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These simple products help to introduce systems in which vials and packaging with similar appearances, look alike or sound alike, are marked or distinguished to avoid choosing the wrong medication. E M Innovations provides a range of error prevention and medication safety items to help provide safe storage and promote safe use of medications.
ABSTRACTAn estimated 300 million radiologic procedures are conducted per year in the United States.
This program and its full series in now available through the Nursing Center App in the Google Play Store and Apple Store. As they grapple with a severe federal funding cutback, Employment Development Department staff have been told that they need to look for work. The news came in an internal memo from EDD Chief Deputy Director Sharon Hilliard earlier this month that employees forwarded to The State Worker. Hilliard said the Congressional sequestration spending reductions and ongoing underfunding of the Unemployment Insurance program by the federal government translates into a more than $150 million budget shortfall for the department through June 2015.
With the economy recovering from the recession, demand for unemployment benefits is coming down, said EDD spokeswoman Patti Roberts.
With just 400 to 450 words for our weekly State Worker column, much of what we learn each week never sees print. Our State Worker column in today's Bee notes that Professional Engineeers in California Government filed a grievance triggered by furloughs started in July.
The then-Department of Personnel Administration (now dubbed the Department of Human Resources), said that the June 4 grievance was "premature" because it was filed before the July 1 start of furloughs so that no union members had suffered a loss. The administration also said that Brown was acting in his role as governor in presenting a budget plan, not as the state's employer. PECG attorney Gerald James asked for arbitration to keep the association's options open, but hasn't pushed the matter any further, union spokesman Ryan Endean said Wednesday. Our recent story on student assistants losing their state jobs mentioned that the California Association of Professional Scientists has taken issue with the decision to ax students who work with its members. We never get all of what we learn into a news story, but this blog can give users the data, the notes and the quotes from the notebook that informed what was published.
Our story in today's Bee takes a closer look at the state's plan to ax hundreds of its student assistants at the end of next month, in keeping with a furlough agreement Gov. In the course of reporting, we talked to about a dozen students and corresponded via email with about the same number. Continue reading From the notebook: A student assistant comments on her impending layoff, tuition hikes and job prospects. Here's an email from state employee Paul Warrick to SEIU Local 1000 leaders regarding the 5-percent pay reduction that union and Brown administration negotiators have been discussing since June 9. Thousands of state workers are concerned that you won't stand up for us, and force the state to honor our contract. Please don't act complicity with the Governor by continuing to further sacrifice our benefits and wages for political appearances aimed at persuading the electorate to support the Governor's tax increase in November.
When the Governor begins his campaign for the tax initiative, his recitation of cuts and concessions mentioned in the first paragraph above is more than sufficient to illustrate that rank and file state employees have done their fair share in these tough economic times. In a letter to members this afternoon, SEIU Local 1000 officials said that they are preparing to negotiate with Gov. The chairs of Local 1000's nine bargaining units said that whatever concessions they negotiate will be put in a "side letter" agreement. Ahead of that, union officials are soliciting savings ideas to offer as alternatives to Brown's furloughs. The union's bargaining team will review all of that information ahead of negotiations scheduled to start June 9. State worker Tamara Martfeld sent the following email in response to last Friday's post, "Reader of State Worker furlough column defines 'fair.' " We're posting the email unedited and with her permission. Reader Linda Clark emailed her reaction to Thursday's State Worker column about whether it's fair for several hundred California government employees in five departments to be paid the wages they lost to furloughs. The State Controller's Office is "very close" to settling all the thorny issues connected with issuing furlough back pay to hundreds of current and former state workers, but some questions still need to be answered before the checks will be cut, according to a letter provided to The Bee that went out Friday to the affected departments.
The letter from the controller's office, which we've posted below, doesn't commit to a payment date. The controller's office also will withhold garnishments and union dues or fair share fees from the checks. It also looks like employees may be paid at different times, depending on how quickly their employers submit documentation.
Continue reading California controller's office 'very close' to finalizing furlough back pay. Despite an unprecedented downsizing that has cut jobs and emptied out agency offices around California, the State Compensation Insurance Fund's board of directors has OK'd a new incentive bonus program for employees. It's not clear how much this will cost State Fund, a quasi-private state agency that provides workers' compensation insurance to businesses, but employees could receive up to 10 percent of their base pay depending on how well they perform. E M Innovations introduces simple and effective new products to help prevent medication errors.

