Norovirus

Nursing Home Deaths, Hospitalizations Spike During Norovirus Outbreaks, Study Finds  10/18/2012  Sarah Langmead Page Content Nursing home hospitalizations and deaths spiked at least 10 percent during norovirus outbreaks, a new study published in the Journal of the American Medical Association reported Thursday. “Among nursing home residents, we saw about a 10 percent increase in hospitalizations and deaths during norovirus outbreaks,” said Tarak Trivedi, study co-author and University of Chicago medical student, Thursday in announcing his team’s findings. Researchers examined 1,257 nursing homes in Wisconsin, Pennsylvania, and Oregon between January 2009 and December 2010. They found that, during norovirus outbreaks, the homes saw 2,533 hospitalizations and 1,097 deaths. Data show that “the rates of hospitalization and death were significantly elevated during outbreak periods” in all three states, Trivedi and colleagues wrote. The question, now, is whether there is a direct cause behind the correlation, the researchers said. “As a next step, research should be directed to determine if this increase is directly attributable to norovirus infections and subsequent gastroenteritis,” Thursday’s report said. “Additionally, more detailed information is necessary to understand the specific contributory causes … of norovirus-associated deaths.”   But if norovirus is as lethal as data from the three states appear to show, then administrators and staff will have to be more vigilant about stomach flu outbreaks, the researchers said. “Annually, more than 1,000 outbreaks of acute gastroenteritis are reported by nursing homes to U.S. public health agencies, and this likely represents only a fraction of the actual number, due to underreporting,” the study said. Of the 1,257 nursing homes observed, 308 (24 percent of the total group) “reported at least one suspected or confirmed norovirus outbreak during the two-year study period.” Most of the outbreaks occurred during the winter. “These nursing homes reported a total of 407 outbreaks, with 230 reporting one outbreak, 60 reporting two outbreaks, 15 reporting three outbreaks, and three reporting four outbreaks,” the report said. Seventy-two percent of the total documented cases were laboratory confirmed outbreaks.

Centerville Jr. High cheer squad welcomes kids of all abilities

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Centerville Jr. High cheer squad welcomes kids of all abilities

The Sparkle Effect • Grant from group helped kids with Down syndrome join the team.

By Carol Lindsay

Special to The Tribune

Published: October 12, 2012 09:38AM
Updated: October 12, 2012 09:38AM

Steve Griffin | The Salt Lake Tribune Centerville Junior High cheerleader, Maegan Lindsay, right, forms a tunnel with other cheerleaders as the school's volleyball team runs through during a game at the Centerville, Utah school Wednesday September 26, 2012. The squad has four cheerleaders with special needs, including Maegan, and the school has rallied around the kids and really supported them.

Centerville • The cheerleaders, stacked two high to form a tunnel, chant “Go Chargers, go Chargers, go!” as volleyball team members run beneath them as they are introduced.

Eighteen cheerleaders cheer, volleyball players pound the floor, kids and parents in the stand clap, the noise is deafening as Centerville Junior High prepares to play South Davis Junior High. In the thick of this organized chaos are four Centerville Junior High students with Down Syndrome.

Those four junior high students — eighth grader Colton Beck, 13; eighth grader Mary Lee, 14; eighth grader Caleb Monsen, 13; and seventh grader Maegan Lindsey, 12 — are not sitting in the stands, they aren’t sitting at all. They are on the court with the other 14 cheerleaders, dressed out in cheerleading garb preparing to cheer their team to victory.

Amber Stott, the Functional Skills teacher at Centerville Junior High was approached by cheer coach Angela Petty after Petty attended a cheer camp and learned about a grant that supported integrating special needs students into cheer programs. Together they decided this was a great program and they wanted their students to participate.

The grant came from The Sparkle Effect, a student-run program that helps students create cheerleading and dance teams that include students with disabilities.

The Sparkle Effect’s goal is to change the lives and outlooks of student participants, those with and without disabilities. The group’s goal is to replace insecurities with confidence and joy. Sparkle Effect President Sarah Cronk states “teams are not about perfection, they are about connection.”

At Centerville Junior High, the connection is there.

Teacher Amber Stott selected the cheerleaders based on a previous performance her students had done to the Michael Jackson song “Thriller.” Stott chose the students who enjoyed performing and had parents willing to provide all the extra support required for such a time-intensive extracurricular activity.

Stott has not seen any negatives to the program and said students at the Junior High have taken the addition of special needs cheerleaders in stride and welcomed it.

“No one has questioned it, it’s just normal to them” she said.

Colton Beck is a born performer. He’s been in plays since he was young and loves to be in the spotlight. He loves to cheer and his enthusiasm is contagious. Colton has a smile and a hug for everyone he meets.

