Hospital Workers Axed for Snapping Photos of Patients, Uploading to MySpace

Two University of New Mexico Hospital employees have been fired for using their cell phone cameras to take photos of patients receiving treatment and then posting the images to a social networking Web site.

Director of Public Affairs Sam Giammo said Sunday the photos — mainly close-ups of injuries being treated in the Albuquerque hospital's emergency room over the past few months — were posted on an employee's private MySpace page.

Giammo said he's never heard of a similar incident at the University of New Mexico Hospital or any other hospital.

A few other hospital employees were disciplined and the investigation is ongoing, he said.

UNMH values patient privacy "very, very highly and we will do everything we can to protect them," Giammo said. "We just won't tolerate unprofessional actions by any of our staff. We just won't stand for that."

The photos were discovered after a hospital supervisor received an anonymous tip about them Tuesday and launched an investigation.

Hospital managers personally oversaw the removal of the photos from the Web site and from the employees' cell phones, Giammo said.

"We have to rely on the people telling us that they don't have any others," he said.

The patients in the photos could not be notified that their pictures had been taken because their faces and personal identifying features had been removed from the photos, Giammo said.

Giammo said the MySpace page could only be accessed by the employee's online friends, not the general public.

Giammo said the employees who were fired violated a hospital policy that bans the use of cell phone cameras in patient areas. The other employees were disciplined for not bringing the photos to the attention of managers, he said.

The hospital is treating the matter as an employment issue and law enforcement has not been involved, Giammo said.

The use of cell phone cameras in hospitals have caused breaches of patient privacy or concern about such violations in California, Arizona and South Dakota in recent years.

States work to avert nurse shortage

By Pauline Vu, Staff Writer

If America is to solve its nurse shortage crisis, health-care leaders will have to figure out a way to keep people such as Nancy Burtis in the profession. 

Burtis, 52, was an emergency room and surgical nurse in the Chicago area for almost 25 years. But after growing weary from the constant stress of the job — including forced overtime and extra shifts — and seeing peers in understaffed units suffering with backaches from lifting patients without help, Burtis left the profession six years ago for a research job in the suburbs with a pharmaceutical company.
“You were always running, trying to get everything done, always afraid you were missing something or forgetting something,” she said. “I don’t think anybody can work that hard for that long.” 
A perfect storm of retiring baby boomers, an aging nurse population that’s leaving the profession and too few nursing instructors is setting up a health-care crisis. One report estimates that by 2020, there will be a staggering shortage of nurses — possibly more than 1 million vacancies. 
States are trying to head off that shortage by helping colleges turn out more nurses and by improving their working conditions. But the question remains whether it’s enough to avert a crisis. 
“I’ve been in this business for 37 years; there’s been a shortage every year,” said Janet Haebler, the associate director for state government affairs for the American Nurses Association (ANA). “This is probably the worst.” 
The country is expected to be short about 1 million nurses by 2020, the Health Resources and Services Administration reported four years ago. According to the Kaiser Family Foundation, 30 states had a shortage of nurses in 2000; by 2020, 44 are expected to face a shortage. 
Nurses are leaving the profession in droves, largely because of retirement — the average age of a nurse is 47 — but also because of stressful working conditions. 
At the same time, schools aren’t graduating enough replacements. A shortage of nursing instructors has left 40,000 qualified students on waiting lists nationwide. Because nurses can make more money working in clinics or hospitals than teaching, few return to school to earn the advanced degrees needed to teach. 
States are pouring money into the problem. More than two-thirds of states have committed funds to nursing education in the past five years, increasing money for scholarships and loan-forgiveness programs for nurses who return to school. 
In Mississippi, for example, where nursing educators’ salaries had been well below the southeastern U.S. average, the state Legislature approved a $12,000 pay increase in 2006 for nursing faculty, a move that drew younger nurses into teaching and helped keep faculty who were planning to retire. 
The Legislature this year awarded enough funding for one extra full-time faculty position at each of the state’s five public universities and 14 community colleges that have nursing programs. “That was just phenomenal in a state which typically has a deficit,” said Wanda Jones, executive director of the Mississippi Office of Nursing Workforce. 
Jones said the strong partnership among her office, the Legislature, state colleges and the state’s nursing associations helped Mississippi almost double the number of its nursing graduates since 2001, from 820 to more than 1,530.
Kansas also has seen success so far with a 10-year, $30 million plan initiated in 2006 to boost the number of nurses by 25 percent. Colleges compete for the money, made up of both state funding and matching dollars from the schools. 
While the Legislature expected schools would turn out an extra 250 nursing slots annually, they instead turned out 507 during the first year of the program. They also added 28 full-time and 23 part-time faculty positions.
It’s so successful this year that Kansas expanded the program, awarding $100,000 in grants to private nursing programs. 
“When you make it a competitive process, that’s how you get the kind of results that we did,” said Blake Flanders, vice president of workforce development for the Kansas Board of Regents, which administers the grants. “I really don’t know of a more successful nursing initiative … than we’ve had in Kansas for the amount of dollars that were invested.” 
But even if states succeed in getting more future nurses in the pipeline, nurses will continue to leave the profession if hospitals don’t begin fixing workplace problems, they say. Shortages have led to mandatory overtime and fewer nurses to take care of more patients. Those conditions, in turn, have worsened patient care and also been linked to an increase in violence against nurses, many times by patients or their families. 
“Out of 300 nurses we graduate, we lose anywhere from 100 to 150 because the hospitals don’t appreciate the resources,” said Deborah Burger, president of the California Nurses Association. 
In 1999, California became the only state to limit the number of patients under one nurse’s care in hospitals to five. Though critics say the law removes flexibility for hospitals, the California Nurses Association maintains the law promotes better patient care. 
No other state has enacted a similar law, although several have considered it, and the Massachusetts state nursing union has been pushing for one. 
Instead of backing nurse-to-patient ratios, the ANA supports legislation requiring hospitals to have committees, half of which are nurses, to draw up staffing plans. The committee would determine staffing based on employee skill and experience, as well as the typical patient population. This year, three states — Connecticut, Ohio and Washington — enacted safe staffing legislation, bringing to at least 13the number of states with similar laws. 
Mandatory overtime is also a long-standing problem for nurses. So far, 14 states have placed limits on or banned mandatory overtime for nurses.
Seven states also have laws requiring hospitals to have workplace violence prevention programs that include requiring hospitals to track how often there are violent incidents against health-care workers, and offering assault prevention and protection training. Oregon and New Jersey enacted laws last year. Another eight states have increased penalties for violence against nurses. 
One big fear about the nursing shortage is that the need for nurses will lead schools and hospitals to lower standards. Some states already allow aides to perform tasks in nursing homes that 30 years ago only nurses could do, such as administering medicine and injections, said the ANA’s Haebler. 
“I’m already worried,” she said. “I’m aging and I’m worried about who’s going to be taking care of me.” 

