The Effect of Barcode Technology Use on Pathology Specimen Labeling Errors

Pathology specimen labeling errors occur for a variety of reasons. We investigated the use of barcode technology as a method to improve the accuracy of pathology specimen labeling and patient safety. We also assessed nurses' perceptions of system quality, information quality, service quality, user satisfaction, and net benefits. Sixty-eight perioperative nurses who work in a teaching hospital in Taiwan completed the survey. Nurses scored net benefits as highly contributing to their satisfaction, whereas system quality contributed most to dissatisfaction. Further, we analyzed pathology specimen records before and after implementing the barcode system and found that specimen management errors significantly decreased. The use of a reliable barcode system could improve specimen labeling accuracy and enhance nurses' satisfaction with this technology.

Salivary Cortisol As Indicators of Pain in Preterm Infants

Assessment and management of pain in preterm infants is critical and complicated. The addition of salivary cortisol measurement may improve the specificity of assessment and guide care to alleviate pain. The purpose of this study was fourfold: (a) assess the feasibility of a method of saliva collection in premature infants, (b) assess reliability of a method of measuring salivary cortisol in response to heelstick, (c) identify relationships between salivary cortisol and a measure of pain behavior (using CRIES) following heelstick, and (d) identify peak response times for elevations of salivary cortisol following heelstick in preterm infants. This was a prospective, descriptive pilot study. Serial saliva samples were collected from eight healthy infants 30 to 36 weeks’ gestational age in a Newborn Intensive Care Unit. Cortisol levels were determined using enzyme-immuneassay. Samples were collected without use of stimulants. Sample means supported peak and trough patterns previously described in the literature. Behavioral measures of pain did not correlate well with peak cortisol levels.

Cerebrospinal fluid collection: a comparison of different collection sites on the external ventricular drain

BACKGROUND

Intracranial pressure monitoring using an external ventricular drainage (EVD) system is the most commonly used technology to monitor intracranial pressure or drain cerebrospinal fluid (CSF) in neurological and neurosurgical patients. CSF samples are collected routinely from the EVD system for laboratory tests. No study has been conducted to identify where the most appropriate site for CSF collection is in order to reduce the disruption of the closed EVD system and reduce the risk of infection.

PURPOSE

The purpose of this study was to identify a CSF sampling port in the EVD system that is easily accessible, provides accurate results, and minimizes disruption to the closed EVD system.

SAMPLE

Fifty patients admitted to the neurological and neurosurgical intensive care step-down unit with the EVD system between July 2007 and September 2009 agreed to participate in the study. There were 21 women and 29 men. Forty-seven patients' data were analyzed.

METHOD

The design was quasi-experimental using a convenience sample. Two samples of CSF were collected daily. One sample was collected from the proximal port and another sample was collected from the distal port. The second sample was collected immediately after the first. Each set of samples (proximal and distal) was tested and compared for any differences in appearance, culture results, and concentrations of protein, glucose, and white cell count.

RESULTS

Using a two-tailed paired t test with 95% confidence interval, there was no statistically significant difference between the samples obtained from the two collection sites for protein, glucose, white cell count, appearance, and culture. Pearson's correlation coefficient was also used to analyze the correlation for the continuous measures. Both protein and glucose had very high correlations. However, the white cell count, and white cell counts and culture had very low correlations.

CONCLUSION

The distal port of the EVD system is safe and easy for CSF collection. It also provides accurate results for CSF samples. When the CSF sample is collected from the distal port, the entire volume of CSF in the drip chamber should be collected and tested to obtain an accurate WBC count per unit of volume.

[A medical test laboratory specialised in pediatrics]

A medical test laboratory in Paris specialises in children's biological samples. Renowned for its practice of collecting samples from children without difficulty and for its medicalised and paediatric interpretation, the laboratory's main objective is to ensure the quality and comfort of the healthcare it provides. A visit alongside the laboratory's founder, a paediatrician-biologist, and a nurse who has chosen to work there.