While Petty said the four cheerleaders with Down Syndrome may be one or two beats behind in the cheers, they don’t let it slow them down.

“It chokes you up. I feel like these kids are on the front line with this program. I hope this goes into other schools and becomes the norm, and people will start seeing kids with disabilities as regular kids” said Colton’s mom Laurie Beck.

Beck was not worried about the reception the kids would receive from Centerville Junior High students because they have been with the same kids since kindergarten. She was concerned about how the special needs cheerleaders would be treated by students from visiting schools, but thus far all reactions have been favorable.

Parents of the cheerleaders love the physical fitness aspect, practicing verbal and memorization skills and the social interaction that come from their participation.

Petty works weekly with the students and is pleased with the program. Her cheerleaders have been receptive to their new team members.

“The girls are really good about being friends and have enjoyed the relationships,” Petty said.

Mary Lee loves cheering and looks forward to all the games and practices. Her mom said that learning the routines has helped her with her coordination and mental abilities.

Caleb Monson is the shyest of the cheerleaders, but he still loves participating. Mostly he loves his megaphone and cheer shirt with his last name across the back. The only thing that would make him happier would be if they could replace the letters CJH on their blue uniforms with the letters BYU.

Caleb’s mom, Jeanine Monson, said that children with Down Syndrome tend to imitate and model the behavior they are exposed to. The cheerleading team has been a great group of role models.

One of those role models is 14-year-old ninth grade cheerleader Abby Oligschlaeger. In addition to working with the cheerleaders, Oligschlaeger is a peer tutor. Working with the special education students comes naturally to her.

“Sometimes it’s hard to get them to cooperate, but we just try to talk them through it and we have a lot of fun,” she said.

closeup@sltrib.com

Twitter:@sltribDavis

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© 2012 The Salt Lake Tribune

Centerville Jr. High cheer squad welcomes kids of all abilities

By Carol Lindsay

Special to The Tribune

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Nursing interventions benefit homeless youth

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Nursing interventions can significantly decrease substance abuse among homeless youth, according to a study.

At least 1.2 million adolescents are homeless in the United States, according to background information in the study, which is scheduled for publication in the American Journal on Addictions. These youths abuse substances with far greater frequency than do their non-homeless counterparts, and once under the influence, they are more likely to participate in delinquency and a host of assorted destructive behaviors.

One such behavior, often called "survival sex" because youths exchange sex for necessities such as food or a place to stay, is accompanied by a lower rate of condom use, which can lead to unwanted pregnancies and HIV infection, hepatitis and other sexually transmitted diseases.

"Homeless youth often justify their use of drugs because of the need to stay awake at night to avoid getting mugged, because they are 'self-medicating’ to quell the voices in their head or because of the need to cope with the stress of life," Adey Nyamathi, ANP, PhD, FAAN, the study’s lead investigator and associate dean for international research and scholarly activities at the University of California, Los Angeles, School of Nursing, said in a news release.

"But the sad truth is that once substance abuse is entrenched, drugs begin to dominate all aspects of homeless youths’ lives. We must put programs in place that break this vicious cycle."

The study involved 154 drug-using homeless youths in Santa Monica, Calif., many of whom had experienced a multitude of life crises, including a history of foster care, a low level of education and a support system of individuals who themselves use drugs and/or alcohol.

The study assessed the impact of two group interventions: an HIV/AIDS and hepatitis health program led by nurses and an "art messaging" program led by artists.

The nurse-led program featured three highly interactive group sessions that focused on educating youths about disease transmission and vaccinations and providing them with training in self-management and the development of healthy social networks. In these settings, participants shared their experiences and discussed how they could integrate health promotion strategies into their lives.

In the art messaging program, faculty from the California Institute for the Arts engaged the youths in an exploration of their thoughts and feelings through art, photography and video and encouraged conversations about good health, risky behaviors and ways to stay safe.

After six months, alcohol use decreased 24% in the nurse intervention program and 25% in the art messaging program, while marijuana use declined 17% in the nurse intervention program and 20% with art messaging. Youth in the nurse-led program reported additional reductions in drug use for cocaine (15%), methamphetamine (18%) and hallucinogens (20%).

"These results are very promising, as reducing alcohol and drug abuse in any population is very difficult," Nyamathi said.

Support for the research was provided by a grant from the National Institute of Drug Abuse. The study abstract is available at http://onlinelibrary.wiley.com/doi/10.1111/j.1521-0391.2012.00288.x/abstract.

