should be a mandatory read by anybody involved in healthcare in any way, shape, form or fashion.

www.nursinglink.com/topics/8226-can-states-administer-universal-healthcare-better/posts

I have included the below link to the newspaper I know this investigating is being published in. The report is by the Houston Chronicle and being posted in all other Hearst newspapers. I think there is enough medical industry in Houston that the newspaper had no problem raking up this information.

www.chron.com/deadbymistake/

It is a strong argument for some form of federal intervention as it is obvious the individual states cannot, or simply will not, do it themselves. Could this be due, in part or in whole, because of influence from insurance and for-profit hospital lobbys?

I am not killing patients that I know of..... If i were I would be the sunject of Morbidity and Mortality rounds.... and trust me you NEVER want to be there. It is where the chart is projected on a BIG screen and about 100 of your co-workers sharp-shoot and monday moring quarterback you to death....

The only med error I have ever made was a doozy. But I reported it IMMEDIATELY and wrote of the incident report myself and did not lie on it. That was 22 years ago but I have never forgotten it. It happened stupidly because the ER had 1 doc, me as the only nurse and an Army 91C. That was it! Everybody esle called in because of this unreal blizzard. They could not get to work but over 100 patients in an 8 hour shift managed to. Army hospital.

The patient was lucky and I have felt stupid every time I think about it. I have told the story in person to people who I have seen being stupd or careless or, like when I made mine, you are worked almost to death.

I also know where people's mistakes DID kill people and management covered it up and did not even generate an incident report.

Well cruzka, I will wager a years wages that if one of these incidents in this story by the Chronicle killed one of your kids or close family members you would change your tune.

I am well aware of the punitive side of nursing. I say nursing because doctors get away with this kind of crap. And you are the first person I have heard call the Chronicle a liberal paper. Even if it were, facts are facts. And this story has been going on for years. The issue is on the 10th anniversary of the original report by the IOM.

But I guess back then the IOM knew that there would be a Democratic president and Congress by now? Instead of worrying about the issue, work to change how "adverse events" are addressed in your work institution.

You know, again this is a case of shoot the messenger. Would you feel differently if the paper that ran the story was owned by Rupert Murdoch? Obviously I feel you would.

No, questioning and even testing any proposition is not only alright but is necessary. It's fine to question authority. But to be vehently opposed to an entire proposal because you disagree with parts of it make one appear, let's say, shallow. Lazy. Or even risk appearing stupid.

PDCA. A nursing model.

• P - Plan


• Do - Do what you planned and discover the weaknesses


• C - Correct


• A - Act. Act on correcting the weaknesses

This came about because educated and experienced people recognize that no planned action will likely be perfect when first implemented or employed. They also recognize that, while not being perfect, one must act out the plan simply to discover the weaknesses or faults.

One then reinforces what does work and changes what doesn't.

One also recognizes that the second, or even thrird or fourth or ad infinitum, may not be "perfect". But you MUST act to find out what works and what doesn't.

And I'm sorry your ex was a bum. But lady, $200.00 a month would not prevent one from going bankrupt. It was probably the straw that broke the camel's back - if that. I don't buy that as a reason for bankruptcy. Neither did the bankruptcy court trustee or you would not have bankruptcy granted.

I never said anyones life was trouble free. But how did a nosocomial infection become a political issue with you? The whole point of the research was to show how the medical system is fraught with a lack of oversight and the self-imposed liability of a lack of willingness to change. Facts are flipping facts!

Only a dunce would tag a study and presentation of facts as political. Perhaps the impetus to DO the study stems from someone feeling that since the medical system charges an arm and a leg to heal you that they should live up to that position! Or pay the consequences.

Nobody said your life was easy. Sorry for your losses. But if you didn't raise hell about any of those losses that were preventable what can make these institutions change?

My ex did not pay support for 6 years! I went to the govt agencies for assitance with this over and over with no response or help. I was forced to live on credit cards in order to survive. And yes, $200.00/month may seem miniscule, but it was alot for me back then, and would have made a difference. He owed me $10,000 in backpay, and I bankrupted at $13,000 in debt. So, yeah it did contribute to my financial downfall.When I went to bankruptcy court , I was asked if anyone owed me a signifigant amount of money. When I told the judge of my ex's debt, her jaw dropped.

I could have easily gotten out of $3000 of debt. I seriously bought groceries and paid my bills with my credit cards. I was an LPN making $10.50/hr. I was also a single mother going back to school at a community college one class a semester non stop for 2.5 years.

I worked hard to get my degree. I've been an RN 5 years, and after struggling with no help for years, when I finally get decent pay, universal healthcare is suddenly what I need to do?

Making my job harder thanks to media is also what I now have to contend with? So, this is how it goes. I finally have decent pay and now I have to give my pay to the have nots? Where was my bailout when I struggled?  Where was the media when my life sucked? Oh, that's right showing the love to President Clinton and touting the economic boom that I seemed to not be a part of.

If you think about it, PDCA has a lot in common with the nursing process.

