#RNchat for September 11, 2010 - Moderated by

@EllenRichter - Follow @RNchat for regular updates!
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#RNchat topics tonite: how RNs deal with isolation for MRSA of the nares ... AND ...
rnchat fatal medication errors: how can tube feedino be qiven IV?
#RNchat if time allows, we will talk about how & why medical smartphone apps
rnchat for health care must be reoulated for safety & accuracy?
RT @rnchat: #RNchat topics tonite: how RNs deal with isolation for MRSA of the
wantnews nares ... AND ... fatal medication errors: how can tube feedinq be clven IV?
RT @rnchat: #RNchat if time allows, we will talk about how & why medical
wantnews srnartohone aons for health care must be reoulated for safety & accuracy?
RT @EllenRichter: #RNchat topics tonite: how RNs deal with isolation for MRSA of the
wantnews nares ... AND ... fatal medication errors: how can tube feedino be qlven IV?
Just a few more minutes til #RNchat tonight! If you know a nurse, tell them to sign
rnchat onto Twitter & chat with us! Use the hashtaq to follow!
rnchat I'm slqnlnc into http://tweetorid.com to loin in the chat on #RNchat toniqhtl
Well, good evening Twitter RNs & health care professionals, #hcsm folks &
rnchat others. Thanks for iolnlno us at #RNchat tonioht!
This is @EllenRichter filling in for @PhilBaumann tonight & as always, I enjoy
rnchat our hour nurslno chat sessions! #RNchat
A big thanks to everyone who spread the word and RT'd the info about tonite's last
rnchat minute chat schedule! LOL an excitinq Sat nite! #RNchat
Lets begin the hour by seeing who is joining in. Introduce yourselves & tell us in
rnchat 140 or less what brlnqs yOU to #RNchat toniqhtl
I'm Ellen, a 35-yr veteran of the nursing profession, an leU nurse & a legal
rnchat nurse consultant. I'm here because I love nurses! :) #RNchat
#RNchat is a way for nurses & others in health care to meet, tweet &
rnchat share feelinos, thouchts. ldeas-: And silent lurkers are OK too!
The topics will be labeled T1, T2, etc. Please remember to add topic label &
rnchat hashtac #RNchat to ea tweet so we can track your responses! Suzanne Tietjen, Neonatal NP, writer (books & nursetogether.com) &
suzlshepherd shepherd. Just moved n2 our new 60 bed NICU a couple weeks ago. #rnchat
@suzishepherd 60-bed NICU? thats pretty darn impressive! That move was an
rnchat accomplishment I'm sure! #RNchat
Donna Petko, Home Health RN and FNP student. I'm here because I think #RNchat is
DonnaPetko loreat!l :-)
Hi Ellen & Suzanne! Lisa here - clinical editor for NursingCenter.com, former
NursinaCenter MICU nurse and women's health NP. #RNchat
#RNchat hi everyone! my name is natalie, am a nurse here in d US for 4 years now,
stan rose was in the long term facility and now in behavioral health
It was an event, for sure. All single room arranged in little neighborhoods, family-
suzishepherd friendly and very high tech. Mostly loving it. #rnchat
Hi Ellen & all -rung late. Vernon in N. Orleans - Crit. Care - been nur long
nursinqoins enough to have seen nur sent home for wearing pants. #RNchat
DonnaPetko Hi Suzanne, Hi Ellen! #RNchat
Welcome @DonnaPetko @NursingCenter @stan_rose @nursingpins &
rnchat I@suzisheoerd ... 1 thouaht I miaht have been solo tonite! LOL #RNchat
rnchat I'm aoina to start since we have a crowd! :) #RNchat
RT @RNchat is a way for nurses & others in health care to meet, tweet &
BonnieRN share feelings, thoughts, ideas& silent lurkers are OK too! #RNChat
Tl With mandatory MRSA screening of admitted pts, we find many wi MRSA in the
rnchat nares. How does ur facility treat this type of MRSA? #RNchat
Tl Do you find that as more patients are placed on isolation for MRSA of the nares,
rnchat this affect how we give nursing care? #RNchat
rnchat I@BonnieRN Hi there Bonnie & thanks for the RT! :) #RNchat
I'm going to lurk on this topic since I'm not in practice right now - interested to hear
NursinaCenter the resoonses! # RNchat
DonnaPetko I@NursingCenter Hi! Nice to see you tonight. :-) #RNchat
nursinqpins Tl contact iso - door siqns - ? policy for specific location - will be ltstenlnq. #RNchat
Tl Where I work, most of the newly screened MRSA pts have it only in their nares,
rnchat lvet we put them in ovt rooms & on isolation #RNchat
DonnaPetko Tl I'm going to lurk too since I'm in the home environment. #RNchat NursinqCenter Have nurslnq staff had swabs done of their nares? #RNchat
T1 @rnchat same here - but also allow MRSA pts. (any source) to be in the same
nurslnqplns room - not private at 3 hoses> # RNchat
Nurstncoenter oops - foruot the T1: have nurses been swabbed for MRSA? #RNchat
T1 Nares MRSA is definitely costly for nursing care hours. Gowning up for many
rnchat isolation nts on every floor takes precious time #RNchat
nursinaoins T1 - no swabs here. #RNchat
T1 @NursingCenter I would love to hear from others. Where I have worked of late,
rnchat they are no lonqer swabbinq nurses nares. Others? #RNchat
T1 In the late 1980s & early 1990s we swabbed all nurses when a pt had hosp-
rnchat acquired MRSA & most ended UP positive! We couldnt work! #RNchat
DonnaPetko T1 -no swabs here either. #RNchat
RT @rnchat: T1 In the late 1980s & early 1990s we swabbed all nurses when a
pt had hosp-acquired MRSA & most ended up positive! We couldnt work!
