A recent worldwide study has shown that more women are dying in childbirth in Canada, the US and Denmark. The study was funded by Bill Gates' Foundation to better understand the current rates of women dying from complications of pregnancy in several countries.
I couldn't help but reflect on these results reported on the Medscape Nurses website. As a veteran perinatal nurse who has experienced firsthand the circumstances of women dying while giving birth, and knowing that many "close calls" are only survivals because of the experience and skill of the health care team, I have to think that changes to health care delivery is costing women their lives.
Senior nurses always play a major role in any life threatening situation. The hospital budget may welcome two new nurses for the price of one senior nurse but is this budgetary decision costing patients their health and maybe even their lives? A chart review and interviews can quickly uncover just who was caring for that patient and if poor decisions were made by rookie staff. The right questions during discovery can reveal circumstances and events which secure the chain of events and the consequences for that woman and her baby.
A maternal death is always tragic. Maternal disability from complications of childbirth is also tragic. Only intimate knowledge of the entire health care team and their approach will uncover the merit of pursuing legal action. An increase in incidents means more clients seeking legal advice from a complete team approach. Are you ready?
Friday, April 16, 2010
Thursday, October 1, 2009
Should we believe what we read in professional journals?
When I pick up a professional journal, I am already convinced that what I read is based on impartial research and evidence. But should I be?
My assumption that articles are being provided by professionals with the public interest as a priority is the wrong assumption. I was unaware until just recently that pharmaceutical companies and medical device companies can be very generous in order to receive positive press about their latest drug or gadget. While, as a health care professional, I would like to believe that other health care professionals can provide unbiased research despite the gifts, I am not that trusting of human nature.
To be fair, journals are taking steps to prevent this practice of padding their publications with articles favouring the “latest and greatest.” Until it becomes routine, and every journal checks the background of their authors, I would suggest a double-check on that research your case may depend on.
My assumption that articles are being provided by professionals with the public interest as a priority is the wrong assumption. I was unaware until just recently that pharmaceutical companies and medical device companies can be very generous in order to receive positive press about their latest drug or gadget. While, as a health care professional, I would like to believe that other health care professionals can provide unbiased research despite the gifts, I am not that trusting of human nature.
To be fair, journals are taking steps to prevent this practice of padding their publications with articles favouring the “latest and greatest.” Until it becomes routine, and every journal checks the background of their authors, I would suggest a double-check on that research your case may depend on.
Saturday, September 5, 2009
Toddlers at risk from codeine
The maternity world was turned upside down in the past few years with the realization that a common painkiller administered to mothers following childbirth was having disasterous results for newborns. Now it has been established by Canadian researchers that toddlers with the same genetic variation as those newborns have died from the same drug given directly to them following surgery.
According to research done at the University of Western Ontario in London and the Hospital for Sick Children in Toronto, the very common drug is acetaminophen and codeine (one familiar brand name of this combination is Tylenol 3). Unfortunately, there are very young children with a genetic variation who convert the codeine into morphine very rapidly. The morphine then slows breathing and a high enough dose will stop breathing resulting in death.
These findings are significant for cases where an otherwise “healthy” young child has undergone an uneventful procedure yet had complications such as respiratory arrest or death. If the child received codeine, that could be the root of the problem.
According to research done at the University of Western Ontario in London and the Hospital for Sick Children in Toronto, the very common drug is acetaminophen and codeine (one familiar brand name of this combination is Tylenol 3). Unfortunately, there are very young children with a genetic variation who convert the codeine into morphine very rapidly. The morphine then slows breathing and a high enough dose will stop breathing resulting in death.
These findings are significant for cases where an otherwise “healthy” young child has undergone an uneventful procedure yet had complications such as respiratory arrest or death. If the child received codeine, that could be the root of the problem.
Sunday, August 23, 2009
Avandia Increases Risk to Type 2 Diabetics
In a recent study by Toronto’s Clinical Evaluative Sciences, the drug Avandia (rosiglitazone) demonstrated an increased risk of heart failure and death when compared to the other drug for the treatment of Type 2 diabetes, Actos (pioglitazone).
