The current pandemic has placed available PPE supplies at an all-time low. Many front-line providers are forced to reuse face masks that would have normally been thrown away. The result is lots of anxious providers, myself included, worried about spreading infection to ourselves, our patients, and those around us. Fortunately, studies have shown that pathogen transfer remains low from breathing through a used mask. Research shows that the greatest risk in reusing N95s is that we cross-contaminate ourselves or those around us with germs that are on the outside of the mask. Are you surprised? I was. So what can we do?
In laboratory studies on N95s, one study found that germs applied to N95 mask material remained infectious for 6 days after application. Another study found that 10% of applied germs survived 4 days on N95 samples, with all samples having detectable levels of the germ on the 10th day after application.
The take-away is those masks we are reusing are fomites (materials which are likely to carry infection) and they put us, the wearer, as well as those around us, at risk of cross-contamination and spreading infection.
During this coronavirus pandemic, what can we do to reduce the risk?
Wearing the mask all day is safer than taking it on and off. (If only they weren't so miserable to wear!) The risk of pathogen transfer from N95s is high by contact (taking it on and off) and low is we just leave it on.
Not taking the mask on and off decreases the frequency of touching the outside of the mask, which is likely contaminated. Being careful to wash hands before and after applying and removing a N95 will reduce the risk of cross-contamination. Storing the mask so it isn't contaminating surfaces or people is important too. But some of us are being asked to store these masks in paper bags and plastic containers, and wearing them day after day. As you read above, those germs aren't going anywhere soon. So how do we keep the masks as germ free as possible?
Keep your N95 covered. NIOSH 'recommends for consideration' wearing a cleanable face shield over the mask as a preferred method to reduce surface contamination of the N95 (like the airmen in the photo are wearing). OSHA also suggests that a faceshield be 'considered' to reduce N95 contamination. The CDC and NIOSH both 'suggest' covering N95s with surgical masks that are changed after each patient encounter, but one study found that a mask worn over a N95 increased work of breathing, which is not what we need when working through a 12 hour shift. Personally, I like the shields, because they protect the whole face and don't fog up like goggles do. Plus, it reminds me to keep my hands away from my face. And if it's good enough for the United States Air Force, it's good enough for me!
Here's the data that is behind the above information. Please take a look. It's very interesting!
ECRI (Emergency Care Research Institute) recently published this report:
Until we have enough supplies to return to disposing of used N95 masks after each use, we need to do everything we can to protect ourselves, our patients and those around us from cross-contamination.
Stay safe out there!
The writers at Pharmacy Practice News have compiled information collected in ISMP Safety Alerts! Acute Care and organized them in easy to read tables so the most frequently reported medication errors and causes can be easily reviewed. The goal is to learn from others mistakes so they don't get repeated. "Preventing medication errors is an essential component of caring for patients.."
Is our sometimes blind trust in the safety offered by EHRs misguided?
"A 2016 study by The Leapfrog Group, a patient-safety watchdog based in Washington, D.C., found that the medication-ordering function of hospital EHRs—a feature required by the government for certification but often configured differently in each system—failed to flag potentially harmful drug orders in 39% of cases in a test simulation. In 13% of those cases, the mistake could have been fatal."
Read the full article that addresses medication safety and more:
Death by a Thousand Clicks: Where Electronic Health Records Went Wrong
by Fred Schulte and Erika Fry
Christina Michalek, RPh from ISMP (Institute for Safe Mediation Practices), www.ismp.org/ gave an overview of the most common medication errors reported to ISMP in 2018 when she spoke at the midyear clinical meeting of the American Society of Health System Pharmacists. Take a look at the Top Four and consider what you and your facility might do to prevent them from recurring where you work.
Is your institution following ISMP guidelines?
"Automated dispensing cabinets (ADCs) are used by most hospitals as the primary means of drug distribution.... The safe use of this type of technology can only be achieved through the adoption of standard practices and processes that are directly associated with ADC design and functionality."
Read what ISMP (Institute for Safe Medication Practices) recommends:
(You'll need to download the PDF for the specifics)
The alarming reality of medication error: a patient case and review of Pennsylvania and National data
"A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months." ..."Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms." Read what Brianna A. da Silva, MD* and Mahesh Krishnamurthy have to say, and learn about the Swiss Cheese Model of how errors occur in a system.
