Patients should prepare for fewer nurses

NASHVILLE, March 28 (UPI) -- Patients should brace for a severe shortage of nurses, which could reach 500,000 by 2025, U.S. health researchers said.

Peter Buerhaus of Vanderbilt University School of Nursing, Douglas Staiger of Dartmouth University and David Auerbach of the Congressional Budget Office said the demand for registered nurses is expected to continue to grow at 2 percent to 3 percent per year.

The supply of registered nurses is expected to grow very little as large numbers of nurses begin to retire or leave work.

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Heart Association: Hands-only CPR works

NEW YORK (AP) -- You can skip the mouth-to-mouth breathing and just press on the chest to save a life.


Jared Hjelmstad, right, used hands-only CPR to help save Garth Goodall's life in California.

In a major change, the American Heart Association said Monday that hands-only CPR -- rapid, deep presses on the victim's chest until help arrives -- works just as well as standard CPR for sudden cardiac arrest in adults.

Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.

"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.

Hands-only CPR calls for uninterrupted chest presses -- 100 a minute -- until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.

This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest -- the heart suddenly stops -- which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.

A child who collapses is more likely to primarily have breathing problems -- and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.

But in either case, "Something is better than nothing," Sayre said.

The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those "unable or unwilling" to do the breaths could do presses alone.

Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.

Sayre said the association took the unusual step of making the changes now -- the next update wasn't due until 2010 -- because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.

An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get hands-only CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.

Dr. Gordon Ewy, who's been pushing for hands-only CPR for 15 years, said he was "dancing in the streets" over the heart association's change even though he doesn't think it goes far enough. Ewy is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.

Ewy said there's no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths -- 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.

Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.

"When people are honest, they're not going to do it," he said. "It's not only the yuck factor."

In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.

"They love it. It's less complicated and the outcomes are better," said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.

One person who's been spreading the word about hands-only CPR is Temecula, California, chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California

Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad's 15-year-old son Josh called 911 in the meantime.

Hjelmstad said he pumped on Goodall's chest for more than 12 minutes -- encouraged by Goodall's intermittent gasps -- until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.

On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.

"After this whole thing happened, I was on cloud nine," said Hjelmstad. "I was just fortunate enough to be there."

Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there'd been no hint that he had clogged heart arteries.

"I was lucky," he said. Had the situation been reversed, "I wouldn't have known what to do."

"It's a second lease on life," he added.

CNN: Associate Press

Before Code Blue: Who’s minding the patient?

Little-known ‘failure to rescue’ is most common hospital safety mistake

High-profile medical errors such as operating on the wrong body part or receiving a mistaken dose of drugs should take a back seat to a far more common and insidious mistake, a new report reveals.

For the fifth straight year, an analysis of errors in the nation’s hospitals found that the most reported patient safety risk is a little-known but always-fatal problem called “failure to rescue.”

The term refers to cases where caregivers fail to notice or respond when a patient is dying of preventable complications in a hospital.

Between 2004 and 2006, failure to rescue claimed more than 188,000 lives, amounting to about 128 deaths for every 1,000 patients at risk of complications, according to the latest report from HealthGrades, a health care ratings organization.

That’s far more than any other measure found in the new study, which detected 1.12 million safety problems during nearly 41 million hospital stays logged by the country’s Medicare recipients. The mistakes, tracked in 16 areas, accounted for more than 238,000 preventable deaths over three years and an estimated $8.8 billion in unnecessary medical costs, the report showed.

The numbers included 6-year-old Christian Padilla of Fort Wayne, Ind., who sailed through a successful heart surgery to correct a birth defect in 2005, only to die days later from the preventable complications that characterize a failure to rescue case.

“The nurse didn’t recognize his symptoms as something of concern,” said the boy’s father, Jim Padilla, 38, an assistant professor at a local university. “She described him in her medical notes as ‘acting fidgety.’”

Padilla family
Christian Padilla, 6, of Fort Wayne, Ind., came through heart surgery fine, but died after a nurse failed to notice signs of brain swelling.

In reality, the child was unconscious and suffering seizures as a result of the brain swelling that killed him, said Padilla, who received a $1.25 million combined settlement from the Indiana Patient’s Compensation Fund and Riley Children’s Hospital, according to the Indiana Department of Insurance.

It's not clear whether a drug reaction or another problem caused the swelling, said Padilla, who was at his son's side, frantic, throughout the ordeal.

"We got to the point where I had asked multiple times: 'Should he be sleeping so long?'" he said. "Over and over, I was told this was normal.'"

The nurse’s failure to notice Christian’s subtle but increasing symptoms of distress is a key element of this measure of how well hospitals respond to unexpected complications — or don’t, said Dr. Samantha Collier, chief medical officer for HealthGrades.

“As an example, somebody comes in for an elective surgery like a knee replacement and turns up with vague symptoms, like shortness of breath, and the next thing you know, somebody dies,” explained Collier. “It’s obvious that if you go in for a knee surgery, you shouldn’t die.”

When simple procedures go wrong
Failure to rescue is a marker that should concern anyone who’s ever been a patient in a hospital. It predicts whether even simple procedures suddenly could go wrong, said Dr. Michael DeVita, a professor of critical care medicine at the University of Pittsburgh School of Medicine.

“It’s before Code Blue,” he said, referring to the common term for patients in acute distress. “Somewhere between two-thirds and fourth-fifths of Code Blue incidents are preceded by this.”

Every year, at least 61,000 people die from failure to rescue mistakes, the report showed. The deaths have decreased by more than 11 percent since 2004, a bright spot in a study where about half of the patient safety indicators improved, but the rest didn’t. Four important post-operative indicators got worse: respiratory failure, pulmonary embolism or deep vein thrombosis, sepsis and abdominal wounds that split open after surgery.

Overall, the rate of patient safety problems has remained steady at about 3 percent of Medicare hospitalizations, the report indicated. The percent of patients who died after enduring one or more mistakes dropped by nearly 5 percent, to about 26 percent.

Although HealthGrades has been measuring failure to rescue since 2002, when it counted some 200,000 cases during a three-year reporting period, the agency has changed how it analyzes data from the federal Agency for Healthcare Research and Quality, Collier said.

Critics charged that the agency was including patients who might have been predisposed to complications, artificially inflating the results, but Collier said those patients have been excluded from the new analysis.

Still, even 11 percent improvement isn’t nearly enough in a condition that should be preventable, said Sean Clarke, associate director for the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia.

“Failure to rescue is not whether you get the wrong IV in the first place,” said Clarke. “It’s how fast do people pick up that you’re going south and turn it around?”

Too often, overworked, overwhelmed and inexperienced nurses and other hospital workers fail to notice basic problems, or to accurately interpret their meanings, said Clarke.

Surgery, painkillers raise risk
The two trickiest situations involve patients who’ve just come from surgery, or those who are taking medications for pain, Clarke said. In each case, subtle reactions can escalate from mild concern to near catastrophe within a matter of hours.

“It’s the basics. It’s about breathing, it’s about circulation, it’s about bleeding. Breathing issues are a huge, huge, huge deal,” he said.

The situation is hardly new. The term “failure to rescue” was first coined in the early 1990s by Dr. Jeffrey H. Silber, director of the Center for Health Outcomes and Policy Research. He was looking for a way to characterize the matrix of institutional and individual errors that contribute to patient deaths.