E M Innovations' new line of high alert labeling, shrink bands and storage options to segregate high alert medications are great tools to prevent medication mix-ups and to draw attention to the medications, as well as verify strength and expiration dates. In cardiac catheterization laboratories, radiology, and other diagnostic departments, medications such as contrast media are administered, rates are adjusted for intravenous (IV) fluids, and IV access lines are flushed. A department spokeswoman verified the authenticity of the memo and said that downsizing will eventually affect some customer services.
In response, the department is doing everything from cutting phone service hours and moving staff to more dependably-funded programs to squeezing operational spending and limiting overtime.
In the second quarter of 2013, UI claim numbers decreased 37 percent compared to the same three-month stretch at the height of the recession in 2010. Column Extras give you some of the notes, the quotes and the observations that inform what's published.
The union claims that the Brown administration violated the PECG contract by suggesting a 2012-13 budget that funds only 95 percent of their members' wages. Whatever agreement is reached at the table will go to the rank and file for a ratification vote.
Payments will go out "within 10 working days from the date SCO receives the completed Furlough Settlement Pay Template from your department (further details regarding the template will be forthcoming)," the letter says. None of the bonus money would come from tax dollars, since State Fund operates solely on policyholders' premiums and investments. In addition to specific medications that are used in radiology, high-alert medications such as IV sedatives, vasopressors, and blood coagulation modifiers are given in this setting. Nearly 1,000 event reports submitted to the Pennsylvania Patient Safety Authority specifically mentioned medication errors that occurred in care areas providing radiologic services. The agreement also says that the state won't hire any more student assistants as long as Local 1000-represented employees are on furlough through June 30, 2013. The administration of wrong drugs and unauthorized drugs was the most commonly reported medication error, followed by wrong-dose errors.
While contrast agents and radiopharmaceutical products were cited in almost a quarter of all medication error reports, a majority of the drugs listed are used across the spectrum of patient care settings, not just in radiology. Further qualitative analysis of events classified as wrong-rate medication errors in these areas shows no radiologic medications.
Strategies to address these problems include conducting organizational examinations of the medication-use processes in radiology areas to uncover risks that could lead to harmful errors, proactively addressing the plan for the management of the patient’s infusion therapy while they are undergoing a radiologic procedure, and including radiology staff when evaluating and validating the level of training and competency to perform medication administration or related tasks. Radiologic services are provided in a variety of inpatient and outpatient settings but most commonly involve cardiac catheterization, radiology, and nuclear medicine services. These services use medical imaging, such as radiography, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine, positron emission tomography, and ultrasound. Pharmacopeia (USP) report on medication errors in radiology1—that pooled error reports to MEDMARX® from 2000 to 2004—revealed that, while medication errors in radiologic services are not more prevalent when compared to other settings, they do have more potential to cause harm. Twelve percent of the medication errors reported by USP in radiologic services resulted in patient harm (“harm” defined as National Coordinating Council for Medication Error Reporting and Prevention [NCC MERP] harm category E or higher) compared to 1.7% of all medication errors. As a patient is being transferred to and from a radiologic care setting, the opportunity for miscommunication and lack of access to patient information sets the stage for errors to occur.
Because the care provided to the patient is very much focused on a particular procedure, drugs that were administered pre-examination, or those to be continued postexamination, may not be given sufficient attention. Certification and training requirements for radiologic staff can vary by setting, state regulations, and institutional policies.
Frequently, staff directly dispense and administer medications; however, there is no true standard on how much or what kind of medication-use training they receive.
In cardiac catheterization laboratories, radiology, and other diagnostic departments, staff administer medications such as contrast media, adjust rates of IV fluids, and flush IV access lines.
In reality, these medications are sometimes administered without a radiologist ever actually seeing the patient or the patient’s medical record. Additionally, there is sometimes no written prescription and no written documentation on a patient’s medication administration record when these drugs are administered.
Because of this, there is very little opportunity for a pharmacist’s involvement in reviewing the orders and screening the patient for allergies, drug-drug interactions, or drug-disease state warnings before the medication is administered. A Look at the NumbersLittle information in the literature specifically mentions medication errors that occur in the radiologic setting.
Table 2 identifies the top 15 most common drugs mentioned in reports associated with the radiologic unit. When combining the medications listed into their respective class of medications, 28.3% of all medications mentioned are considered high-alert medications, excluding IV contrast agents (which are also high-alert medications). Top 15 Medications Involved in Medication Errors in the  Radiologic Care Area (n=15)       Table 3. Forty (28.4%) of the wrong-drug errors involved mix-ups of the various formulations of technetium, a radiopharmaceutical widely used as a diagnostic aid.