In-out catheterization of young children with suspected urinary tract infection: a retrospective journal study

It is important that pediatric nurses know that the methods they use are reliable and the most appropriate for the child's security and well being. In-out catheterization is a sterile invasive method to obtain a urine sample in young children. To confirm this as a reliable method, a study of medical records from 61 children ages 0 to 24 months with suspected urinary tract infections (UTIs) was performed. Each child had produced both a urine sample from an adhesive bag and a urine sample from in-out catheterization. Dipsticks were taken from both samples; and the methods were compared with kappa analysis. Cultures were obtained from the catheter urine. UTI was verified as a growth in the catheter urine in 32 out of 61 children. Catheterized samples of urine with 3+ or 4+ of leucocytes all had a growth of bacteria in the culture. This examination of medical records showed that in-out catheterization is a reliable method to use to confirm UTIs in children 0 to 24 months.

Urine collection in infants and children

June Rogers and Caroline Saunders review current evidence and best practice regarding obtaining a urine specimen from children.

Retrieval of DNA from the faces of children aged 0-5 years: a technical note

Approximately 21% of children suffer from some form of physical abuse. It is hypothesized that when an individual hits a child some of that person's DNA will be deposited onto the child's skin. As yet, no one has reported a method of sampling DNA from the skin of this vulnerable group of individuals. We have sampled DNA from several facial areas of 30 children aged 5 years of age and under. The results show that it is possible to swab the faces of this age group without distressing them or contaminating the samples. Additionally the results indicate that the DNA obtained is almost entirely that of the subject, with little nondonor DNA being observed.

Caregiver and health care provider satisfaction with volumetric bladder ultrasound

OBJECTIVES

Conventional (nonimaged) bladder catheterization has lower first-attempt success rates (67%-72%) when compared with catheterization aided by volumetric bladder ultrasonography (US) (92%-100%), yet the total time to urine sample collection with US can be quite lengthy. Given the advantage and disadvantages, the authors assessed caregiver and health care provider satisfaction with these two methods.

METHODS

Caregivers and health care providers of children enrolled in a prospective, randomized, controlled trial examining the first-attempt urine collection success rates with these two methods completed standardized questionnaires. Each child's caregiver, nurse, and physician noted their perceptions, satisfaction, and future preferences using Likert-scale assessments.

RESULTS

Of 93 caregivers, 45 had children randomized to the conventional arm and 48 to the US arm. Nine physicians and three nurses participated. Both caregiver groups had similar previous catheterization experience; none had children undergo volumetric bladder sonography. Caregivers in the conventional group rated their children's discomfort higher (4.4 vs. 3.4; p = 0.02) and were less satisfied (4.5 vs. 6.4; p < 0.0001) than those in the US group. Nurses' satisfaction with catheterization in the conventional group was lower than in the US group (3.0 vs. 5.5), as was physicians' satisfaction (4.3 vs. 5.7; p < 0.0001). Both nurses and physicians indicated that they would be less likely to use conventional catheterization in future attempts.

CONCLUSIONS

Caregivers in the conventional group rated their children's discomfort higher than did caregivers in the US group. Both caregivers and health care providers expressed greater satisfaction with US and were more likely to prefer this imaging modality with future catheterization attempts.

Use of the six sigma methodology to reduce incidence of breast milk administration errors in the NICU

Breast milk is the optimal source of nutrition for infants. According to research, neonates fed breast milk have a reduced risk of sepsis, increased feeding tolerance, a decreased incidence of necrotizing enterocolitis, and better neurodevelopmental outcomes. Unfortunately, researchers have not identified practices to reduce or eliminate the risk for errors in breast milk administration. This article discusses the potential hazards of incorrect administration of breast milk. It then describes how the tertiary care center at Children's Hospital of Illinois implemented a policy utilizing six sigma quality improvement methodologies to improve breast milk administration. Since implementation of this policy, the NICU at our hospital has reduced the risk of breast milk administration errors to less than 3.4 mistakes per million opportunities.

