		Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN

 Oncology Nursing Consultant, Adjunct Assistant Professor of Nursing

		Louisiana State Health Sciences Center in New Orleans, Louisiana

	Christopher R. Friese, PhD, RN, AOCN®, assistant professor, University of Michigan School of Nursing, has had a long-standing interest in extending his research on quality of cancer care to the community, where an estimated 85% of cancer care is delivered. He and his research team began by conducting focus groups with staff nurses and learned that many outpatient oncology practices did not have consistent processes in place to keep nurses safe, and that nurses were at risk for unintentional chemotherapy exposure. To learn more about this risk, Friese sought input from a nursing expert in safe handling of hazardous drugs, Martha Polovich, PhD, RN, AOCN®, associate director of Clinical Practice, Duke Oncology Network, and conducted a study to identify the organizational structures and processes of care that are associated with an increased risk of unintentional chemotherapy exposure.

	Friese’s research team sent a survey to 1339 outpatient oncology nurses in one state and received 402 responses (response rate, 30.5%). There were minimal demographic differences between respondents and nonrespondents, and 16.9% of the respondents reported that their skin or eyes had been unintentionally exposed to chemotherapy in the previous year. The likelihood of exposure decreased when nurses reported adequate staffing levels and resources, and when they reported that chemotherapy doses were verified by 2 nurses either frequently or very frequently.

	When asked if the study findings surprised him, Friese said, “We anticipated that unintentional exposure occurred, but the rate of reported exposure was higher than we thought. Sadly, the reported rate of 17% is consistent with a finding from a study published in the 1980s. We also were surprised how strong the relationship between nursing workloads and exposure was.”

	Polovich was also surprised by the reported skin or eye exposure. “Given that nurses are inclined to underestimate their hazardous drug exposure, it is very concerning. Since no information was collected about precaution use, it’s not possible to determine the cause(s) of the exposure. The adverse effects of exposure make this a serious issue.”

	Friese has launched a second study to better understand when, where, and why exposure occurs, and what personal protective equipment (PPE) elements and precautions were in place at the time. “This will help us identify the ‘danger zones’ to nurses. Another intriguing area is how clinicians are handling patient excreta. The direct effect of exposure to patient waste is unclear but is ripe for research,” he noted.

	The influence of staffing on chemotherapy exposure in Friese’s study is similar to what Polovich found in her soon-to-be published study on precaution use: As the number of patients per day increased, the use of precautions decreased. “Certainly, lower precaution use can result in increased exposure,” she noted. “Since the nurse-patient ratio seems to be related to worker safety as well as patient safety, we need to determine what is the most appropriate staffing for nurses administering chemotherapy. We need to develop and validate acuity systems for outpatient infusion centers. For inpatient chemotherapy, nurses need to have assignments adjusted or be relieved of other patient care when they are responsible for chemotherapy administration. No nurse should be too busy to use safe handling precautions. Managers of chemotherapy nurses have to understand that and plan for it.”

	Sadly, the reported rate of 17% is consistent with a finding from a study published in the 1980s. We also were surprised how strong the relationship between nursing workloads and exposure was. ”

—Christopher R. Friese, PhD, RN, AOCN®

	Polovich also noted that an interesting finding of Friese’s study is that chemotherapy exposure was less likely to occur in organizations where nurses perform a double-check before chemotherapy administration. “It’s not just ‘slowing down’ the process, as some have suggested. To me, it represents the influence of the safety culture in the facility. Organizations with a better safety climate do not separate patient safety from staff safety—they value both. In my study, a positive workplace safety climate was related to higher hazardous drug precaution use. Employers share the responsibility for safe practices, whether it’s adherence to the ASCO/ONS Chemotherapy Safety Standards or the NIOSH, OSHA, or ONS hazardous drugs safe-handling guidelines.”

	Friese hopes that his study helps nurses articulate health and safety risks to their employers, and that oncology nurses lead the way in standardizing the process by which chemotherapy is prepared, administered, handled, and disposed. He noted that “increased attention to the workplace is likely to not only confer benefits to patients, but to the clinicians who care for them as well.”

