Alarming Statistics
According to the Food and Drug Administration medication errors can be attributed to one death every day and injure approximately 1.3 million people annually in the U.S.
Causes

The administration of an improper dose of medicine accounted for 41% of fatal medication errors. Administration through the wrong route and giving an incorrect drug accounted for 16% of the fatal errors equally. Geriatric patients were more susceptible to medication errors largely due to medication interactions and the multiple medications they may be taking. Other causes can be attributed to the lack of teaching or comprehension of the medication regime.

Prevention
As a Registered Nurse, it is essential for us to evaluate what we can do to prevent medication errors. Here are several ways to protect the patient from preventable injury due to medication error:

•    Review all medications of your patient and become familiar with their use, dose, and interactions with other medications
•    Check for patient allergies
•    Do not assume medication dosages are correct
•    Refer to pharmacology resources concerning medications
•    If medication dosage requires calculations have another nurse validate calculations prior to administering
•    Observe dependent patients take their medications
•    Teach patient or family member about the medication
•    Assure that a competent person will be in charge of the administration of the medication when discharged home
•    Teach the patient and caregiver to question any new medications prescribed

Remember the 5 “R” s
1.    Right Patient
2.    Right Drug
3.    Right Dose
4.    Right Route
5.    Right Time and Frequency

Reviewing the Math
Registered Nurses should review mathematical skills in medication calculations on a regular basis. Here are a few helpful websites to review your knowledge of medication calculations and medication testing:

http://www.childrensmn.org/web/webrn/webrnpdfs/128121.pdf
http://www.testprepreview.com/modules/nclex.htm
http://www.scribd.com/doc/9805/USNI-Medication-Test

ADEX Medical Staffing is committed to excellence in Nursing. ADEX Medical Staffing strives to supply our employees with the most up to date information in the medical community. Please call us for more information on joining the ADEX team.

- Jim Shoemaker, RN, Director of Clinical Services

Never has an industry been scrutinized as much as the healthcare industry in the past several years. Healthcare reform has become the hot topic throughout the country and a raging debate has ensued. The main focus has been to provide the best possible care at the lowest possible cost. There are few nursing positions that have as great of an impact on the delivery of excellent patient care in an efficient cost effective way than that of the RN Case Manager.

An RN Case Manager is responsible for coordinating patient care upon discharge from the hospital. This may include setting up durable medical equipment, patient follow up visits, therapy, making arrangements for nursing home placement, supplies, etc. The failure to provide excellent case management can result in re-hospitalizations and greater cost to the healthcare system. The RN Case Manager must be very energetic as well as extremely organized. They have to deal with multiple issues at once on an ongoing basis.

Case Managers may obtain certification from several sources. Check out this site for more information: http://www.nursecredentialing.org/.

You may also visit the Case Management Society of America’s website to find out more information on Case Management. http://www.cmsa.org/

As the population of the United States ages, the demand for qualified RN Case Managers will also increase. ADEX Medical Staffing has great opportunities come up throughout the year for qualified RN Case Managers. Please contact us to become part of ADEX’s Case Management Team.

- Jim Shoemaker, RN, Director of Clinical Services

The good news is you received an offer from a facility for a 13 week contract, typical travel length.  Now the real work starts!  What most nurses are not aware of is that Facilities, Vendor Management companies and large Hospital groups require a signed confirmation from the Staffing Company to confirm the offer.  The Staffing Company will not send in a signed confirmation unless they receive a Signed Employment Agreement (contract) from the nurse.  Many offers have been pulled by the facility/client because the Staffing Agreement is unable to confirm the assignment without the nurse signed agreement.

When a nurse receives an offer from a Facility it is imperative that the nurse is in constant communication with their Recruiter/Account Manager to assist with the confirmation.  In addition, if the offer is for a Quick Start (less than 2 weeks), then the nurse must be able to fax/email all required Medical Documentation/Credentials.   Facilities will pull offers and cancel contracts if the required documentation is not turned in by the Staffing Company by the facilities deadline.  The Facility may require documentation to be turned in 10-14 days prior to the start date.

Once an offer is received the Recruiter/Account Manager will be contacting the nurse to move forward with the offer.  There might be several attempts to call and email the nurse.  Since the Recruiter/ AM only has 24 hours to confirm the offer, the nurses that call back and follow up have the best chance of confirming the offer.  The Best Practice for a nurse is to call the Recruiter/AM as soon as they finish an interview.  Then the Recruiter can follow up with the client to see if there is an offer.  When the offer is received be available to discuss the offer and contract terms with your Recruiter.  Finally, be available to sign and fax/email back the confirmation.

- Ken Rickert, Director, Eastern Regional Operations

• Always make sure your recruiter has at least one good contact number and email address for you.
• Let your recruiter know when the best time to contact you is.  If you work nights, receiving and making phone calls during the day can be hard.
• Do you have a vacation planned?  If so, let your recruiter know if you are not going to be available for phone calls and emails or if you will have an alternate contact number during that time.
• If you can’t answer your phone or respond to email because of work, please try to return messages and emails in a timely manner.
• It’s a two-way street, so make sure to find out when your recruiter is available.  Most ADEX Medical Staffing Recruiters are in the office during normal business hours Monday through Friday, but can be reached via their cell phone and email after hours.  If normal business hours do not fit your schedule, let your recruiter know, and ask for their email address and cell phone.

Setting clear communication expectations with your recruiter during the application process is essential to a great long-term working relationship.

- Catherine Warrington, Recruiter

The client telephone interview is essential to getting a travel assignment. Most facilities have interviewers call travel nurses pre-screened by Human Resources or Staffing who best meet their minimum qualifications.  Time is of the essence since the interviewer is often a unit manager or charge nurse with other responsibilities.  The interviewer typically calls each nurse at least once, so it’s extremely important to provide your recruiter with the best telephone number and times when you can be reached.