As published in the British Medical Journal, the study examined the records of 40 000 patients treated with these drugs; 23% were less likely to be hospitalized for heart failure and 14% less likely to die when given Actos (pioglitazone) instead of Avandia (rosiglitazone). This has major implications for the millions of patients treated for Type 2 diabetes in the last several years. Based on the study, for every 120 people taking Avandia, one more was hospitalized and for every 269 people, one would die.
The makers of Avandia, GlaxoSmithKiline, have initiated their own study in response. The results will not be known for several years probably after the two drugs become available as generic formulas.
Dr. Juurlink, principal investigator, has dismissed criticisms from GlaxoSmithKline that the study may have only dealt with patients who were sicker. He points out that you would expect to see more heart attacks if the patients taking Avandia were sicker yet the study revealed that there was no difference in heart attack rates between the two groups.
As Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, has said, “I guess the final word would be: Who would want to take the chance? Why would you? So from my perspective while you can argue that it may not end the story, in the meantime, what should physicians do? And I think the answer is they should use the safer of the two drugs.”
As published in the British Medical Journal, the study examined the records of 40 000 patients treated with these drugs; 23% were less likely to be hospitalized for heart failure and 14% less likely to die when given Actos (pioglitazone) instead of Avandia (rosiglitazone). This has major implications for the millions of patients treated for Type 2 diabetes in the last several years. Based on the study, for every 120 people taking Avandia, one more was hospitalized and for every 269 people, one would die.
The makers of Avandia, GlaxoSmithKiline, have initiated their own study in response. The results will not be known for several years probably after the two drugs become available as generic formulas.
Dr. Juurlink, principal investigator, has dismissed criticisms from GlaxoSmithKline that the study may have only dealt with patients who were sicker. He points out that you would expect to see more heart attacks if the patients taking Avandia were sicker yet the study revealed that there was no difference in heart attack rates between the two groups.
As Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic, has said, “I guess the final word would be: Who would want to take the chance? Why would you? So from my perspective while you can argue that it may not end the story, in the meantime, what should physicians do? And I think the answer is they should use the safer of the two drugs.”
Monday, August 17, 2009
Changes in Health Care
Health care as an industry is changing in Canada and the US. Budget concerns seem paramount and are apparently the stimulus for these changes. It must be remembered though that fiscal responsibility should not compromise patient care. Already in my nursing practice, I see incidents that lead to unsafe situations for patients and staff. Professional responsibility forms are being filled out at an alarming rate as staff try to stop the tide of unsafe health care sweeping Canada.
This past weekend, the CEO of Alberta Health Services was quoted as saying that just because a unit had a registered nurse running it in the 1990s does not mean it needs to be run by one now. He states that things must change not stay the same. Dr. Duckett could not be more wrong! I shudder to think of the professional liability of health care workers who make mistakes because they are not trained to see the entire medical picture. And let’s not forget the human price of those mistakes—the patient, the family and the staff all pay a high emotional and psychological price for a negative impact on a poorly managed case.
A registered nurse has always been in charge of a hospital unit. Not because of her special status in the hierarchy but because of her experience, skills and education. To have the head of Alberta Health Services not comprehend (or appreciate) the importance of this role is shocking. It also means that negligence and malpractice is about to become a common theme in Alberta trial law.
I wonder if Dr. Duckett has budgeted for increased insurance , settlements and claims?
This past weekend, the CEO of Alberta Health Services was quoted as saying that just because a unit had a registered nurse running it in the 1990s does not mean it needs to be run by one now. He states that things must change not stay the same. Dr. Duckett could not be more wrong! I shudder to think of the professional liability of health care workers who make mistakes because they are not trained to see the entire medical picture. And let’s not forget the human price of those mistakes—the patient, the family and the staff all pay a high emotional and psychological price for a negative impact on a poorly managed case.