	Friese CR, Himes-Ferris L, Frasier MN, et al. Structures and processes of care in ambulatory oncology settings and nurse-reported exposure to chemotherapy [published online ahead of print August 16, 2011]. 

Articles

Study finds 17% of oncology nurses in outpatient infusion clinic are exposed to chemotherapy drugs.

Chemotherapy Exposure: Is Your Workplace Safe?

 Now more than ever, oncology nurses need to be able to fill the knowledge gap and accurately educate their patients and the public about cancer screening tests and their frequency.

	The news media has done a good job of informing the public about cancer screening. So good, in fact, that it seems that not a day goes by without hearing that one organization or another has issued updated guidelines and recommendations. As oncology nurses, we’re expected to be knowledgeable about cancer screening. Our patients, the public, and even our own health depend on our having an accurate and up-to-date knowledge base.

	Let’s start with mammograms. In July 2011, the American College of Obstetricians and Gynecologists (ACOG) issued new breast cancer screening guidelines that recommend that women begin having screening mammograms annually at age 40. Previous ACOG guidelines recommended mammograms every 1 to 2 years starting at age 40 and annually beginning at age 50. ACOG cited the incidence of breast cancer, the sojourn time for breast cancer growth, and the potential to reduce the number of deaths from breast cancer as the rationale for revising their breast cancer screening guidelines.

	Now on to cervical cancer screening. Current cervical cancer screening guidelines, issued by the American Cancer Society (ACS) in June 2011 and ACOG in November 2009, recommend a combination of a Papanicolaou (Pap) test and a human papillomavirus (HPV) test for women age 30 and older. Upon screening, if the results of these 2 tests are normal, women can wait 3 years for their next cervical cancer screening test.

	In June 2011, researchers from Kaiser Permanente in northern California reported that their National Cancer Institute—initiated study of 33,818 women in community settings supports the ACS and ACOG recommendation. They concluded that concurrent Pap test and HPV testing allowed the screening interval to be safely extended to 3 years for women who had negative HPV tests and normal Pap smears.

	Despite the evidence and recommendations from well-respected and reputable organizations, there’s been reluctance to implement a 3-year cervical cancer screening interval recommendation in clinical practice. Researchers from the Centers for Disease Control and Prevention (CDC) recently found that primary care providers still recommend annual cervical cancer screening. According to the study, <15% of the 592 physicians surveyed extend the screening interval when using the Pap and HPV tests together, as the ACS and ACOG guidelines recommend. The CDC analysis found that there is a need for healthcare provider education, and noted that use of Pap and HPV testing and adherence to the extended screening interval reduces patient harm caused by overtesting, such as pain, inconvenience, morbidity, and unnecessary followup procedures and treatments. The CDC researchers also identified the need for continued surveillance on cervical cancer screening guideline adherence.

	Obviously, adhering to cancer screening interval guidelines requires awareness and knowledge of the currently recommended guidelines. As oncology nurses, we need to stay abreast of cancer screening guidelines and counsel our patients appropriately. For many women, lowering the age at which breast cancer screening should begin makes perfect sense. However, increasing the interval of cervical cancer screening from annually to every 3 years is not as easily understood. After all, even physicians are grappling with the new interval recommendation. Now more than ever, oncology nurses need to be able to fill the knowledge gap and accurately educate their patients and the public about cancer screening tests and their frequency.

	Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN, is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA, and the editor-in-chief of 

			American College of Obstetricians and Gynecologists. Annual mammograms now recommended for women beginning at age 40. 

			American Cancer Society. Cervical Cancer: Prevention and Early Detection. 

			American College of Obstetricians and Gynecologists. ACOG Practice Bulletin no.109: cervical cytology screening. 

			Katki HA, Kinney WK, Fetterman B, et al. Cervical cancer risk for 330,000 women undergoing concurrent HPV testing and cervical cytology in routine clinical practice. In: 

 29 (15 suppl). Chicago, IL: American Society of Clinical Oncology; 2011. Abstract 1508.

			Roland KB, Soman A, Benard VB, et al. Human papillomavirus and Papanicolaou tests screening interval recommendations in the United States [published online ahead of print June 12, 2011].