New Show About A Nurse- Cool!

Showtime will soon have a new series about a nurse that works in an inner city hospital, called "Nurse Jackie." Jackie will be played by Edie Falco (yay!).

Trailer is provided in the link. Looks like it's going to be a great show that actually highlights what nurses deal with on a daily basis. It's supposed to be a dark comedy. How appropriate.

Hand washing: is near enough good enough?

Anne Little 

MORE hand washing doesn’t result in a corresponding reduction in hospital-based infections, according to research from the United Kingdom. 

In health care, hand washing is touted as the panacea for eliminating nosocomial infections. Despite the convention that hand washing alone can reduce hospital based infections, a combined University of Bradford and Harrogate District Hospital study has found that increasing the frequency of hand washing by health care workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward.

Co-author and Department of Microbiology professor at Harrogate and District National Health Service Foundation Trust, Kevin Kerr, said the assumption that hand washing could prevent all hospital care-acquired infections (HCAI) had led to the research.

“There is a perception by some healthcare regulators that the problem of HCAI has been largely created by healthcare professional not washing their hands,” he said.

“There is also a perception that increasing hand hygiene rates to as close to 100 per cent as they can get will solve the problem.”

The study, headed by UB professor of medical technology, Clive Beggs, aimed to evaluate the impact of hand-washing technique and frequency on the transmission of staphylococcal infection and identify if there is a limit at which further compliance would not show results.

The results published online in the journal BioMed Central Infectious Diseases revealed that while hand hygiene is an effective control measure, the laws of diminishing returns apply.

When it comes to hand washing, the most benefit is seen in the first 20% of compliance. The researchers concluded there is little benefit in a 100% rate of hand-washing compliance and a compliance rate of more than 40% should be enough to prevent outbreaks of staphylococcal infection.

While the frequency of hand washing in relation to HCAI has previously been researched, the team said they consider hand washing to be an imperfect process. 