Mommalncredible #RNchat
T1 There needs to be a differentiation between colonized MRSA and active infection.
rnchat But colonized MRSA can be transmitted too. #RNchat
suzisheoherd 1@leaalnurses Children's Hosoital of Illinois in Peoria. #rnchat
RT @rnchat: T1 There needs to be a differentiation b/w colonized MRSA &
NursinqCenter active infection. But colonized MRSA can be transmitted too. #RNchat
RT @rnchat: T1 In the late 1980s & early 1990s we swabbed all nurses when a
pt had hosp-acquired MRSA & most ended up positive! We couldnt work!
MrsHillM228 #RNchat
RT @suzishepherd: T1 Rarely positive on admission. isolate, treat with antibiotics to
suzlshenherd nares & antiseptic baths. Not a lone-term fix. #rnchat
T1 We need to identify which MRSA-infected pts come in with active infection vs who
rnchat laets it after admission #RNchat
stan rose #RNchat contact isolation precaution and use of private room for MRSA patients
RT @rnchat: T1 We need to identify which MRSA-infected pts come in with active
rnccaula infection vs who cets it after admission #RNchat
T1 Do any nurses find that their facilities are strained from so many isolation pts now
rnchat that MRSA is belnc actively screened for? #RNchat Two more minutes & we will move on to the next topic--near-fatal & fatal
rnchat medication errors #RNchat
Tl PICC lines have been a prob here with MRSA - importance of biopatch stressed by
nursinqoins I@infusionnurse at #IVchat #RNchat
@nursingpins Tl Good point about biopatch & good plug for @infusionnurse
rnchat & #IVchat (smile!) #RNchat
RT @rnchat: @nursingpins Tl Good point about biopatch & good plug for
rnccaula I@infusionnurse & #IVchat (smile!) #RNchat
Tl Seems like so many nursing home/ long-term pts come to acute care facilities
rnchat with positive nares MRSA. #RNchat
Tl problem remains with adherence in busy units - esp cleaning bed-scales when
nursinqpins taken from room to room etc. (MRSA #RNchat
RT @nursingpins: Tl problem remains with adherence in busy units - esp cleaning
DonnaPetko bed-scales when taken from room to room etc. (MRSA #RNchat
DonnaPetko I@nursinqpins Time consurnlno but so important. #RNchat
T2 As we know from the news, there are still fatal errors resulting from tube feeding
rnchat or oral meds olven IV. How can this happen? #RNchat
@nursingpins Tl Yes, I just read about accucheck machines being harborers of many
rnchat resistant orqanisrns #RNchat
T2 Will there ever be a way to prevent fatal medication errors from occurring? How
rnchat can nurses successfully advocate for ot safety? #RNchat
T2 a few of the TF connectors will still fit - seen it happen. Not paying attention and
nursinqoins rushed. Prob. with irriq ti IV's too #RNchat
#RNchat Tl in the nsg home where i used 2 work we hd a lot of pts with MRSA of d
stan rose wound that came frm d hoso bec of takno 2 much antibiotics
T2 Should the manufacturers of IV tubing be responsible for preventing connections
rnchat that fit tube feedlnc tubes? #RNchat
T2 must make IV & enteral tubing incompatible. Need special syringes/tubes 4
suztshepherd oral/enteral use only that CAN'T connect 2 IV tublnq. #rnchat
T2 Oral liquid medications should comepre-packaged in syringes that cannot fit on
rnchat leur-locks of IV tublnq #RNchat T2 - they should not be compatible - Irrigation of bladder & wound fluids should
nursinqpins not be compatible either. #RNchat
@suzishepherd LOL T2 We said the same exact thing in different wording! :)
rnchat #RNchat
suzlsheoherd Continued (This is our practice @ CHOI NICU). #rnchat
NurstnoCenter I@suzishepherd YES - thank you! I couldn't cet that into 140 characters! #RNchat
@nursingpins T2 Good point about CBI fluid & wound irrigation fluid. I'm sure
rnchat they have all been aiven IV erroneously. Its scary. #RNchat
RT @suzishepherd: T2 must make IV & enteral tubing incompatible. Need
special syringes/tubes 4 oral/enteral use only that CAN'T connect 2 IV tubing.
