ED management : the monthly update on emergency department management
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Informed by the cases of two nurses who contracted Ebola virus disease (EVD) while caring for a patient with the disease in Dallas, TX, the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, has unveiled strengthened guidance for health care workers. Further, nursing organizations are pledging to work together to identify gaps and make system-level improvements to protect both patients and caregivers. ⋯ Experts stress that the new guidance does not change the fundamental issue that Ebola is transmitted through contact with infectious substances from patients. Nursing organizations are pledging to work together to identify problems and improve safety for both caregivers and patients.
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To reduce the risk of dangerous tubing misconnections, the ISO is rolling out new tubing connector standards that will eventually make it nearly impossible for tubing associated with one delivery system to be connected to a delivery system that serves a different purpose. Experts welcome the change, noting that tubing misconnections that cause injury and even death have been happening for years. However, TJC has issued a Sentinel Event Alert, warning that health care organizations need to be vigilant in managing the risk posed by these misconnections during the phased-in transition to the new connectors. ⋯ It will not connect to IV tubing, making that type of misconnection unlikely. The new connector should be available early next year. Since hospitals will continue to use older tubing until their supplies are exhausted, manufacturers will temporarily provide adapters capable of making new administration sets compatible with older tubing.
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With the outbreak of Ebola virus disease (EBD) accelerating in West Africa, public health authorities are urging frontline providers in the United States to be vigilant in questioning patients who present with a suspected infectious disease, and in adhering to infection control practices. Recent travel to West Africa and contact with others who may have been exposed to EVD are key points that need to be covered at triage, say experts. The World Health Organization (WHO) indicates that mortality from the latest outbreak is 55%, although it is as high as 75% in Guinea. ⋯ Experts say that one of the greatest times of risk for health care workers is while a patient is at triage because he or she has not yet been placed in isolation precautions. The CDC is recommending that hospitals rigorously apply standard infection control policies at a minimum, and that extra protective equipment may be required when there are body fluids in the patient environment. Hospitals in 27 states have reported dozens of suspected cases of EVD to the CDC, but at press time, none had yet tested positive.
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While many older patients experience symptoms of delirium while in the emergency setting, the condition often is not recognized by emergency providers. Further, a missed diagnosis can lead to enhanced caregiver stress as well as a higher risk of institutionalization, readmission, and death. Experts suggest that providers need to be better educated on the subtle clues that a patient may be delirious so that steps can be taken to find and address the inciting cause. ⋯ Many patients with hypoactive delirium are mistaken as being depressed, and as a result, this is a subtype that is frequently missed by clinicians. While no screening tool is 100% effective, researchers have had the best success with a two-step process that involves use of a rapid Delirium Triage Screen (DTS) to rule out delirium. Patients who are not ruled out by the DTS then undergo a more formal Brief Confusion Assessment Method or B-CAM, a tool that is a modified form of the CAM-ICU.