Briefs

ATLANTA — Results of a national research study conducted by Harris Interactive® and commissioned by McKesson show that 72 percent of frontline registered nurses surveyed believe that medication safety has improved in their hospital over the last five years. Eighty percent of those nurses identified technology as a major contributor to that improvement. However, 94 percent of respondents reported seeing one or more serious medication errors within that same time frame, indicating that much work remains to be done to improve safety in the nation’s hospitals.

These results are among the key findings in a study conducted in April 2005, which surveyed 216 experienced registered nurses selected randomly from hospitals across the United States with at least 125 beds. The purpose of the study was to learn how frontline nurses view their jobs, the current state of medication use and the extent to which technology is being employed to make healthcare safer. The findings were released at the first annual Nursing Leadership Congress, an invitational event in Sonoma, Calif., focused on medication safety.

The study found that 43 percent of nurses surveyed use online documentation tools at a nursing station. Only 32 percent of respondents use these tools at the point of care. While automated medication cabinets are by far the most commonly used technology (cited by 70 percent of respondents), bar-code medication administration tools are used by only 23 percent of nurses polled. Scanning bar codes on patient wristbands enables nurses to check for the “five rights” of medication safety — right patient, right drug, right dose, right time and right route — before administering medications to patients.

“Despite the availability of advanced technologies for making care both safer and more efficient, nurses are largely still practicing in a manual, paper-based world that by nature is very complex,” said Billie Waldo, MS, RN, BC, McKesson’s vice president and general manager of medication safety. “Combined with nursing shortages in many parts of the country, it’s not difficult to understand why errors occur. However, we owe it to both nurses and patients to make tools available that not only prevent errors but also lead to better care. Bar-code scanning and online documentation at the bedside are great examples of solutions that help nurses to achieve these goals while enabling more time with patients.”

At Presbyterian Healthcare Services in Albuquerque, N.M., nurses’ practice of scanning bar codes on patient wristbands has led to a 77.9 percent reduction in medication errors, with uncharted medications reduced to less than .05 percent. Concord Hospital in Concord, N.H., reduced its already low medication error rate by 80 percent when it introduced bedside bar-code scanning of medications in 1994. This reduced error rate has been sustained for more than 10 years while improving productivity and efficiency, which has increased clinician satisfaction and retention.

“Starting with the most senior levels in hospitals, we must be firmly committed to the people, process, and technology changes that are required to create safe, high-quality healthcare environments,” said Marilyn Bowcutt, MSN, RN, president of the American Organization of Nursing Executives and vice president of patient care services at University Health System (UHS) in Augusta, Ga. “To achieve safer care, we must understand what frontline nurses are thinking and experiencing. From there, we can look at the role technology and other factors can play in making the hospital environment both safer for patients and more supportive and rewarding for nurses.”

UHS is one of only 132 hospitals in the country to receive the Magnet Award, which recognizes nursing leadership and safe, high-quality care provided by the nursing staff. UHS nurses have online access to patient information and chart patient care online, and the hospital is in the process of implementing bar-code scanning of medications at the point of care.

“Nurses know firsthand how heavier patient loads, sicker patients, and growing regulatory requirements can affect safety,” said Shayne Roberson, RN, a staff nurse at UHS and a member of the Shared Governance Coordinating Council. “Strategies to improve patient safety are a constant focus for us. The use of medication cabinets and online patient charting have absolutely made a difference. There’s less paperwork, and they provide an extra safety net that nurses really appreciate. We’re now moving toward bar-code scanning, which will further improve the safety of the medication use process.”

The survey’s findings, located at http://mpt.mckesson.com, confirm some commonly held beliefs about nursing but challenge others. Besides technology, an environment that supports the examination of errors (69 percent) is a reason cited for improvements in medication safety by respondents who feel medication safety is better in their own hospital. Other reasons given include better communications between nurses and pharmacists (57 percent), and better communications between nurses and doctors (49 percent).

Among those nurses surveyed who responded that there are times when medication errors are more likely to occur, 72 percent said that administering an unfamiliar medication is a time they are most concerned that a medication error may occur, supporting the need for more education about new drugs and better communication between nurses and pharmacists. Patient transfers ( 53 percent) and shift changes (52 percent) were also identified as times when these respondents were most concerned that errors may occur.

Study Examines Characteristics of Cancers of the Esophagus

Gastroesophageal reflux disease (GERD) may be associated with more cases of cancers than previously thought, according to a study in the June issue of Archives of Surgery.

The relationship of GERD and adenocarcinoma of the esophagus is clear for tumors located along the tubular portion of the esophagus, regardless of whether Barrett mucosa is found, according to background information in the article. But there is controversy about the origin of tumors located at the far end of the esophagus where it connects to the stomach. Two distinct cancer types arise there. One type is associated with Barrett mucosa and that it is caused by reflux is widely accepted, the authors write, but the second type has no associated Barrett mucosa and it has been proposed that these tumors originate differently. The major evidence in support of this position has been that the second type of tumor has a worse prognosis.

Guiseppe Portale, MD, of the University of Southern California, Los Angeles, and colleagues compared demographic information, clinical features and tumor characteristics in 215 patients who underwent surgery for cancer of the lining of the far end of the esophagus from January 1992 to December 2002. Pathology reports were reviewed to determine whether there was adjacent Barrett mucosa and whether these tumors represented distinct tumor types.

The researchers found that patients with Barrett mucosa had tumors that were diagnosed earlier; were smaller in size; earlier in stage, with fewer node metastases; and had a better five-year survival. “Although overall survival in the two groups was significantly different, survival by tumor stage was similar,” the authors write. “This suggests that adenocarcinomas without detectable Barrett epithelium may not be a different type of tumor but rather a more advanced stage of the same disease. It is likely that these larger, more aggressive tumors have overgrown the Barrett epithelium in which they arose.”

Based on cancer registry data, the authors suggest that this conclusion would double the number of cases of loss of life due to malignancy from gastroesophageal reflux disease. Arch Surg. 2005;140:570-575.

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