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Salt Lake City CNA training

Clinical

I'm at clinical. I was talking with a resident who has aphasia and I'm guessing Alzheimer's. I was asking him what he did before he retired. He couldn't get the words out. I said "you have aphasia. That means you know what you want to say but the words won't come out." I said that must be bothersome and he said "you're bothersome!" Later I was walking down the hall and I spoke to him again as I walked around the corner he said to an aide "She doesn't like you at all!"
Trouble maker:)

CNA job opening Utah

CNA

Caregiver Support Network Home Health & Hospice

310 East 4500 South, Suite 200, Murray, UT 84107

Summary:

Caregiver Support Network Home Health & Hospice is seeking a friendly, dependable CNA to perform patient visits in Salt Lake County.  Join our award winning team!

This position is a part-time position. Part-time employees receive mileage reimbursement, travel pay and are eligible for: 401(k), profit sharing and supplemental benefits.

Requirements:

* CNA certification

* CNA experience preferred

* At least 18 years of age

* CPR certification

* Compassionate, team player attitude

* Available for weekend work as needed.

* Possess clear verbal and written communication skills.

* Pass background check.

* Have reliable transportation to patient visits

* Able to independently lift 50 pounds to handle equipment and resident transfer/transport.

How to Apply:

Come into our office to fill out and application

OR

Email your resume: jobs@cgsn.info

Six benefits of early childhood education

• Improve grades; strengthen commitment to and attitude toward school
• Lead participants to take better care of their health throughout their lives
• Start children on the path to financial stability and independence
• Increase the likelihood that mothers of participating children get good jobs
• Enhance the parenting skills of participants’ parents
• Produce positive effects that extend into future generations

From ISMP Medication Safety Alert!® Acute Care Edition

Raising the Index of Suspicion

Posted: 08/31/2012; ISMP Medication Safety Alert © 2012 Institute for Safe Medication Practices

Abstract and Introduction

Introduction

Disruptive behaviors, intimidation in the workplace, and a culture of disrespect among healthcare professionals have repeatedly surfaced as a significant barrier to patient safety. The hierarchical nature of patient care and the autonomy with which healthcare professionals have been taught to practice set the stage for a culture that does not respond well to even the slightest queries about possible problems with patient care, particularly from subordinates. It's clear that such a culture needs to be repaired, and many healthcare organizations are working to address disrespectful behavior, staff reluctance to speak up about risks and errors, and blatant disregard of expressed concerns. However, there's a less obvious but no less dangerous risk related to the culture that often goes unnoticed until a serious adverse event happens: staff do speak up about potential concerns, but they are too easily convinced that their concerns are unfounded.
When a person voices a concern, there's often no disruptive, disrespectful, or obvious intimidating behavior involved per se, but rather an explanation from competent practitioners that dispels the initial concern too quickly, before it has been given sufficient consideration. A pharmacist reassures a technician that the compounding directions are correct when questioned about an unusual volume of ingredients; a pharmacist assures the nurse that the strength of the infusion is correct when questioned about the final volume; a nurse reassures a patient that the medication is correct when questioned about its appearance; a physician convinces a pharmacist that the prescribed dose is correct when questioned because it differs from a protocol—these are all-too-frequent examples that have led to fatal adverse drug events. Those who questioned the patients' care were easily convinced that others knew more than they did, particularly if the provider who was questioned had an otherwise stellar reputation.
Is this a form of intimidation? Perhaps, but it is more akin to a logical deference to expertise, meaning it is natural and often reasonable for people to defer final judgment to those who they perceive to be more "qualified." If the person voicing the concern was reluctant to pursue it, avoided or backed down from the conversation, or felt the provider was not listening, workplace intimidation may play a role. But this is not always the case. Instead, the issue may be that the person questioning the patient's care has been easily convinced that their concern is unfounded, and the person being questioned has not perceived the voiced concern as a possible, credible patient threat. Neither possesses a required element to safeguard patients: an appropriately high index of suspicion for errors. A low index of suspicion is particularly problematic in a healthcare system that already is reluctant to acknowledge human error or value the contributions from every person, regardless of rank, who interacts with the patient.
An index of suspicion is defined as "awareness and concern for potentially serious underlying and unseen injuries or illness."^[1] Suspicion is defined as "the act or an instance of suspecting something wrong without proof or on very slight evidence, or a state of mental uneasiness and uncertainty."^[2] A high index of suspicion requires consideration of a large differential so that a serious possibility is not accidentally discounted; a potential medical error should always be considered one of the possibilities. An appropriately high index of suspicion should lead a person with a concern to pursue it until it's proven to not be a credible patient threat, even when met with opposition from experts. It should also prompt the provider to be responsive to voiced concerns and to initiate a suitable investigation to determine if there is a credible threat to the patient.
ISMP has previously discussed the need to maintain a high index of suspicion for errors in our newsletter, including in the March 9, 2006, newsletter about mindfulness, a defining characteristic of high-reliability organizations (HROs). Mindfulness refers to the deep and chronic sense of unease and preoccupation with failure that arises from admitting the possibility of error, even with well-designed, stable processes.^[3] People in HROs worry about system failures and human errors. They ask, "What will happen when an error occurs?" not "What will happen if an error occurs?" Like healthcare, HROs are hierarchical, but position and experience do not necessarily dictate who is an important contributor or decision maker. They are wary of complacency and naturally suspicious, so they expect people to speak up about any concerns they may have. Their high index of suspicion is a predominant factor in achieving laudable safety records.
To improve patient safety, healthcare needs to raise the index of suspicion for errors, always anticipating and investigating the possibility when any person, regardless of experience or position, voices concern or when patients are not responding to treatment as anticipated. Functional patient care teams, in which every person's perspective, skills, knowledge, and observations are considered important and worthy of mention and investigation, must be developed. Staff need to be mentored on how to resolve potential concerns and to trust in their own experiences to augment the expertise of others. All healthcare practitioners need to encourage and be receptive to staff who ask questions, even if staff just have a sense that "something" is wrong or can't articulate the concern well. When concerns are met with quick answers that initially appear to be "evidence" of safety, caution is recommended. Thirteen years ago, our colleague, Timothy Lesar, PharmD, of Albany Medical Center in Albany, New York, allowed us to publish a list of phrases he called "magic words" which have been repeatedly offered in explanation to voiced concerns and erroneously accepted as "evidence" (Table 1).^[4] No doubt, these still ring true today, along with many others. Such phrases should be viewed as "red flags" that require more reliable answers and actual proof.

