Care Issues

The category of Care Issues covers a myriad of topics around the care of the medical-surgical patient. Solving these complex patient care issues involves using effective communication collaboration with the interdisciplinary health care team.

Photo: "The Many Faces of AMSN Members," taken at a recent annual convention.

Question: Our staff needs to increase the use of sterile technique when inserting catheters. What would be the best way to approach this when educating the staff?

Answer: It is important to first focus on developing a culture of safety in your area. Nurses and nursing assistants need to be aware of standards of practice and policies related to this aspect of patient care, as well as the notion that they are to be followed...

Question: The pros and cons of Multidisciplinary Walking Rounds

Answer: The Institute for Healthcare Improvement has published a guide for multidisciplinary rounds which may be helpful. It can be downloaded from the website at no cost (IHI, 2015).

Question: What does AMSN recommend for care and maintenance of the small bore feeding tube?

Answer: The AMSN itself does not have any specific standards on this particular practice, however, many organizations state that verification must always be identified with an X-ray, the feeding tube must be marked so dislodgment can be noted and monitoring must be completed at a minimum of every 4 hours (AACN, 2010).

Question: A female patient has CIDP and receives Gamminex C every four weeks... blood tests... symptoms... general treatment...?

Answer: Upon investigation of your clinical question, members of the committee have provided their expertise in regards to Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). CIDP is closely related to Guillain-Barre syndrome and it is considered the chronic counterpart of that acute disease...

Question: Regarding Clinical Leadership (CL) in the unit... the best way of having everyone on the same page but not meeting with all CL members at the same time...

Answer: ...may be of some help in the preparation of your leadership group. First you will want to make sure that you follow the elements of the Nursing Professional Practice Model...

Question: What can we do to reduce patient falls? (Four questions posed)

Answer: ... It has been identified that is hourly rounds are appropriately and accurately competed, there is a significant reduction in patient falls and outcomes...

Question: Are you aware of any guidelines for use of warming blankets on medical-surgical patients?

Answer: Many organizations queried do not use have a specific policy in regards to a warming device (Bair Hugger). Additionally...

Question: ... Do Not Disturb Vest while administering medications are now being implemented within our facility per the director. How many facilities have actually implemented this practice and are there any other alternatives?...

Answer: Many organizations queried do not use “do not disturb” vests as a means to limit distractions for the nurse. However, many organizations have designated “do not disturb” or “no talking” zones and similar practices to achieve this goal, including posting signs that will aid in safety with the medication administration process...

Question: Delegation of task... do you have any information about whether you can delegate urinary catheter and/or peripheral IV removal to trained nonlicensed personnel?

Answer: Each state board of nursing outlines the tasks that may be performed by, and delegated to unlicensed assistive personnel (UAP). Each state also defines the educational program requirements for nursing assistant programs...

Question: Should patients with less than 20 weeks gestation be admitted on a regular medical surgical unit?

Answer: The guidelines that address this practice are the American College of Obstetricians and Gynecologists (ACOG) and the Association of Women's Health, Obstetrics and Newborn Nurses.