We assess a situation to see what the problem is (Assesment).  We identify the problem from the data (Nursing Diagnosis).  We make a Plan, Implement it, and Evaluate the results.

The same prinicples easily work to evaluate political events.  What is happening with our health care system (Assessment).  What problems do we identify (nursing diagnosis)--high costs, lack of access to care, preventable errors, profit over care.  We're stuck on the Planning stage because there is considerable disagreement on what the plan should be.  And because we haven't committed to a plan, we can't implement it or evaluate the results.

If I am caring for a patient with an oxygenation problem, then I know I need to apply oxygen or otherwise work with the airway.  Then I need to check vital signs, esp RR and POX, skin signs, mental status and get some idea if the interventions work--because if they don't then the patient may eventually need to be intubated.

But I also know that even if I do all the right things at the right times, I may still need to change my plan in some way based on the patient's needs.

Your PDCA model understands this--and it applies perfectly to the reason why health care reform has stalled.  Because until we make the reform and evaluate the results, we won't know how to tweak it to make it best.

We have to assume there will be things that need to be changed.  One of the complaints I often hear about health care reform is that opponents fear the law will create unintended consequences.  It probably will--just about every law ever passed has.  The Founding Fathers didn't know the Constitution would work when they wrote it.  The Bill of Rights was hotly debated.

And yet the Constitlution and the Bill of Rights led to the formation of one of the best governments in history.  Our experiement in democracy works.

Health care reform can work.  That's why the fearmongers are working as hard as they are to mislead and trick people--because they dont want change.

mrbrownrn49 says ...

You know, again this is a case of shoot the messenger. Would you feel differently if the paper that ran the story was owned by Rupert Murdoch? Obviously I feel you would.

No, questioning and even testing any proposition is not only alright but is necessary. It's fine to question authority. But to be vehently opposed to an entire proposal because you disagree with parts of it make one appear, let's say, shallow. Lazy. Or even risk appearing stupid.

PDCA. A nursing model.

• P - Plan


• Do - Do what you planned and discover the weaknesses


• C - Correct


• A - Act. Act on correcting the weaknesses

This came about because educated and experienced people recognize that no planned action will likely be perfect when first implemented or employed. They also recognize that, while not being perfect, one must act out the plan simply to discover the weaknesses or faults.

One then reinforces what does work and changes what doesn't.

One also recognizes that the second, or even thrird or fourth or ad infinitum, may not be "perfect". But you MUST act to find out what works and what doesn't.

And I'm sorry your ex was a bum. But lady, $200.00 a month would not prevent one from going bankrupt. It was probably the straw that broke the camel's back - if that. I don't buy that as a reason for bankruptcy. Neither did the bankruptcy court trustee or you would not have bankruptcy granted.

I never said anyones life was trouble free. But how did a nosocomial infection become a political issue with you? The whole point of the research was to show how the medical system is fraught with a lack of oversight and the self-imposed liability of a lack of willingness to change. Facts are flipping facts!

Only a dunce would tag a study and presentation of facts as political. Perhaps the impetus to DO the study stems from someone feeling that since the medical system charges an arm and a leg to heal you that they should live up to that position! Or pay the consequences.

Nobody said your life was easy. Sorry for your losses. But if you didn't raise hell about any of those losses that were preventable what can make these institutions change?

However, to answer your question about "are we killing our patients?"

There isn't a nurse alive that hasn't made a med error.  If she says she hasn't, she is either very new to the profession, or fibbing.

Most errors don't result in harm.  Some do.  I've made med errors, but none that ever harmed a patient.  But I've seen scary errors (a nurse didn't set an old model pump correctly, and a patient got 25, 000 units of heparing in 15 minutes.  I pushed morphine too fast once, and depressed the respiratory rate--simple fix, shook her shoulders.

Most of the errors I've seen, however, are systems errors.  I've used bar coding systems and they do work.  The hospital where I teach clinics implemented one 2 years ago.  In May 2008, the med error rate was 14%.  May, 2009, less than 1%.

When it comes to errors, the biggest problem is systems that focus on productivity and not safety.  I quit ER nursing because the system was more focused on getting patients through the system, and not with providing safe care.  Staffing was not sufficient to meet production goals.  I didn't sign up to be a factory worker.

Reducing ER abuse would do a great deal to reduce these kinds of problems, but we also need to improve staffing and support, and put the focus back on the patient.

Yes, staffing issues are a problem that always seems to be there.Large hospitals consistantly cut staffing to save money, and yet in the end the pt's safety is put into compromise as a result. I can never understand how this never seems to compute with management.

If staffing were better, nurses would be happier as well as their pt's feeling they are getting the care they need and deserve. I can cite many a day when without my trying, my patients can plainly see I am being overworked. I cannot give them my full attention d/t the acuity and non stop interruptions during the day. I have on more than on one occasion miscounted narcotics b/c of distractions while trying to get a pain med.That's not counting other nursing interventions that are put at risk. Spectralink phones should be otlawed! Yesterday while starting an IV, my phone rang non-stop! I refused to answer it, but felt my patient was beacme more anxious while the phone was ringing, and a needle was in his arm!