Now more than ever, oncology nurses need to be able to fill the knowledge gap and accurately educate their patients and the public about cancer screening tests and their frequency.

Cancer Screening: Are You Recommending the Right Intervals?

Am I just noticing the ads, billboards, and TV commercials more often, or have cancer centers increased their advertising? And is it the messages, rather than the number of them, that have caught my eye?

	Not all cancer centers and oncology providers advertise, and there are some that provide straightforward, objective information in their ads. However, there are more than a few that have messages and patient testimonials that, in my opinion, are misleading. I’m not alone in this observation. Back in December 2009, Natasha Singer wrote a piece in The New York Times titled, “Cancer Center Ads Use Emotion More Than Fact” (

). She reviewed multimedia ads from prestigious cancer centers and found that they “often use superlatives, promote the latest technologies, promise unique care, or recount miraculous patient recoveries.” Not much has changed in the 2 years since that article was published, except that I’m noticing that more and more local and regional cancer providers are doing the same thing in their ads.

	Patient testimonials always get my attention, and as Singer noted, it’s the patients who have been cured or have far outlived their projected life expectancies that appear in these ads. I’ve never seen an ad featuring a person with advanced cancer or one who is visibly affected by the disease. In fact, in the ads I’ve seen, patients are smiling and appear to be vibrant and active, with some even holding tennis rackets or golf clubs. Both the stated and implied message is that cancer treatment at the featured facility will fully restore health and well-being. And sometimes, the treatments do, in fact, result in what many would call, “miraculous outcomes.” However, the ads do not note that these results are atypical, and patients are led to believe that they too will respond this well to treatment. Even weight loss ads include the disclaimer that the results are not typical, yet cancer treatment ads are not required to state this.

	Some of the patient testimonial ads link a new treatment modality with a desirable treatment outcome, such as “freedom from cancer” or “life without cancer.” The problem with these ads is that they are only partly correct; it may be true that no other facility provides the new treatment, but it’s misleading to so visibly link the new treatment with curing the patient.

	Other ads focus on the facility itself and use adjectives such as “the first,” “the best,” and “the only” to describe some facet of the services it offers. Some ads are more specific and claim that the facility has “the highest” or “unsurpassed” cure rates. Because this is advertising, these claims don’t need to be substantiated.

	It’s not surprising that patients are asking about a facility’s cure rate, complication rate, death rate, and so on. However, even these numbers can be misleading. Selection bias can occur and skew the data. For instance, the cure rates are higher for a community oncology practice that only treats patients with early-stage cancers than for a cancer center that is administering investigational agents to patients with metastatic disease. And conversely, outcomes for patients who require complex treatment are better in facilities in which specialized services are routinely provided (eg, cancer centers) than in facilities that rarely provide this type of cancer treatment.

	Choosing an oncology provider is a big decision when a person is diagnosed with cancer. There are many things that influence this decision, including a physician’s recommendation, health insurance stipulations, recommendations from relatives and friends, and, of course, advertising. It’s unclear to what extent advertising influences this decision, but since advertising of cancer care is so prevalent these days, it’s worth examining.

	Take a look at the advertising being done by your practice or facility. Is the information accurate? Is there anything that could be misconstrued by a patient or is potentially misleading? Are claims based on solid evidence and data? If you see something disturbing, take action and make your concerns known. Nurses are patients’ advocates, and patients deserve fair and balanced information about cancer treatment care and outcomes.

Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN, is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA, and the editor-in-chief of

There are many things that influence this decision, including a physician's recommendation, health insurance stipulations, recommendations from relatives and friends, and, of course, advertising.

Truth in Advertising

 Attendance at national nursing conferences has decreased in recent years, and this drop-off has been attributed to the high cost of travel, reduced (or eliminated) budgets for nursing education, and the emergence of alternative ways to update knowledge (eg, online programs). It’s understandable that some nurses are unable to go to nursing conferences, but what about all of the other nurses who can go, but choose to not attend?

	For these nurses, who have the support of their employers, it may be “too hard” to be away from family or work, or it may be “too far” to go to learn something new, or it may simply be “too complicated” to attend a conference. So, why should nurses attend nursing conferences?