"After a hospitalization, being discharged is a key step on the road to recovery. But that road can take a dangerous turn—namely, a serious problem with one or more medications," says Heidi Godman.
“Half the patients had medication errors when they went home, whether there was a pharmacist intervention or not,” says Dr. Jeffrey Schnipper, one of the authors of the study....
We attended the ANA Quality and Innovations Conference in Kissimmee, FL last month, and were thrilled to meet an amazing group of nurses.They represented a cross section of specialties from all across North America, and everyone seemed to have similar goals in mind: Learn ways to improve quality of care, network and connect with peers, and get smarter! There were wonderful posters that showed the hard work nurses had done to improve quality of care in their institutions. We can learn so much from each-other. Nurses can and do make a difference!
Manning Our Booth
As an exhibitor/nurse innovator, I manned our MagniMed booth so couldn’t attend the sessions, but I heard they were great! As nurses filed through the exhibition hall, they stopped to check out our MagniMed solutions, using our lighted magnifiers to read the fine print on our real drug labels, and found how easy it was to read them once light and magnification was added to the equation. It was especially exciting to see nurses’ faces light up when a hard to read label was displayed on a computer screen using our new MedView Cube II.
Many shared personal experiences. They talked about often finding meds misloaded in medication dispensing cabinet bins. They spoke of challenging requests, like being asked to manually type in NDC codes when their barcode scanners were down. They talked about how hard labels are to read in emergency situations when so much is going on. Nurses spoke about how important it is to carefully read medication labels, and how challenging reading the labels has become. We shared laughs when nurses talked about coworkers that would particularly benefit from MagniMed products, and one nurse joked that with MagniMed she wouldn’t have to hold the medication labels so far away to read them.
Booth visitors’ recommendations for additional places to use our lighted magnifiers included:
· in clinic settings when reading lot numbers on vaccines
· on crash carts
· in emergency rooms
· in environments where there aren’t other nurses to verify difficult to read labels
· distributed in outpatient settings to help patients read their drug labels at home
· presented as a patient satisfaction “gift” on discharge after being used during patient teaching in preparation for discharge
All agreed that hard to read medication labels are a problem that we all deal with and they are adding risk to safe medication administration.
Most nurses weren’t aware that ISMP (the Institute for Safe Mediation Practice) recommends that lighted magnification be near all dispensing cabinets (i.e. Omnicell, Pyxis, etc.) and on medication carts even where barcode scanning is used. That’s because barcode scanning doesn’t take away the need to read the label. User feedback we’ve gotten from those using MagniMed products is that lighted magnification needs to be everywhere health care professionals are administering or handling medications.
Hard to read medication labels are a problem for nearly everyone. Nearly 90% of surveyed nurses and pharmacy staff report having trouble reading medication labels, which correlates with our ANA experience. It’s a universal problem. We can’t let small print on a label lead to an error that can destroy a patient’s, hospital’s or provider’s life or reputation. Identifying and acknowledging safety risk as a team, and addressing it before it leads to tragedy should be the goal we all strive for. This is common sense, of course, but also a recommendation by The Joint Commission regarding patient safety systems. Nurses, pharmacy staff, physicians, respiratory therapists, patients and caregivers all have to deal with hard to read medication labels.
If your hospital isn’t already complying with ISMP’s recommendations and addressing this issue, contact us and we will show how MagniMed can make medication administration safer at your institution while at the same time improving the work environment for your staff.
I am pleased to report that I achieved most of my goals for attending the ANA Conference in Kissimmee, Florida: I learned ways to improve quality of care for my patients, and learned of more places that my product can make a difference, I networked and connected with some amazing nurses, and I do feel a bit smarter, but……unfortunately, I didn’t get my Florida suntan. Oh well, maybe next year!
"The syringe had inadvertently been filled with Lanoxin [digoxin, a cardiac medication] instead of naloxone. The packages of both drugs, made by the same manufacturer, were almost identical. "
Why Neither the “Five Rights” Nor Bar Code Medication Administration Alone Will Prevent Medication Errors
"Poor lighting, inadequate staffing, poorly designed infusion devices, ambiguous or difficult to read medication labels, and lack of an effective double check system for high alert medications can contribute to a failure of the “five rights.” http://www.chpso.org/post/neither-five-rights-bar-code-medication-administration-alone-will-prevent-medication-errors