NursinqCenter #rnchat
T2 Rushing, stress, pressure, demands create an environmnt that can easily lead to
rnchat errors while administerinq meds. No interruptions #RNchat
nursinqoins T2 seen a ot have a BM in a urinal - if it can happen - it will :) #RNchat
FDA is pushing manufacturers to provide safeguards to ensure safe use of tube
Debfiruots feedlno and IV products. Some are color codinu, #RNChat
@nursingpins T2 Gosh, I have seen patients DRINK from their urinals! But its nursing
rnchat errors that we must control, not ot errors! ',) #RNchat
@DebErupts T2 Color coding would be a simple & effective way to assure that
rnchat the correct route is used for liquid meds! Good point! #RNchat
#RNchat T2 i have seen PEG flush administered via foley cath, i also think
stan rose manufacturers could also help by chanqlnq the tube compatibility
Hospital purchasing departments should consider safety of various systems and
DebErupts connections when ourchaslno new inventory. #RNChat
T2 med errors are rampant - very few are reported on busy units - even with pyxis -
nursinaoins many oroblems - so many PT nurses to staffina. #RNchat
@stan_rose T2 Another great example! PEG tubes & Foley catheters have
rnchat similar ports--yet another way for accidents to happen #RNchat
@DebErupts Yes! and nurses should be part of that process (deciding on device
NursinqCenter safety). #RNchat
nurslnqplns T2 @DebErupts rlqht - they could eliminate compatibility orobs, #RNchat
nurslnqplns T2 @rnchat riqht - anvthlnq will fit a Lopez valve. #RNchat T2 Yes, nurses should be part of the product-purchasing team in hospitals to make
rnchat sure enteral tubinqs are incompatible with IV ones #RNchat
Actually, nice as they are, they should be banned >> RT @nursingpins: T2
rnchat I@rnchat riqht - anvthinq will fit a Lopez valve. #RNchat
Some hospital have a "zone" around people @ the pyxis or med-prep
suzlshenherd area where YOU are warned not 2 speak. Interruptions R danoerous, #rnchat
I guess I will save the T3 topic of medical app regulation for smartphones for next
rnchat time! I hooe YOU will all ioin in next week! #RNchat
Don't assume (based on tubing/connection) where a med will enter the body - follow
NursinqCenter loath of tublnq before administerinq anvthlnc #RNchat
@suzishepherd T2 Thats a very good idea. I will bring that to my facility! We dont
rnchat currently have any quiet zones! Good point. #RNchat
DonnaPetko I @suzishepherd Very coed idea! # RNchat
DebErupts I@suzishepherd I like the "zone" idea. #RNChat
@NursingCenter T2 Nurses should take the time to place a label on each port before
rnchat uslno them to administer anvthinu, #RNchat
Good night Ellen, Vernon, Lisa, Donna, Bonnie, Stan and anyone else I may have
suzisheoherd missed. Hooe I'm around for the ano discussion. #rnchat
Like a Iibrary---"Shhhh, quiet zone" RT @DebErupts @DonnaPetko:
rnchat I@suzishepherd Very eeoc idea! #RNchat
RT @rnchat: T2 Yes, nurses should be part of the product-purchasing team in
stan rose hospitals to make sure enteral tublncs are incompatible with IV ones #RNchat
Yes, labeling ports and tubing should be part of the education in preventing errors.
DebErupts #RNChat
Thanks for all of your contributions to tonight's chat! Great suggestions &
rnchat looints. Thanks for rnaklnc it meaninqful! :) #RNchat
nurslncolns Good nlcht all - Thanks Ellen - creat tob as usual. Good to see all. #RNchat
DonnaPetko I@suzishepherd Thanks, a good night to you too! #RNchat
And thanks to @PhilBaumann for stepping aside to let others moderate #RNchat on
rnchat occasion! Be on the lookout for the transcript link!