The ability of hand washing to limit hospital-based infection depends on the products and technique used, and the duration of the washing. 

The amount of hand washing needed also plays a part in compliance, with previous studies suggesting health workers may need to wash their hands up to 43 times per hour, leading to a compliance rate of less than 50%.

In generating the results, the researchers used a model to determine the effectiveness of hand-washing frequency on HCAI rates from a previous study, which they modified to include the impact of the efficiency of hand washing. 

They also considered the impact of washing with soap and water and the use of alcohol hand gels.

Within the model, the researchers made a number of assumptions, including that transmission is caused by colonised hand contact and health care workers pick up the contamination when they touch a colonised patient. 

It was also assumed that it is just as easy for a patient to contaminate a health worker as it was for the health worker to contaminate the patient.

While the team acknowledged their results could only approximate what happens in clinical practice, they felt it was useful in identifying general trends in infection control, especially if the ward conditions mirrored the research model.

According to the researchers, the study confirmed that hand washing is an effective infection control measure, but laws of diminishing returns apply with the greatest benefit seen in the first 20% of hand-washing compliance. 

The results also indicated that there is little benefit in very high levels of compliance. 

Other infection factors

In the discussion, the team indicated many staphylococcal outbreaks could be prevented through moderate levels of hand washing, however, there are four reasons why this might not happen. 

Ward management issues such as overcrowding and under-staffing may play a role in infection rates. The number of patients admitted with the infection can also increase the risk of an outbreak. Also, environmental factors can play a part as inanimate objects can support infection.

The researchers also raised the issue of the Hawthorne Effect, which indicates people can change their behaviour when they are being observed, so what researchers observe may not reflect the reality of what happens on the ward.

Not just staph

While the study referred to outbreaks of staphylococcal infections in study, Prof Kerr is confident the results can apply to other infections as well.

“It is not unreasonable to extrapolate the research to other HCAI-causing bacteria whose route of transmission is primarily via the hands of health care workers,” he said.

Hand washing training

To combat the risk of HCAI, Prof Kerr identified a need for health care workers to be trained in hand-washing technique.

“Frequency of hand washing is obviously important,” he said.

“Ensuring that health care professionals cleanse their hands effectively is just as significant.

Multi-faceted approach needed

While hand washing is an important infection control measure in health care settings, Prof Kerr cautions health carers not to rely on it solely.

“HCAI is a universal problem and the fundamental issue is the same [on different wards],” he said.

“Hand hygiene, although a crucially important infection control measure, should not be seen as the sole intervention.

“A multi-faceted, coordinated approach is needed in preventing HCAI.

“But if you are going to wash your hands, you need to do it properly.”

Tons of Drugs Dumped Into Wastewater, Study Finds

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America's drinking water, according to an ongoing Associated Press investigation.

These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands.

Few of the country's 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. Based on a small sample, though, the AP was able to project an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging, with no way to separate out the drug volume.

One thing is clear: The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories — the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans.

Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs.

The original AP series in March prompted federal and local legislative hearings, brought about calls for mandatory testing and disclosure, and led officials in more than two dozen additional metropolitan areas to analyze their drinking water.

And while most pharmaceutical waste is unmetabolized medicine that is flushed into sewers and waterways through human excretion, the AP examined institutional drug disposal and its dangers because unused drugs add another substantial dimension to the problem.

"Obviously, we're flushing them — which is not ideal," acknowledges Mary Ludlow at White Oak Pharmacy, a Spartanburg, S.C., firm that serves 15 nursing homes and assisted-living residences in the Carolinas.

Such facilities, along with hospitals and hospices, pose distinct challenges because they handle large quantities of powerful and toxic drugs — often more powerful and more toxic than the medications people use at home. Tests of sewage from several hospitals in Paris and Oslo uncovered hormones, antibiotics, heart and skin medicines and pain relievers.

Hospital waste is particularly laden with both germs and antibiotics, says microbiologist Thomas Schwartz at Karlsruhe Research Center in Germany.

The mix is a scary one.

In tests of wastewater retrieved near other European hospitals and one in Davis County, Utah, scientists were able to link drug dumping to virulent antibiotic-resistant germs and genetic mutations that may promote cancers, according to scientific studies reviewed by the AP.

Researchers have focused on cell-poisoning anticancer drugs and fluoroquinolone class antibiotics, like anthrax fighter ciprofloxacin.