[ CLOSE WINDOW ]

Table 1. Responses to Voiced Concerns Considered "Red Flags"

"The attending told me to order it that way."

"The patient says that's how he takes it at home."

"It was published in … (e.g., JAMA)" (without providing the reference).

"This is a special case."

"The patient's been titrated up to that dose."

"The patient is on a protocol" (without providing the protocol).

"The dose is the same as listed on the patient's old chart."

"That's the way the dose is written in the progress notes."

"It's on the list of medications the patient gave me."

"We always give it that way."

ISMP is not discounting the fact that intimidation may play a role in a reluctance to speak up about possible concerns and a tendency to be easily convinced that a concern is unfounded. We also do not discount the extraordinary courage it may take for many to step up to these conversations. However, healthcare practitioners also need to acknowledge that a natural deference to expertise can lead to unintended complacency and tolerance of risk that goes unchallenged. To combat that, all who interact with patients must reduce their tolerance of risk and raise their index of suspicion of errors.
A 2010 study conducted by VitalSmarts, the Association of periOperative Registered Nurses (AORN), and the American Association of Critical-Care Nurses (AACN), offers insight into the key skills that can encourage an appropriate response to voiced concerns.^[5] These skills are summarized in Table 2. The study concludes that there is cause for optimism—concerns are being voiced nearly three times more often than just 5 years ago. Healthcare practitioners need to ensure that these concerns are not only raised but also properly investigated and addressed. You can be sure that those involved in serious errors wish that they had taken the opportunity to do just that.

 Table 2. Key Skills When Communicating Concerns to Encourage Appropriate Investigation⁵

Explain your positive intent – how you want to help the caregiver as well as the patient.

Use facts and data as much as possible to support your concern.

Assume the best, but speak up.

Make an effort to communicate the concern in a safe environment (e.g., away from patients, caregivers) if possible to avoid defensive posturing.

Don't show frustration or anger; keep emotions in check, even if the initial response is not as expected.

Avoid telling negative stories, making accusations, or using threats.

Diffuse or deflect the person's anger and emotion by staying calm.

 References

1. American Academy of Orthopedic Surgeons. Emergency Care and Transportation of the Sick and Injured, 10th ed. Sudbury, MA:Jones and Bartlett Learning; 2010:747.
2. Merriam-Webster. Online dictionary. Accessed on July 23, 2012 at: www.merriam-webster.com/dictionary/suspicion
3. ISMP. Safety requires a state of mindfulness (part 1). ISMP Medication Safety Alert! 2006; 11(5):1-2.
4. ISMP. "Magic words" or "red flags?" ISMP Medication Safety Alert! 1999;4(4):1–2.
5. Maxfield D, Grenny J, Lavandero R, Groah L. The silent treatment; why safety tools and checklists aren't enough to save lives. Report: VitalSmarts, AORN, AACN. 2010. Accessed on July 23, 2012 at: www.aacn.org/WD/hwe/docs/the-silent-treatment.pdf

ISMP Medication Safety Alert © 2012 Institute for Safe Medication Practices

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