	The most compelling reason, in my opinion, is that nursing conferences offer something that is only available at nursing conferences: human interaction. Nothing can take the place of networking with colleagues, participating in a live question-and- answer session following an educational program, or learning about new drugs and products firsthand in the exhibit area. Nursing conferences foster feelings of camaraderie and offer multiple opportunities to interact and connect with other attendees. These interactions may be fleeting or have long-lasting effects; many enduring friendships have sprouted and been renewed at nursing conferences.

	Nursing conferences are also highly rejuvenating. It’s a great feeling to head for home feeling inspired and armed with new information or insight, which can be brought back to the workplace and shared with others. Most conferences have multiple tracks or offer concurrent sessions on different topics; this allows nurses to customize their educational experience and tailor it to their individual needs. Conferences also help identify clinical resources, programs, and people who can be contacted in the future to help solve problems or answer patient care questions.

	The conference forum is also an easy way to earn continuing nursing education contact hours, which are required for state RN licensure renewal. The live educational sessions offer a more interesting and rewarding experience than print or online CE activities.

	As I mentioned earlier, conference exhibit areas can also be a valuable resource. With vendors gathered all in one place, exhibit halls make it easy to learn a lot in a short amount of time. In addition to offering promotional/marketing information about their drugs and products, vendors also offer medical information. This may be one of the most underutilized features of the exhibit hall. I jot down my non-urgent clinical questions throughout the year and ask my questions at the annual conferences that I attend. Further, the medical affairs department of drug and product manufacturers will often disseminate postmarketing information to conference attendees that is not in the package/product insert or otherwise readily available.

	It would be naïve to expect that every nurse can or should attend a conference. After all, some nurses are needed to stay behind and provide patient care while others go to the conference. Those unable to attend should take advantage of technological advances offering “virtual attendance,” that is, viewing archived conference sessions online. Gone are the days of purchasing audiotapes from the conference and hearing a presentation; now, the presentation can be viewed as well as listened to. Viewing an archived presentation is not quite like being there in person, but it is a reasonable alternative.

	Also very helpful are the nursing conference recaps that many websites and publications, including

 to watch the speakers’ interviews and learn additional information that can only be gained by listening to the speakers’ points of view. 

 also covers other conferences, such as those designed for oncologists and hematologists. Online coverage and reporting of these meetings allows nurses like me, who are unable to attend medical conferences in person, to view important new information that is critical to the care of our patients.

	If you have the opportunity to attend a nursing conference, take it. If the opportunity doesn’t arise, seek out other ways to update your knowledge, such as viewing online conference coverage and archived presentations. It’s now easier than ever to attend a nursing conference, and take it from me, you don’t know what you’re missing.

	Lisa Schulmeister, RN, MN, APRN-BC, OCN®, FAAN, is an oncology nursing consultant and adjunct assistant professor of nursing at Louisiana State Health Sciences Center in New Orleans, LA, and the editor-in-chief of OncLive Nursing.

It's understandable that some nurses are unable to go to nursing conferences, but what about all of the other nurses who can go, but choose to not attend?

You Don't Know What You're Missing: Why Nursing Conferences Remain Relevant

Adoption of research findings in clinical practice tends to evolve over time and can be highly variable. Contrary to this traditionally slow pace, the American College of Surgeons Oncology Group’s Z0011 trial has seemingly changed practice overnight.

	The Z0011 study examined the survival impact of axillary lymph node dissection in breast cancer patients with sentinel lymph node metastasis. Axillary lymph node dissection has long been the standard of care for women with breast cancer who have a positive sentinel lymph node biopsy. In the Z0011 trial, women with 1 or 2 positive sentinel lymph node biopsies had the same outcome with or without axillary lymph node dissection. This means that women who are diagnosed with stage T1 or T2 invasive breast cancer no longer need to have their axillary lymph nodes removed.

	The phase III trial followed 891 women who underwent lumpectomy, whole-breast radiation, and sentinel lymph node dissection that confirmed metastasis. Patient accrual took place between 1999 and 2004, and trials were conducted at 115 centers across the United States. Trial enrollment was halted early in 2004 when it was determined that accrual of more women in the study would not alter the survival findings, and final follow-up for data analysis was completed in 2010. The results were presented in June 2010 at the American Society of Clinical Oncology Annual Meeting in Chicago, Illinois, and were published this past February in the 

Journal of the American Medical Association

	Want to share your thoughts on the impact of the Z0011 trial on clinical practice?

