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If your patient is abusing narcotic pain medications, he or she isn't likely to come out and tell you this. However, ED visits involving misuse or abuse of pharmaceuticals nearly doubled during the past five years, according to a new report, totaling about 1.2 million visits in 2009, compared to 627,000 in 2004.
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If you're taking a verbal order from an emergency physician, remember that there is always a potential for miscommunication, warns René Borghese, RN, BAS, unit educator in the ED at Duke University Medical Center. "This is the primary reason we utilize them only when absolutely necessary," she says.
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David M. Solomon, RN, BSN, CEN, EMT-P, patient care coordinator in the ED at Catawba Valley Medical Center in Hickory, NC, says that usually, medications for boarded patients have to be ordered from the pharmacy.
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When a man with a known history of seizures came to the ED at the University of California San Diego Medical Center very agitated, diaphoretic, and yelling, ED nurses first thought he was having a schizophrenic breakdown, says Tia Valentine, RN, CEN, ED clinical nurse educator.
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If a patient presents visibly intoxicated and announces his or her intent to harm others, it's easy to make the decision to involve security. However, any ED patient or visitor has the potential to become physically violent, warns Gordon Lee Gillespie, PhD, RN, PHCNS-BC, CEN, CCRN, CPEN, FAEN, assistant professor and director of population-focused care at University of Cincinnati (OH) College of Nursing.
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Dog-bite injuries resulting in hospital admissions have increased drastically in recent years, from 5100 cases in 1993 to 9500 in 2008, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ).
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If your ED patient sustained a few rib fractures, would you expect this to lead to rapid respiratory decompensation, pneumonia, and death? Minor injuries can have profound effects in the elderly, warns Avery Nathens, MD, division head of trauma and general surgery at St. Michael's Hospital in Toronto, Canada.
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If ED nurses believe a patient poses a risk of harm to themselves or others, a patient safety checklist is used for "closed-loop" communication with security, says Alexandra Penzias, RN, MEd, MSN, CEN, clinical nurse educator in the department of emergency medicine at Tufts Medical Center in Boston, MA. "This ensures that all members of the ED team are aware of the patient's status and plan of care," she explains.
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Is a cardiac-arrest patient failing to wake up and follow commands? "Therapeutic hypothermia is one of the few therapies we can offer," says Marion Leary, BSN, RN, assistant director of clinical research at the Hospital of the University of Pennsylvania's Center for Resuscitation Science in Philadelphia.
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Editor's Note: This is a two-part series on medication safety for inpatients being held in the ED. This month, we give strategies to reduce errors with inpatient medications. Last month, we gave strategies to avoid missed dosages.