Sexually transmitted infections in preadolescent children

Pediatric nurse practitioners may be called on to conduct an assessment for sexual abuse of a young child. Depending on the type of sexual contact, a decision may have to be made to obtain cultures for sexually transmitted infections (STIs). Recognizing the symptoms of STIs in preadolescent children, along with having knowledge of the modes of transmission, diagnostics, and treatment, are part of the clinical decision. The impact of STI in preadolescent children has physical and emotional consequences for the child and family, along with legal consequences for an accused perpetrator. Knowledge about types of sexual contact that necessitate STI cultures, incubation periods, and symptomatology is essential. Accurate techniques and appropriate selection of culture materials are necessary. Proper positioning of the child for obtaining cultures can decrease the potential for discomfort during the examination. Gonorrhea, Chlamydia trachomatis, herpes simplex virus, human papillomavirus virus, syphilis, Trichomonas vaginalis, hepatitis B, and HIV are reviewed.

Are true-negative nitrite results affected by a two-hour delay in dipstick/pad analysis of urine in incontinence pads?

OBJECTIVES

To determine if true-negative nitrite results of a urine dipstick pressed into an incontinence pad (dipstick/pad method) are affected by a 2-hour delay in analysis.

DESIGN

A quantitative study.

SETTING AND SUBJECTS

Clean-catch urine specimens from a convenience sample of clinic patients, staff, and long-term care facility residents.

INSTRUMENT

Changes from negative to positive for each group of urine specimens were evaluated using percentages within the groups.

METHODS

Urine specimens were collected and a portion was cultured. Urine specimens negative for a urinary tract infection were included in the study. A portion of the specimen was poured into an incontinence pad. Initial nitrite results were determined using a dipstick pressed into an incontinence pad. Pads with true-negative dipstick/pad nitrite results were tested 2 hours later in the same manner. Urine culture results determined groups: mixed colonies; 50,000 to 75,000 colony-forming units per milliliter of a single type of uropathogen; greater than or equal to 50,000 cfu/mL diphtheroids; no significant growth; and no growth.

RESULTS

Of the 443 urine cultures negative for a urinary tract infection, 441 initial dipstick/pad nitrite results were negative. Two initial true-negative nitrite dipstick/pad results, or 0.5%, changed from negative to positive over the 2-hour period: 1 in the "mixed colonies" group (0.4%) and 1 in the "no growth" group (0.7%).

CONCLUSIONS

Results of this study indicate that true-negative nitrite results of a dipstick pressed into urine in an incontinence pad do not appear to be affected by a 2-hour delay in analysis.

Strategies for salivary cortisol collection and analysis in research with children

Salivary cortisol has emerged in pediatric research as an easy-to-collect, relatively inexpensive, biologic marker of stress. Cortisol is highly variable and is responsive to a wide range of factors that should be considered when incorporating this measure into research with children. Strategies for sample collection include: (1) standardizing the time for sample collection, including baseline samples; (2) using consistent collection materials and methods; (3) controlling for certain drinks, foods, medications, and diagnoses; and (4) establishing procedures and protocols. Other strategies for laboratory analyses include: (1) selecting the appropriate assay and laboratory; (2) identifying units of measure and norms; and (3) establishing quality controls. These strategies control extraneous variables and produce reliable and valid salivary cortisol results.

Development of catheter care guidelines for Guy's and St Thomas'

The need for an up-to-date, evidence-based guideline for urethral catheter care became apparent after the author started working as continence advisor in the urology, gynaecology and elderly care directorates at Guy's and St Thomas' NHS Foundation Trust in 2003. This article details the processes and difficulties the guideline group went through when developing and passing the guidelines through the Trust's clinical governance committee. It details the aims and objectives of the new guidelines and the areas of debate pursued following the consultation period.