	Responses may be published in an upcoming issue.

	The study randomized women to either axillary lymph node dissection (n = 445) or sentinel lymph node dissection alone (n = 446), with adjuvant chemotherapy being administered at the discretion of the treating physician. Patients in the axillary lymph node dissection cohort had a median of 17 lymph nodes removed compared with 2 for women randomized to sentinel lymph node dissection alone.

	The results were nearly identical for the 2 cohorts, with 5-year overall survival rates of 91.8% for the women who had axillary lymph node dissection and 92.5% for the women who had sentinel lymph node dissection alone. Five-year disease-free survival rates also showed no significant difference. Patients were followed for a median of 6.3 years.

"The Z0011 trial appears to be changing breast cancer treatment overnight."

	The researchers noted that forgoing the standard practice of axillary lymph node dissection when sentinel nodes are positive for metastasis constitutes a practice change that could potentially improve the clinical outcomes in thousands of women each year by reducing the complications associated with axillary lymph node dissection. As oncology nurses, we’re familiar with those potential complications—infection, sensory changes, and lymphedema. And even if a complication does not occur, women who have had axillary lymph node dissection need to avoid having their blood pressures taken and IVs started in the arm on the side of the dissection. I would also think that not needing axillary lymph node dissection would allow women to preserve the veins in both of their arms, which may reduce the need for central line catheter or implanted port insertion for chemotherapy.

	If you’ve been in practice for a long time, you probably remember the days of caring for women who had radical mastectomies. Then there was a period of time when modified radical mastectomies became the standard of care, and now, breast-conserving lumpectomies are the standard of care. Axillary lymph node dissection has been around a long time, and it is astounding to learn that it may no longer be needed in women with stage T1 and T2 invasive breast cancer. The National Comprehensive Cancer Network’s updated 2011 Guidelines in Breast Cancer now even reference the results of the Z0011 study in a footnote to an invasive breast cancer treatment algorithm. T he Z0011 trial appears to be changing breast cancer treatment virtually overnight.

Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis. A randomized clinical trial. 

Contrary to the traditionally slow pace of research adoption, the American College of Surgeons Oncology Group's Z0011 trial has seemingly changed practice overnight

New Study Findings Change the Standard of Care for Women With Breast Cancer

March was National Kidney Month. Here are some myths and facts about kidney cancer.

Renal cell carcinoma is the only type of kidney cancer that can occur.

 The most common type of kidney cancer is renal cell carcinoma; however, less common types of kidney cancer include transitional cell carcinoma that affects the ureters but begins in the kidneys, and Wilms’ tumor of the kidney that can occur in children.

People with Von Hippel-Lindau syndrome are at higher risk for developing kidney cancer.

 Von Hippel-Lindau (VHL) syndrome, a rare familial disease caused by an abnormal VHL gene, increases a person’s risk of developing kidney cancer. The gene can also cause cysts or tumors to develop in the eyes, brain, and other body parts. Family members of patients with VHL who have kidney cancer can be tested to determine if they have the abnormal VHL gene, and if they do, can work with their healthcare providers to detect kidney cancer and VHL-related cysts/tumors before symptoms develop.

 Blood in the urine is a sure sign of kidney cancer.

: While blood-colored, rusty, or deep red urine is a symptom of kidney cancer, red-appearing urine may also be a sign of noncancerous disorders, such as a urinary tract infection. Red-tinged urine should never be ignored; it should be promptly evaluated by a healthcare provider. Other signs and symptoms of kidney cancer include persistent fl ank pain, lumps or masses in abdominal tissue, fatigue, fever, and weight loss.

March was National Kidney Month, so here is an opportunity to test your knowledge about kidney cancer.

