CRITICAL DIFFERENCE INC.
PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
12/19/06   Issue XLIX   850-477-1234   Toll Free 866-CDI-NURSE
didn’t have to spare.  Add in the cost
of the loss of billable OR time, the cost
of anesthesia’s unplanned down time,
and the cost of folks staying overtime
to cover your patient, now
rescheduled for later in the day.  This
impacts everyone involved…the patient’
s cost of an extended hospital stay,
the surgeon who will miss dinner with
her husband, the patient’s family and
their arrangements at home/work, the
patient waiting in the ER for a bed to
open.  This is the best-case scenario.
Move into the equation that the error
was not caught, the patient aspirated,
and died.  We must make our
colleagues understand how important
it is to write these errors up.  Clearly
state the problem, the outcome, the
cost to the department and patient.  
This one error costs more than was
spent on in-service training for the
dietary department for an entire year.  
Yet no one wrote it up. Look for it to
happen again
500,000
The number of surgical site
infections in the US each year
causing 3.7 million
excess hospital days and $1.6
billion in extra costs.  Clin
Infect Dis, 33,S67.
60%
The likelihood a patient with a surgical
site infection will have to spend time in
an ICU. Additionally, they are 5 times
more likely to be readmitted and twice
as likely to die from complications. RN
Vol.69, No. 8.

40 to 60%
The number of surgical site infections
that are preventable.  It turns out that
simply making sure the antibiotic was
given within an hour (2 hours if
Vancomycin) of the initial incision, we
could have prevented a high
percentage of these infections.  
According to a study by M. Hall, the
antibiotic should be given in the OR to
prevent timing errors.  

27%
The percentage decline in heart
attacks in Pueblo, Colorado since a
2003 ban on smoking in public places,
per a study reported in Circulation.
CRITICAL DIFFERENCE INC.
PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
7/9/06   Issue XLVII   850-477-1234   Toll Free 866-CDI-NURSE
3%
The percentage of American adults
following a healthy life style, according
to Archives of Internal Medicine.  This
includes not smoking, keeping a
healthy weight, eating enough fruits
and veggies, and getting regular
exercise.


Florida’s Death Row
Inmates introduced to a bispectral
index monitor already know they are
in trouble.  They are about to die.
Making A Difference
Nurses have always had to prioritize
and  have really gotten pretty good at
it.  One of our patients develops a
wheeze, we drop what we are doing to
jump on it. Day in and day out we weigh
which needs come first and with great
accuracy.  How is it we miss the mark so
far in our own lives?  We dream of a
better life for ourselves.  Better
understanding of the job we have now
or a totally different job.  We dream of
kids who don’t push our buttons at
every turn.  We dream of a moment
when the reflection in the mirror doesn’t
make us flinch.  It is time to prioritize
our own lives.  Put into prospective
what is most important and work
towards that vision that has been
fading to black as the years pass.   If
you can learn a language in 10 minutes
a day, you can make incredible headway
in each of our priority areas with the
same 10 minutes.
Your first priority is yourself.  You have
to live long enough to make the most of
the new life you created.  That means
you are going to have to take 10
minutes as the very first step, and
exercise.  Doesn’t matter what it is, you
can do it while you watch TV (Americans
watch an average of 120 min. of TV a
day), but you have to do it.  Next get a
handle on the weight. Read The Zone
Diet. You can do that in the
commercials.  Still gaining weight?  Get
help, and stay away from anyone
talking surgery.  
Wrapped, Effective, Ready
and unfortunately infected.
Yankauer suction catheters stand
ready at the head of each patient’
s bed in almost every hospital I
have ever been in.  Effective, easy
to hook up and when connected
does one of the best jobs going of
clearing an oral cavity.  
Researchers at a  Southern
California hospital over a 3 month
period cultured the Yankauers in 3
ICUs placed at the bedside.  
Eighty percent of them cultured
positive (with moderate or
abundant colonization),  60%
grew out MRSA and 5% grew out
VRE.   Use the catheter, please
don’t let the patient change or the
shift end before setting up a new
one.
Our patients in the ICU shouldn’t have
the same concern. Yet, one study (RN
vol 68, No.9) points out that 54% of
our patients were over sedated for
procedures, and even more
concerning, 15% were under sedated.  
Enter the bispectral index monitor,
once used solely in the OR, now being
introduced in the Units, allowing the
nurse to read a more precise view of
the medication’s effect on the brain.  
290,000
The number of women whose lives are
extinguished by cervical cancer each
year.  In a nation that outspends the
entire world on pap smears, 10
women will die form the disease each
day in the US.  The sickle of death was
slowed in May, when the FDA advisory
panel voted 13 to 0 to approve the
medication Gardasil.  This vaccination  
could cut the worldwide deaths from
cervical cancer by 2/3s, and protects
against two other virus types
responsible for 90% of genital warts.  
We truly do live in  remarkable times.
CRITICAL DIFFERENCE INC.
PROFESSIONAL FREEDOM THROUGH INDEPENDENCE
3/9/06   Issue XLVI  850-477-1234   Toll Free 866-CDI-NURSE
to a plan, total adherence
is just a     dream.  It is
our job to look to where
the program is sliding and
work up a teaching
program that will walk
them through the stages.  
Just because the physician
tells the patient it has to
be so doesn’t make it so.
Know the stages of
change.  Practice what
goes into each level and  
help your patients flourish.
You can’t believe the
difference you make each
and every time you bring
your considerable
knowledge and skills to
bear for your patient.  