Transfusing safely: a 2006 guide for nurses

Transfusion is a 'vein-to-vein' process. The blood supply in Australia is extremely safe in terms of viral risk, although a 'zero risk' blood transfusion is never possible. Safe transfusion practice continues to rely on highly-trained and experienced staff undertaking procedures correctly, in robust hospital systems within a safety and quality framework that includes an adverse event reporting system. Such a reporting system should work to enhance any hospital system where weaknesses or deficiencies are found. Further information on national guidelines and other aspects of transfusion in Australia can be found at: www.anzsbt.org.au/publications and www.transfusion.com.au. A transfusion administration checklist for nurses can be downloaded from: http://www.transfusion.com.au/Resourc eLibrary/resource_safety_2 .asp

Obtaining urine for culture from non-potty-trained children

The accurate diagnosis of urinary tract infection (UTI) in young children is important for initial management and the prevention of long-term damage to the developing kidney. Various methods are used for urine collection from the non-potty-trained age group, including catheterisation, suprapubic aspiration, clean-catch sampling, adhesive bag sampling and urine collection pads. Research literature was examined to identify which method is most effective. The themes that evolved from the review were parents' and nurses' views on ease of use, reliability of sample obtained and cost-effectiveness. Although not the most convenient method, clean-catch gives more reliable results making it also the most cost effective approach. Change management strategies are required to overcome barriers to research implementation and to ensure best practice.

Urinalysis

Urine analysis is an essential component of patient assessment, which is used for screening, diagnosis and planning care. This article discusses specimen collection and reagent strip testing.

Understanding urine testing

Urine is a natural waste product of the body and urine testing is a simple and quick way of monitoring disease and identifying new illness. The results from a urine test can prompt a change in a patient's medical management. Urine testing is not a new procedure: as far back as the ancient Egyptians there are descriptions of polyuria. In 7th Century AD, Protosharis suggested that it was important to look at the colour of urine and by 1674 Thomas Willis, a professor at Oxford University, recorded that the urine of his patients with diabetes tasted sweet (Beer, 1996).

Body piercing: issues and challenges for nurses

To provide safe and effective care for patients with body piercings, nurses must become more knowledgeable about this increasingly common practice. Competent nursing care is more than simply noting the presence or absence of body piercings, but includes accurate assessment, cultural sensitivity, and related patient education. Body piercings can create treatment challenges during trauma or post-assault care. An increased awareness of the history of body piercing, the piercing process, care of piercings, (including related wound care), and issues related to patient education, can enhance comprehensive nursing care.

Organizational characteristics of Sexual Assault Nurse Examiner programs: results from the national survey project

A random sample of representatives from Sexual Assault Nurse Examiner (SANE) programs throughout the United States were contacted to participate in in-depth telephone interviews about program operations and services for sexual assault patients. Programs that had been in operation 5 years or less at the time of this study are compared to older programs to examine trends.

Guidelines for patients undergoing faecal occult blood testing

The literature on faecal occult blood (FOB) testing reveals a vast amount of research determining the efficacy of this test for the early detection of colorectal cancer. However, it offers no details of the information that patients require before undertaking it. The test detects the presence of blood in a patient's faeces that may not be visible on examination.

Significance of toluidine blue positive findings after speculum examination for sexual assault

To determine the incidence of toluidine blue positive findings after speculum examination of sexual assault victims, we performed a prospective before and after study of 27 female patients presenting after sexual assault to a free-standing nurse examiner clinic. Before the insertion of a speculum, a 1% aqueous solution of toluidine blue was applied to the posterior fourchette and photographs were taken using colposcopy with digital imaging (16 x magnification). After the forensic examination was completed, dye was reapplied. Photographs taken before and after speculum examination were reviewed by three EM physicians for superficial lacerations or abrasions. Before speculum examination, genital injuries from sexual assault were documented in 67% of the patients (mean number of genital injuries, 1.4). After speculum examination, one patient (3.7%) demonstrated a new genital injury-an abrasion to the labia. Until further studies are performed, use of a speculum should be delayed until after toluidine dye application.