Its applications include imaging procedures of the brain, myocardium, lungs, thyroid, and bone. Technetium has numerous uses in nuclear medicine, and it is available in more than 60 different products.

This means that 44.7% (n = 63) of wrong-drug reports involved medications specific to that setting. In most cases, the result of this mix-up does not lead to patient harm; however, it may lead to the rescheduling of the intended test and result in increased cost and loss of productivity. In fact, the most common medications listed included insulin and heparin infusions, such as in the following example: The patient has been in radiology since early this morning. Apparently, the insulin pump was disconnected before the patient’s arrival in the radiology department.
After several hours passed, the radiology technicians made the nurse from the unit aware that the patient would be in the radiology department a while longer. The patient’s companion alerted me in the early afternoon to the fact the patient had an insulin pump and it has been disconnected since this morning, so a blood sugar was obtained.
The floor nurse was notified of the patient’s status and that the radiology department does not carry insulin.This example reported to the Authority demonstrates a bigger problem, which is the effect any procedure may have on a patient’s current drug therapy. Errors may occur when the infusion pump is restarted by radiology staff or if the pump is off for a prolonged period of time.
It would be expected that medication errors that occur in this area would primarily involve problems with medications specifically given for radiologic procedures. However, as indicated in Tables 2 and 3, a majority of the medications involved in errors in radiologic settings were not radiologic medications, such as contrast or radiopharmaceuticals.
The following are two examples submitted to the Authority:Patient was consented for MRI with conscious sedation. A registered nurse (RN) administered Versed® (midazolam) and fentanyl IV push prior to MRI. Patient developed respiratory distress and cyanosis for which an airway emergency was called. The patient stabilized and was taken to recovery room and subsequently was transferred to pediatric intermediate care for observation.In addition, analysis of events classified as wrong-rate medication errors in these areas shows not one radiologic medication, and over half of these events involved high-alert medications.
These problems include misprogrammed infusion pumps, infusions that were stopped for the radiologic test but not restarted, tubing misconnections, and wrong-patient errors. The following reports illustrate these problems:The patient arrived to the intensive care unit (ICU) from the cardiac catheterization lab.
When the patient returned from ultrasound, the infusion was found to be no longer running and clamped.
A subclavian catheter and tracheostomy were present and all of the ports had similar injection valves. Patient was then pulled out of the MRI and discovered that contrast had been injected into tracheostomy cuff with a rupture of the balloon.
Following a preliminary investigation, it was determined that an inpatient was in x-ray around the same time the ED patient was in the ED, and for unknown reasons the inpatient’s IV was connected to the ED patient. A review of the data submitted to the Authority reveals 126 reports (13%) where breakdowns in obtaining and using patient information occurred, including the following case examples:Patient presented to the ED with abdominal pain and vomiting. The patient's creatine came back at a critical level and contrast should not have been given.A nurse gave a verbal order for a heparin dose to be given IV push and the physician assisting with the heart catheterization did not know that the heparin was already administered. The patient developed a hematoma at the catheter site and required blood products.A patient received a dosage of IV contrast for a CT scan administered by CT technicians without checking the lab values of the patient’s BUN and Cr before administering the contrast.
The physician was notified and stated [the intent to] hydrate the patient.A four-year-old patient underwent a Cardiolite® (technetium Tc99m sestamibi) cardiac imaging scan.
A routine audit of the records discovered that the dose was based on 50 kg and not the patient’s weight of 50 lbs. Upon internal review, it was discovered that the weight was obtained verbally by the technician and then forwarded to the pharmacy for nuclear medicine. Risk Reduction StrategiesHealthcare facilities should identify the error risks currently present in cardiac catheterization laboratories, radiology, and other diagnostic departments and take steps to implement risk reduction strategies.
Ultimately, the responsibility for patient safety falls to the licensed medical professional supervising the technician.Include radiology staff when evaluating and validating the level of training and competency to perform medication administration or related tasks. Keep technicians in the information loop regarding safe medication administration practices by providing in-service education.11Organizations need to carefully consider current and recent patient information before ordering, dispensing, and administering any medication in this setting that may affect the procedure. MEDMARX® data report: a chartbook of 2000-2004 findings from intensive care units and radiologic services. Contrast material-induced renal failure in patients with diabetes mellitus, renal insufficiency, or both. Incidence, risk factors, and clinical course of acute renal insufficiency after cardiac catheterization in patients 70 years of age or older.

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