54%
The number of night shift
workers in the United
States that fall asleep at
least once a week on the
job… including jet pilots
and yes, nurses.  Worse
yet, PET scans of folks
who have been sleep
deprived showed almost
no          problem solving
capability.
CDIstaffing.com
Added: A new and improved Contact Us
section. Updated: Newsletters Section.

Methemoglobinemia
Has your patient turned Smurf blue, yet
pulse Oxymeter remained in the 90s?
You may be seeing a case of
Methemoglobinemia.  The most
frequent cause in a hospitalized
patient…Benzocaine!  Other causes

Making A Difference
The new year is well under way.  The
once bustling business of selling gym
contracts has come to a screeching halt,
as have the exercise machines that see 3
weeks of hard work and then 49 weeks of
rest.  Our New Years resolutions have
fallen to the sidelines …Ahh, but we tried,
we are human after all.  That is unless, of
course, you are a patient. Then you are  
labeled non-compliant.  We teach our
patients to stay on track with diet,
exercise, life styles, medications and
required visits.  As if there actually is a
solid steel track to ride.  Americans are on
a slippery slope when it comes to health.  
A large number of us are in trouble with
our weight, sky high lipid levels, little to
no exercise and too little sleep.  Nurses
have a strong role to play in helping their
patients, and each other, change
unhealthy behaviors.  

How To Help People Change
According to Prochaska et al., there are 5
stages: Precontemplation, Contemp-
lation, Preparation, Action and
Maintenance.  According to AJN Vol.105,
No.10 (44) how successful a person is at
each of these stages directly relates to
how successful the person will be at the
next stage.  So you want your patient to
adhere to an exercise program.  They
have already advanced through an
understanding of the need for the
exercise, come up with a plan of how to
accomplish it and how and when time
would be made for it. Yet they are getting
hung up on the action stage.  We can
urge notes be posted around the house
and job, gym buddies be formed, minimum
exercise allowed.  Many times it is the first
minute of an exercise that is the hardest,
after we start, we tend to finish.  Find
where they are in the process of change.  
Understand that it may be a stage or two
prior to the patient’s perceived stage that
they are failing at, and help fill the
knowledge gaps so they can move
forward.  We should aim for considerable
adherence

include Cetacaine, Lidocaine, Nitrates,
Sulfonamides, Pyridium, Nitrous Oxide,
Reglan, Dapsone, Antimalarials and
Tylenol.  Call the doc, and the “ICU
Swat Team.” Put your patient on O2
and the cardiac monitor (you already
did the pulse Ox) and get the
pharmacy to send you Methylene Blue
on standby (normal dose 1-2mg/kg IV)
in case the doctor orders it.  According
to the J Med 83(5), 265, such quick
thinking can stave off tachycardia,
seizures, and then circulatory collapse.

Get Cultured
Gulf Coast Chorale presents Sing For
the Cure April 22. If you would like to
attend, call us, we will even pay!  

Don’t Rush The Knife
According to an RN article (Vol.68, No.
9), 79% of women with chronic pelvic
pain that persisted after hysterectomy
actually had interstitial cystitis! To
state the obvious, do the work up,
before the surgery.

44 Times Higher
An article in Ann Intern Med (2005;
143: 785-92) points out that the
incidence of having a stroke after an
MI (in one study) was 44 times higher
than the general population.  Further,
the study points out that those who
had a stroke were three times more
likely to die in their first year post MI
than other MI patients. Giving the
patient his prescription for a platelet
aggregation inhibitor, on discharge…
important.  A nurse that takes the time
to explain the medication’s role… 44
times more important.  
Thanks for being a nurse

Douglas Terrell  RN
CEO CDI
3/06 to 12/06
Making A Difference
Your patient has been waiting for hours to
go to the floor.  You call to see what the
hold up is and find that the room you are
waiting for has yet to be cleaned.  The floor
says they are waiting as well.  Another
hour passes and the room is still not
cleaned.  Your call to the housekeeping
supervisor reveals that no request for a
room clean has been made as far as he
can see!  Delays, errors, dysfunctional
systems…do they impact  patient care?  
Boy, do they.  Often we just chalk it up,
apologize to the patient, and carry on.  
This approach is the path of least
resistance, but it is the approach that
leads to the continuation of  “system
defects.”  
System defects abound in every hospital.
The business world has a calculation for
this, using a system developed at Motorola
in 1986 by Bill Smith, called  Six Sigma.  He
shows that for every 1000 opportunities to
produce a result, if you have 7 system
defects, you are in trouble.  Much more
than that can lead to bankruptcy.   Why is
there no money in the budget for over bed
patient lifts?  It is because we are awash
in costly system defects.  If we want to
make a difference, we must make
intelligent, persuasive, patient centered,
outcome based arguments for change.   A
factory has the advantage in making a nail
that is 3cm in length.  If it is out of
specification, it is tossed.  We deal with
people.  Once a problem develops, they
are nailed with the outcome.  
You find your patient set for 12 noon
surgery was delivered a tray and polished
off his last sausage while you were getting
report.  He acknowledges that he had
been told it was to be clear liquids only
today…but who was he to argue?  If he
was not to eat it, why did it get delivered?  
This is going to require you to devote a half
hour of time you don’t have, to set things
in motion to stop the patient from going to
surgery.  The OR, in turn, has to bump the
case and try to move up a case, killing at
least a half hour of time the OR nurses
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