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(Editor's note: This is a two-part series on prevention of hospital-acquired infections in the ED. This month's issue provides information on avoiding infections when invasive procedures are performed, reducing the risk of infection with peripheral IV insertion, using alternatives to invasive procedures, giving central line education to ED nurses, and decreasing the use of central lines and urinary catheters. Next month, we'll cover how to determine if your patient has arrived at the ED with an infection, tips for cleaning the equipment you use, and strategies to improve compliance with hand hygiene.)
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ED nurses gave 2 mg of intravenous (IV) hydromorphone to a 40-year-old man with severe throat pain. After two additional doses were given in an inpatient unit, the man suffered respiratory arrest. He was resuscitated, but sustained permanent central nervous system impairment and died.
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Congestive heart failure (CHF) patients often wait too long to seek medical treatment and arrive in the ED in an acutely exacerbated state, says Eileen Swailes, RN, nurse manager of the ED overflow unit at Good Samaritan Hospital Medical Center in West Islip, NY.
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You might be waiting for a physician to order the appropriate steroid for your asthma patient, or you might have difficulty prioritizing due to a heavy patient load.
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ED nurses at the University of Kansas Hospital in Kansas City answer this question about every patient using an electronic medical record (EMR): "Does the patient have two or more systemic inflammatory response syndrome criteria?"
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A new process for managing radiological discrepancies in the ED at Catawba Valley Medical Center in Hickory, NC, has significantly improved the efficiency with which notifications are received and acted upon.
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Although the Centers for Medicare & Medicaid Services (CMS) made several minor modifications to the Outpatient Prospective Payment System (OPPS) for 2010 with impact on the emergency department, none result in a significant change in ED facility coding. However, there are references to several planned projects required to provide data to be used in future reporting and/or rate changes.
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As of January 2010, The Joint Commission has incorporated into its Quality Check web site (www.qualitycheck.org/consumer/searchQCR.aspx) the Centers for Medicare & Medicaid Services' (CMS') 30-day readmission rates for heart attack, heart failure, and pneumonia Medicare patients.
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Recognizing and re-emphasizing the fact that children are a distinct population of patients in the ED, the American Academy of Pediatrics, the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) have released a joint policy statement that includes guidelines for the care of children in EDs. The statement was published online in the journal Pediatrics.