Sexual assault evidence collection more accurate when completed by sexual assault nurse examiners: Colorado's experience

INTRODUCTION

The purpose of this study was to determine if sexual assault nurse examiners (SANEs) provide more effective evidence collection compared with non-SANE-trained nurse and physician colleagues.

METHODS

Five hundred fifteen audits were completed by crime laboratory analysts on sexual assault evidence kits submitted to the Colorado Bureau of Investigation from October 1999 to April 2002.

RESULTS

Of 515 evidence kits audited, 279 were completed by SANEs. Non-SANE physicians and nurses completed 236 kits. Evidence kits collected by SANEs were more likely to have a completed chain of custody (92%) compared with 81% of non-SANE-collected kits. SANEs also were more likely to have properly sealed individual specimen envelopes (91% vs 75%), to have labeled the individual specimen envelopes (95% vs 88%), and to have collected the appropriate amount of pubic hair (88% vs 74%) and head hair (95% vs 80%). SANEs more frequently included the appropriate number of blood tubes (95% vs 80%), collected the appropriate amount of swabs (88% vs 71%), and included a vaginal fluid slide for sperm motility (87% vs 72%). Both groups prepared slides at a high rate for each penetrated orifice (87% vs 90%) and both had a high rate of including the crime laboratory report in the completed kit (97% vs 93%).

DISCUSSION

Studies such as this provide documentation that evidence collection kits prepared by SANEs are more accurate and complete when compared with evidence collection kits prepared by non-SANE nurses and physicians. Additional studies are needed to further validate the efficacy of SANE-completed evidentiary examinations.

A prospective comparison of performance of biopsy forceps used in single passage with multiple bites during upper endoscopy

BACKGROUND AND STUDY AIMS

A single biopsy is usually obtained for each passage of a biopsy forceps. It was hypothesized that multiple bites per passage might improve the quantity and quality of tissue obtained, without significant artifacts. This hypothesis was tested in a prospective, pathologist-blinded study using different forceps.

PATIENTS AND METHODS

Forty consecutive patients who underwent elective upper endoscopy were included. Five different forceps were used in six different ways, varying in the number of bites taken per passage. Two pathologists, who were blinded to the type of biopsy forceps used, evaluated the specimens according to the parameters of maximum weight (mg), size of largest fragment (mm), depth, squash artifact, adequacy, and overall rating.

RESULTS

A total of 240 biopsy specimens were obtained. The Microvasive Multibite and Megabite forceps obtained specimens with the maximum weight (P<0.05) and the largest size (P<0.05), respectively. Alligator forceps were able to obtain specimens significantly larger in size than the oval-shaped forceps (P<0.05). The Olympus FB-24K forceps performed best in both the adequacy score and the overall rating score (P<0.05).

CONCLUSIONS

Forceps with a needle, or the Multibite forceps, allow more biopsies to be taken per passage and improve the quality of tissues obtained. "Needleless" forceps can be used to obtain two samples per passage through the endoscope that are as good as when only one sample is collected. This approach can save time, and causes no significant damage to the biopsy specimens.

"Don't destroy the evidence!"

As nurses, we interact with both victims and perpetrators of violence. Our goal is to save the patient; however, we also play a role in the legal outcome of that violence. What we do in caring for these patients is important. Means of preserving and documenting evidence while caring for the victims of violence are discussed and guidelines for the nurses legal role are given.

From breast to baby: quality assurance for breast milk management

Breast milk is a body fluid capable of transmitting blood-borne pathogens when ingested. High-risk infants are frequently fed mother's expressed breast milk and may be at risk if they receive the wrong mother's milk. A multidisciplinary team at this 42-bed Level III regional NICU developed a quality assurance program and audit aimed at reducing the risk of feeding expressed breast milk (EBM) to the wrong high-risk infant in the unit. Changes to the old system included modernizing the handling, storing, and distribution of EBM. Elimination of feeding errors was the priority. A specific protocol to minimize EBM feeding errors became part of the quality assurance program and is consistent with the recommendations of the NICU multidisciplinary team.