Patient Safety

5 Troubling Healthcare Facts Articles PPAHS has been reading the week of January 22, 2018

The articles we have been reading this past week of January 22, 2018 discuss 5 troubling healthcare facts.

#1 Troubling Healthcare Fact – Not enough experienced nurses

Shawn Kennedy, MA, RN asks a very good question in the title of her article, “Experienced Bedside Nurses: An Endangered Species?”:

“The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome.”

We don't have enough experienced #nurses #patientsafety Click To Tweet

#2 Troubling Healthcare Fact – Deaths during childbirth

The article, “Death During Childbirth Has More Than Doubled in the Past 30 Years” discusses worrisome health trend of increasing deaths during childbirth as showed in the CDC graph below:

CDC Maternal death rates

Source: CDC Maternal Deaths

Some of the possible causes are discussed in the article:

“The reasons for higher maternal mortality in the U.S. are manifold. New mothers are older than they used to be, with more complex medical histories. Half of pregnancies in the U.S. are unplanned, so many women don’t address chronic health issues beforehand. Greater prevalence of C-sections leads to more life-threatening complications [emphasis added]. The fragmented health system makes it harder for new mothers, especially those without good insurance, to get the care they need. Confusion about how to recognize worrisome symptoms and treat obstetric emergencies makes caregivers more prone to error.”

However, as alarming as this trend is, William M. Callaghan, M.D., M.P.H. (senior scientist for the maternal and infant health branch in CDC’s Division of Reproductive Health at the National Center for Chronic Disease Prevention and Health Promotion) told PPAHS this trend may actually be under-reported:

“These statistics may represent a conservative estimate of the problem.  Why?  Not all pregnancy-related deaths are accurately identified and reported. Hence, pregnancy-related deaths identified at the national level likely undercount the true number.”

#Death During #Childbirth Has More Than Doubled in the Past 30 Years #patientsafety Click To Tweet

#3 Troubling Healthcare Fact – Overuse of cesarean delivery

One of the causes identified in the above article on increasing deaths during childbirth is cesarean delivery (as bolded in the above quote)

One of the causes identified in the above article on increasing deaths during childbirth is cesarean delivery (as bolded in the above quote). In “Cesarean Delivery Can Pose Long-Term Risks to Mother and Child,’ discusses why it could be a danger to both mother and child

“Compared to vaginal delivery, C-sections were associated with a significant reduction in the risk for urinary incontinence and for pelvic organ prolapse, a dangerous weakening of the muscles that hold pelvic organs in place …

“Children delivered by cesarean had a 21 percent increased probability of asthma by age 12 and a nearly 60 percent increased likelihood of obesity up to age 5.”

Troubling #Healthcare Fact - Overuse of #cesarean delivery Click To Tweet

#4 Troubling Healthcare Fact – How to treat the opioid-addicted patient

Two articles caught our attention regarding the struggles of clinicians to help their opioid-addicted patients:

  • One is a personal story of a doctor in the article, “A Doctor’s Painful Struggle With an Opioid-Addicted Patient” – “Medicine depends implicitly on a therapeutic alliance between a doctor and a patient, but addiction, I learned, distorts that alliance. The doctor shifts from healer to dealer. To the addict, the doctor is contorting the truth; to the doctor, it’s the addict who is constantly inverting reality.”
  • One a story about the challenges being faced by paramedics in, “The Opioid Crisis: A battle first responders face head on” – “First responders will be the first to tell you no two overdoses are ever the same. ‘It depends on the person,’ Carle Regional EMS Medical Director Dr. Michael Smith said. ‘I’ve had people who are very regretful, tearful, you’re very confident they have learned their lesson.’” ‘Others will unfortunately go back into the cycle of using, and probably in the next week or two we’ll be going back to their medical call,’ Atwood Police Chief Rob Bross said.
Troubling #Healthcare Fact - How to treat the #opioid-addicted #patient #patientsafety Click To Tweet

#5 Troubling Healthcare Fact – Over reliance on pulse oximetry

Research by T. Lam et al in, “Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis” looked at the effectiveness of continuous pulse oximetry (CPOX) versus routine nursing care and the effectiveness of continuous capnography monitoring with or without pulse oximetry for detecting postoperative respiratory depression and preventing postoperative adverse events in the surgical ward. They concluded:

“The use of CPOX on the surgical ward is associated with significant improvement in the detection of oxygen desaturation versus intermittent nursing spot-checks. There is a trend toward less ICU transfers with CPOX versus standard monitoring. The evidence on whether the detection of oxygen desaturation leads to less rescue team activation and mortality is inconclusive. Capnography provides an early warning of PORD before oxygen desaturation, especially when supplemental oxygen is administered. Improved education regarding monitoring and further research with high-quality randomized controlled trials is needed.”

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