At the University of Rouen Medical Center in France, 31 of 38 wastewater samples showed the ability to mutate genes. A Swiss study of hospital wastewater suggested that fluoroquinolone antibiotics also can disfigure bacterial DNA, raising the question of whether such drug concoctions can heighten the risk of cancer in humans.

Pharmacist Boris Jolibois, one of the French researchers at Compiegne Medical Center, believes hospitals should act quickly, even before the effects are well understood. "Something should be done now," he said. "It's just common sense."

More Juices Found to Affect Drugs' Effectiveness: Study

Orange and apple join grapefruit on list of drinks that may pose problems

By Kathleen Doheny

HealthDay Reporter

TUESDAY, Aug. 19 (HealthDay News) -- Grapefruit juice, long known to boost the absorption of certain medications, isn't the only juice that doesn't mix well with drugs, according to the Canadian researcher who first identified the ill effects of grapefruit juice.

Other common juices, including orange and apple, may limit the body's absorption of drugs, compromising their effectiveness, said David Bailey, a professor of medicine and pharmacology at the University of Western Ontario, in London, Ontario, Canada.

Bailey was expected to present his research Tuesday at the American Chemical Society's national meeting, in Philadelphia.

"The original finding is that [grapefruit juice] markedly boosts the amount of drug that gets into the bloodstream," Bailey said. He first reported that nearly 20 years ago when he discovered that grapefruit juice increased the body's blood levels of the drop felodipine (Plendil), used to treat high blood pressure.

Since the original finding, other researchers have identified dozens of other medications that could interact adversely with grapefruit juice, Bailey said.

Doctors traditionally warn against drinking grapefruit juice if you're taking certain medications for high cholesterol, high blood pressure and heart rhythm problems, according to the American Academy of Family Physicians.

In his latest research, Bailey found that grapefruit juice, as well as orange and apple juice, can lower the body's absorption of some medications. Those drugs include the anti-cancer drugs etoposide (Etopophos, Vepesid); certain beta blockers like tenormin (Atenolol) and talinolol (Cordanum), used to treat high blood pressure and prevent heart attacks; cyclosporine, which is used to prevent organ transplant rejection; and some antibiotics, including ciprofloxacin (Cipro), levofloxacin (Levaquin), and itraconazole (Sporanox).

Bailey also found that healthy volunteers who took the allergy drug fexofenadine (Allegra) with grapefruit juice absorbed only half the amount of the drug, compared with volunteers who took the medicine with water.

In each case, substances in the juices affected the absorption of the drugs. Some chemicals block a drug uptake transporter, reducing drug absorption; other chemicals block a drug metabolizing enzyme that normally breaks down the drugs, he said.

"We don't [yet] know all the drugs affected," Bailey said.

Michael Gaunt is a medication safety analyst at the Institute for Safe Medication Practices in Horsham, Pa. He said, "If this study holds true [in future research], you are going to have to warn people in a similar fashion" about other juices. 

Gaunt's advice for now: "In general, it's safest to take medication with water."

Bailey agreed. If you opt for water, he said, "a glass is better than a sip. It helps dissolve the tablet." And cool water is better than hot, he added, because your stomach empties cool water faster, sending the medication on its way to the small intestine and finally the blood stream.

As Foreign Nurses Fill U.S. Jobs, Concerns About Abuses Mount

Posted by Sarah Rubenstein 

As the nursing shortage deepens in the U.S., nurses from other countries have been picking up some of the slack. But there’s concern that foreign nurses aren’t being treated as well as their U.S. counterparts.

“We’ve heard anecdotal stories of nurses who are abused — there are pay issues, working-condition issues,” Cheryl Peterson, director of the department of nursing practice and policy for the American Nurses Association, told the Washington Post. That association and a number of other health-care groups have created a code of ethics meant to protect foreign nurses from abusive employment practices, the Post reports.

Archiel Buagas, a 28-year-old nurse who trained in the Philippines, told WaPo that when she came to the U.S. a few years back, her recruitment agency didn’t honor promises to have the proper paperwork in place when she got to work. It also placed her with a different employer than the one with which she’d signed a contract. After connecting with a lawyer, she found at least a dozen other Filipino nurses who’d had similar issues with the same recruiter.

The health groups that created the ethics code also said some foreign nurses are given jobs beneath their skill level that American nurses don’t want to do, and are paid less than American nurses. The code lays out guidelines on such issues and also provides summaries of relevant employment laws and information on training and support of foreign nurses.