A registered nurse has always been in charge of a hospital unit. Not because of her special status in the hierarchy but because of her experience, skills and education. To have the head of Alberta Health Services not comprehend (or appreciate) the importance of this role is shocking. It also means that negligence and malpractice is about to become a common theme in Alberta trial law.
I wonder if Dr. Duckett has budgeted for increased insurance , settlements and claims?
Wednesday, August 12, 2009
Can there be a budget during a pandemic?
It is well established that we are about to face a flu season that will take a heavy toll on health care workers as well as the general public. Meetings are held to provide information and plans on how to cope, but there are also phrases like “we still have stay within budget” from administration. This sets a dangerous environment where the cost of caring for the ill and dying takes precedent over the actual care needed. Can there be a budget during a pandemic? Bureaucrats and politicians think so. Front line health care providers do not. Managers are pressured to keep their budgets under control under all circumstances.
As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.
The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.
As a nurse, I have to question just how safe patient care will be during this crisis. Increased staff shortages will be a certainty with health care workers ill themselves or caring for family members. Paying overtime for replacement staff is already discouraged so how do units replace badly needed staff to care for the ill in the hospitals? There will be a lack of equipment as unit budgets are stretched to pay for supplies. There are already reports of defective protective equipment from poor quality sources and from being stored under the wrong conditions.
The fallout from the H1N1 pandemic will resound for years. No doubt it will also find its way into lawyers’ offices and court rooms. Perhaps there the question of how much a pandemic will cost will be answered.
Friday, August 7, 2009
Cutting the Heart Out of Health Care
As a Registered Nurse at an acute care hospital in the province of> Alberta since 1988, I would like to call attention to an issue that will have a devastating impact on the quality of health care and patient safety in this province.
Health Minister Liepert announced that the nursing shortage in Alberta went from 1400 nurses to 30 in a single day. This was not some miracle. What it means is that a hiring freeze was implemented and vacant Registered Nurse positions mysteriously disappeared. I am writing to tell you that the nursing shortage is NOT over in Alberta and that we need to hire RN's more desperately than ever.
"Replacing" RN's with Licensed Practical Nurses and Patient Care Assistants is not the answer, but rather a question of fiscal short-sightedness. Studies show that investing in Registered Nurses can SAVE money in the long run, with reduced hospitalization times and fewer adverse patient outcomes. If immediate action is not taken, the situation is likely to worsen.
Recruiters from other provinces and other countries have become very active here and we are in serious jeopardy of losing more nurses. Senior nurses are looking to retire in the next few months rather than face more cutbacks like those we had in the 1990s. Memories are vivid of the last cutback experience from which Alberta has never truly recovered.
Registered Nurses are the very heart of health care, and many of us fear that Minister Liepert's dangerous experiment of cutting RNs will leave Alberta's health care system dead on the operating table.
Health Minister Liepert announced that the nursing shortage in Alberta went from 1400 nurses to 30 in a single day. This was not some miracle. What it means is that a hiring freeze was implemented and vacant Registered Nurse positions mysteriously disappeared. I am writing to tell you that the nursing shortage is NOT over in Alberta and that we need to hire RN's more desperately than ever.
"Replacing" RN's with Licensed Practical Nurses and Patient Care Assistants is not the answer, but rather a question of fiscal short-sightedness. Studies show that investing in Registered Nurses can SAVE money in the long run, with reduced hospitalization times and fewer adverse patient outcomes. If immediate action is not taken, the situation is likely to worsen.
Recruiters from other provinces and other countries have become very active here and we are in serious jeopardy of losing more nurses. Senior nurses are looking to retire in the next few months rather than face more cutbacks like those we had in the 1990s. Memories are vivid of the last cutback experience from which Alberta has never truly recovered.
Registered Nurses are the very heart of health care, and many of us fear that Minister Liepert's dangerous experiment of cutting RNs will leave Alberta's health care system dead on the operating table.
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