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Despite dramatic and widely reported breakthroughs in preventing bloodstream infections, the cold truth is that too many infection preventionists labor in obscurity, their programs woefully underfunded by administrators blind to the power of prevention.
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Infection preventionists must seize an extraordinary moment in health care, when divergent forces are aligning to redesign a system that has failed to contain costs and protect the lives to which it has been entrusted, Atul Gawande, MD, MPH, said recently in New Orleans in the keynote address at the 37th annual educational conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
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Alarming public health officials, a highly drug-resistant gram negative bacterial strain that is emerging rapidly in hospitals in India has been detected in patients in three U.S. states.
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While there are uncomplicated patient cases where physician-patient communication is fairly straightforward, such communication also can range to the other end of the continuum involving end-of-life care and related decision-making.
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Internet research has been an issue for institutional review boards since its roots in the 1990s, and the challenges ethics boards face in reviewing such studies are in pioneer territory.
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"The paternalistic model assumes that there are shared objective criteria for determining what is best. Hence the physician can discern what is in the patient's best interest with limited patient participation . . . the physician acts as the patient's guardian, articulating and implementing what is best for the patient...The conception of patient autonomy is patient assent, either at the time or later, to the physician's determinations of what is best.""Four Models of the Physician-Patient Relationship." JAMA. April 22/29, 1992 Vol 267, No. 16.
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Paul Arnstein, RN, PhD, clinical nurse specialist for pain relief at Massachusetts General Hospital, is familiar with The Joint Commission's standards on pain. As president of the American Society for Pain Management Nursing and a liaison representing pain management, Arnstein recently attended an annual meeting with TJC.
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Have you revisited your pain policy? Are you auditing compliance? How will you fare when Joint Commission surveyors come to your facility? Hospital Peer Review spoke with three institutions about the challenges they faced, the interventions they made, and the successes they have seen.
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They just happened to go public at about the same time the Centers for Medicare & Medicaid Services' (CMS') final rule on "meaningful use" as part of the HITECH Act and The Leapfrog Group's study results on computerized physician order entry (CPOE) systems and its subsequent call for action to monitor the safety of such systems and to develop best practices.
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The traditional hospital system in which physicians are staffed during the day and on call at night is not the only model. And certainly, as the health care industry becomes more aware of the quality of care for the traditional off-peak shifts, that model could change quite radically in the future.