When interviewing

• Keep a copy of your resume handy and give yourself plenty of time.
• Avoid distractions. Try and find a low-traffic spot where you will not be disturbed.
• Disable call waiting. If for some reason you are not able to disable call waiting, absolutely ignore it if someone calls.
• Make sure to ask for your interviewers name and their title.
• Do not be afraid to ask questions. You want to make sure you know what the position entails so you can make an informed decision as to whether it is a right fit for you or not.

Usually when an offer is extended, a decision must be made within 24 hrs. After the interview make sure to call your recruiter with feedback and to share your thoughts.

- Sonia Coers, Account Manager

The post anesthesia care unit, often referred to as PACU is an extremely important part of many hospitals as well as outpatient centers. The PACU is focused on caring for the patient recovering from anesthesia, whether general anesthesia, local anesthesia, or regional anesthesia.

The PACU nurse is charged with vital tasks for the care of the post-operative patient. Some of the vital tasks involved are:
•    Monitoring surgical sites for excessive bleeding and other complications
•    Managing pain of the post-op patient
•    Monitoring vital signs
•    Treating symptoms such as postoperative nausea and vomiting
•    Preparing and educating for the use of Patient Controlled Analgesia units
•    Occasional invasive monitoring of arterial lines, central venous lines, etc.

Post-operative complications may arise in this setting. Complications may include laryngospasm or respiratory arrest. The usual stay in the PACU is traditionally a few hours before the patient goes home or to another unit within the hospital.

PACU nurses may obtain certification through the American Society of Perianesthesia Nurses (ASPAN). They may get their CPAN or Certified PostAnesthesia Nurse or CAPA (Certified Ambulatory Perianesthesia Nurse) certifications.  For more information go to the following website: http://www.cpancapa.org/

- Jim Shoemaker, RN, Director of Clinical Services

Over the past 15 years, according to the U.S. Surgeon General, the number of people classified as obese has increased by 85%. The alarming statistics have a direct correlation between the general population’s incidence of diabetes and hypertension. The increase in these diseases has led to a greater incidence in kidney disease as well as End Stage Renal Disease.  The result of this trend in the healthcare industry is a major need for dialysis nurses throughout the U.S.

Dialysis treatment is used to replace the function of the kidneys, which in healthy individuals serves as the body’s natural filtration system. Blood is filtered through a filtration system utilizing a chemical solution known as dialysate. Dialysate removes waste products and excess fluids from the bloodstream.

There are two primary types of dialysis treatment. Hemodialysis is a form of dialysis typically carried out in a dialysis clinic utilizing a dialysis machine that monitors and maintains blood flow as well as administering dialysate. Usually an access site is implanted in the patient for venous access. The other primary type of dialysis is peritoneal dialysis. This type of dialysis can allow for the patient to have more freedom since it can be done at home. The patient’s peritoneum, or lining of the abdomen, acts as a blood filter. A catheter is surgically implanted into the patient’s abdomen.

Nurses have the option of training and specializing in acute dialysis, chronic dialysis, or even both. Acute dialysis refers to a sudden shutdown of the kidneys. Causes may be overdose, trauma, infection, and other sudden onsets. Chronic dialysis involves patients that have lost kidney function over a period of time brought on by diseases such as diabetes and hypertension.

Dialysis jobs are available in many of the nation’s top facilities. The increase in the incidence in End Stage Renal Disease (ESRD) has created a need for exceptional dialysis nurses to care for this patient population. ADEX Medical Staffing prides itself in providing some of the most knowledgeable and proficient dialysis nurses in the industry.

- Jim Shoemaker, RN, Director of Clinical Services

Just in case you hadn’t heard the news – ADEX Medical Staffing has received the Joint Commission Gold Seal of Approval™.

- Jim Shoemaker, RN, Director of Clinical Services

Looking for a career in one of the fastest growing fields in nursing? The Electrophysiology Lab, also known as the E.P. Lab looks at the electrical impulses that control the function of the heart. Cardiac electrophysiology is a medical specialty devoted to diagnosis and treatment of abnormal heart rhythms.

During the procedure, the physician is looking for the misfiring of the conductivity within the heart. Ablations are occasionally performed to eliminate the electrical malfunction. This involves disconnecting the pathway where the abnormal conductivity is occurring.

E.P. nursing needs continue to increase throughout the country as the medical field continues to develop this ever growing field. Telemetry skills as well as Cardiac Catheterization skills and education are a great start towards a career in the E.P. Lab. Check out the following website for more information.

http://www.webmd.com/search/search_results/default.aspx?query=electrophysiology%20lab&sourceType=undefined

- Jim Shoemaker, RN, Director of Clinical Services

Nursing offers many great opportunities and the Cardiac Catheterization Lab may be the place for you. Unfortunately, the average American has continued to show increases in weight and unhealthy living practices. As a result the Cardiac Cath Lab has shown dramatic increases over the past 10 years.

The cardiac catheterization is used for both investigational and interventional purposes. It is used mainly to look at the blood flow to the heart. During the Cardiac Catheterization procedure a catheter is inserted using a long guide wire and moved towards the heart.

The procedure itself is used to look for blockage in the vessels going to the heart or abnormalities in the valve function within the heart. Occasionally, a stent is put in place to open vessels to increase blood flow. Cardiac catheterization has been successful in occasionally taking the place of what previously was only accomplished through open-heart surgery.

The R.N. should be strong in telemetry skills and cardiac assessment along with skills related to cardiac catheterizations. For more information check out: http://www.webmd.com/heart-disease/guide/cardiac-catheterization1

- Jim Shoemaker, RN, Director of Clinical Services