DonnaPetko Thanks Ellen, qood niqht all! Lookinq forward to the next #RNchat! I heard about the quiet zone idea from Linda Lefrak out of Oakland. A very smart
suzlshepherd nurse. #rnchat
@naomibaker Drug errors happen much too much to ignore. Nurses need to
rnchat auoresslvelv & proactively combat med errors #RNchat
NursinqCenter Good nlqht everyone! It was nice chattlno with you! Thanks Ellen! #RNchat
@suzishepherd T2 Quiet zone should also apply to those in pharmacy who mix drugs
rnchat & fill the ovxis machines. No interruptions! #RNchat
RT @rnchat: @naomibaker Drug errors happen much too much to ignore. Nurses
DonnaPetko need to aqqresslvelv & proactively combat med errors #RNchat
RT @rnchat: @naomibaker Drug errors happen much too much to ignore. Nurses
NursinqCenter need to aqqresslvelv & proactively combat med errors #RNchat
stan rose #RNchat Good niqht everyone, it was another interestinq topics! thanks! ;-)
@suzishepherd Tell Linda to come tweet with us one of these days! We would enjoy
rnchat that! :) #RNchat
OK @EllenRichter signing out of this account! It was truly a pleasure to mingle with
rnchat lvou all tonite! Eniov the rest of the weekend! #RNchat
And remember, if you are a nurse & you don't already follow @EllenRichter
rnchat lulease do so! Lets make my RN Twitter list lonoerl #RNchat
END OF CHAT
#RNchat I agree, as individuals we should maintain safe practice of med admin,
naomibaker however human error cannot always be avoided!
RT @rnchat: And remember, if you are a nurse & you don't already follow
rncoaula I@EllenRichter please do so! Lets make my RN Twitter list loncer! #RNchat
RT @PhilBaumann The hospital gives you a cheap survey & an extravagant bill
bobfine #hcsm #rnchat http://bit.ly/aLXNZP
RT @rnchat - Tl Seems like so many nursing home/ long-term pts come to acute
LavineL TCIns care facilities with positive nares MRSA. #RNchat #financial
RT @bobfine: RT @PhilBaumann The hospital gives you a cheap survey & an
DonnaPetko extravaqant bill #hcsm #rnchat http://bit.ly/aLXNZP
Hospitals MUST Adjust Covering Doc Night/Weekend Policies as Patient Problems
HospitalPatient Don't Take Such Convenient Breaks. #RNChat #healthcare #MedEd As a follow-up to tonite's #RNchat discussion "Reducing Oral Medication
Ellen Richter Wronq-Route Aadministrations & Misconnections" http://i.cx/lwk
Another good read relating to tonite's #RNchat "Avoiding Catheter and Tubing
Ellen Richter Mis-Connections: Patient Safety Solutionsaouot: http://i.mp/9kSUMI
#RNchat years ago, nurses wore a tabard sign over their uniform while on drug
naomibaker rounds, so patients and staff alike knew NOT to disturb!
Combating hospital-acquired superbugs "Strike Quickly on MRSA Control -
Ellen Richter Hosoital Manaaement&auot: htto://i.mo/cXMUIO #RNchat
" Medical Smartphone Apps May Need New Federal Regulation - Health Care IT
Ellen Richter from eWeek" httn//t.mo/cosjtc #RNchat
Hospital Patients should B told when ANY "material" changes R made by
HospitalPatient Docs 2 their Patient Care. Not knowinq is Unfair. #RNChat #nursinq
momof2chocdivas I@DonnaPetko I will definetly make sure I do well in Pharm and math meds ... #rnchat
RT @EllenRichter: Another good read relating to tonite's #RNchat "Avoiding
Catheter and Tubing Mis-Connections: Patient Safety Solutions" http://j.
oarnsvulcan mp/9kSUMI
RT @DaphneLeigh: So sad. RT @nursingpins: Once most nurses become part of
taocvicurn admin they become useless as advocates for staff nurses. #rnchat
RT @rnchat: I guess I will save the T3 topic of medical app regulation for
wantnews smartphones for next time! I hope yOU will all ioln in next week! #RNchat
RT @EllenRichter: As a follow-up to tonite's #RNchat discussion " Reducing Oral
Medication Wrong-Route Aadministrations & Misconnections" http://i.
pamsvulcan cx/lwk
@momof2chocdivas That's good to hear. A good understanding of pharrn/rnath is
DonnaPetko very important. #RNchat
@DonnaPetko @momof2chocdivas I still carry a pocket book of drug formulas and
naomibaker calculations on every shift, I.v. Rates can be tricky #RNchat
Hospital PAIN " Rating Index" is as Subjective as Web Dating Index 4
"Attractiveness." What really is a 6? #healthcare #RNChat #Pain
HospitalPatient #nih law

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