Myths and Facts About Kidney Cancer

There are a number of organizations that offer information, resources, and support services for people living with kidney cancer. In addition to the general cancer organizations, there are a few organizations that focus specifically on kidney cancer. Following is a list of organizations that may be of assistance to people living with kidney cancer (information is current as of March 14, 2011):

Increases awareness of kidney cancer and raises money to support research on more effective treatment of kidney cancer. The organization was initially established by people with kidney cancer in 2003.

Supports cancer research, education and advocacy. Provides supportive services for people with any type of cancer, such as transportation and medication assistance.  

Provides professional support services at no cost to people affected by any kind of cancer, including kidney cancer. Services are provided by trained oncology social workers and include counseling, education, financial assistance and practical help.

The Wellness Community and Gilda's Club joined forces in 2009 to become the Cancer Support Community (CSC). CSC provides support groups, counseling, education and healthy lifestyle programs for people with any type of cancer.

Funds, promotes and collaborates on kidney cancer research projects, educates healthcare providers and patients about kidney cancer, and advocates at the federal and state level on behalf of patient interests.

1-800-4-CANCER (1-800-422-6237), website: 

Utilizes information specialists to answer questions about any type of cancer and provides educational and resource materials. The NCI website provides comprehensive information on cancer prevention, diagnosis, treatment, statistics, research, clinical trials and news. Live help can be obtained via NCI’s instant messaging service, at 

National Coalition for Cancer Survivorship

Advocates for quality cancer care for all Americans

 and the empowerment of cancer survivors through federal policy initiatives.

https://www.appliedclinicaltrialsonline.com/

https://www.chiefhealthcareexecutive.com/

https://www.managedhealthcareexecutive.com/

Help kidney cancer patients by being aware of available resources and support services

Resources for People Living with Kidney Cancer

	In October 2010, the Institute of Medicine (IOM) released its highly anticipated report, The Future of Nursing: Leading Change, Advancing Health (the complete report is accessible at 

). In a nutshell, it calls for new and expanded roles for nurses in a redesigned, patient-centered healthcare system. The report presents 4 key recommendations. 

	The first recommendation is that nurses practice to the full extent of their education and training. This doesn’t mean that nurses arbitrarily expand their scope of practice; what it means is that nurses should be able to fully use their knowledge and skills. State licensing laws determine a nurse’s scope of practice, and nurses must practice within this scope. Unfortunately, many nurses discover a disconnect between the skillset their education has equipped them with and what they’re authorized to do at their healthcare facility.   

	 Nursing education is the focus of the IOM’s second recommendation. The Institute proposes that nurses achieve higher levels of education and training through an improved education system that promotes seamless academic progression. This is music to the ears of nurses who want to advance their education but have encountered barriers. Nurses have told me that admission criteria varies and often there is little to no recognition of coursework already completed, especially for nurses returning to school several years after earning their nursing degree. 

	According to the IOM, the renewed focus on nursing education should promote a more diverse nursing workforce, particularly in the areas of gender and ethnicity. This last point is one that should be emphasized, since 94% of nurses are women. Unlike with flight attendants and teachers, in which both genders are represented, nursing remains a female-dominated profession. 

	The third IOM recommendation is that nurses should be partners with physicians and other healthcare professionals in redesigning healthcare in the United States. Nursing education programs must integrate leadership development, and leadership development opportunities must be available to nurses practicing at all levels. Nurses also need to take personal responsibility for their own professional growth by developing or strengthening leadership competencies and demonstrating those competencies across all care settings.

	The IOM’s final recommendation is that effective nursing workforce planning and health policy require better data collection and an improved information infrastructure. Workforce data must be collected and analyzed, and made publicly available. Reliable data will enable researchers to accurately predict future nursing workforce needs.

	As its suggestions demonstrate, the IOM recognizes that nurses represent the largest segment of the healthcare workforce and work on the frontline of patient care. Nurses can—and should&mdash;play a fundamental role in the transformation of healthcare. Unfortunately, not everybody agrees. The American College of Physicians (ACP) and American Medical Association (AMA) promptly released responses to the IOM report. Both organizations noted that although many of the recommendations are consistent with their positions, the IOM report also contains some elements that concern them. These include the role of nurses (especially advanced practice nurses) in providing primary care. The ACP asserts that internists are well suited to providing comprehensive care and that patients may be best served by internists or other physicians who work with a team of healthcare providers that may include advanced practice nurses. The ACP notes that advanced practice nursing cannot substitute for nor replace primary care medical practice. The AMA asserted that only physicians can lead healthcare teams because they are more educated than nurses. 

	So the turf war in healthcare continues. Unfortunately, this struggle is destined to focus less on what patients need and more on publicizing contentious disagreements. Thus, the IOM report is another step forward for the nursing profession, but the medical community’s response is a half step backward. Regardless, the patients themselves will ultimately decide who they want their healthcare providers to be. For my part, I’m hoping that they’ll choose well-educated nurses who practice to the full extent of their education and training.

In October 2010, the Institute of Medicine (IOM) released its highly anticipated report, The Future of Nursing: Leading Change, Advancing Health

The Future of Nursing

	The Joint Commission established its National Patient Safety Goals (NPSGs) program in 2002. The first set of safety goals became effective on January 1, 2003, and was designed to identify areas of practice that require increased attention to safety, such as proper use of abbreviations in healthcare, actions to reduce the possibility of wrong site surgery, and safer practices when administering “look alike, sound alike” drugs. Let’s take a look at what’s new in the 2011 NPSGs.

	The Joint Commission has responded to clinicians’ feedback concerning NPSG.08.01.01, which addresses reconciling patients’ medication information. Input from the field suggested that the 2009 version of this goal was too prescriptive and detailed, making it difficult for clinicians to consistently implement. There is now a streamlined and focused version that focuses on critical risk points in the medication reconciliation process. The new version, NPSG.03.06.01, replaces all of Goal 8 [08.01.01, 08.02.01, 08.03.01, and 08.04.01], as well as its related elements of performance. It takes effect July 1, 2011, for the ambulatory, behavioral health care, critical access hospital, home care, hospital, long-term care, and office-based surgery accreditation programs.

	The elements for performance for NPSG.03.06.01 include 1) clinicians make a good faith effort to obtain/update a list of a patient’s medications, including prescribed and nonprescribed medications; 2) organizations define the types of medication information to be collected, which may vary based on the setting (eg, primary care, inpatient care) and patient circumstances (eg, emergency situations, routine admission); 3) clinicians compare newly prescribed medications to those that have already been prescribed for the patient and resolve duplications, discrepancies, and contraindications; 4) organizations provide patients with written information (eg, drug name, dose, route, frequency, purpose) at the end of the episode of care; and 5) organizations explain to patients the importance of managing medication information (eg, instruct patients to carry a list with them and send the list to their primary care and other physicians).

	The updated medication reconciliation goal appears much easier to implement than its predecessor, but it still presents challenges. It will be difficult to ensure that new medications are consistently compared with previous treatments. Although there are several versions of online drug interaction trackers available, entering a patient’s list of medications can be tedious and time consuming.

	Another challenge is ensuring effective mechanisms for obtaining and documenting patients’ medication lists. At some facilities, patients compile the list themselves. Other institutions have medical assistants record patients’ responses to questions about medication use. Regardless of how the lists are compiled, they should be reviewed by a nurse, pharmacist, mid-level provider, or physician.

	For the 2011 NPSGs, The Joint Commission has created easy-to-read documents for each area of accreditation (hospital, ambulatory care, etc). These one-page documents simplify the language of the NPSGs for the general public. For example, the goal for medication reconciliation is described in part as to “find out what medicines each patient is taking and make sure that it is OK for the patient to take any new medicines with their current medicines.”

	The simplified 2011 NPSGs for hospitals are to identify patients correctly, improve staff communication, use medicines safely, prevent infection, check patient medicines, and identify patient safety risks. For ambulatory care, the basic 2011 goals are to identify patients correctly, use medicines safely, prevent infection, and check patient medicines.

	Clinicians should review the revised 2011 NPSGs and determine their organization’s status with respect to implementing the goals, even if the organization is not Joint Commission accredited or pursuing accreditation. The NPSGs for each program and additional information are available on The Joint Commission’s Website at 

A look at what's new in the 2011 National Patient Safety Goals

Lisa Schulmeister MN, RN, FAAN