| Jason Farley, PhD '08, MPH '03, ARNP, is a man on a mission. This Johns Hopkins University School of Nursing assistant professor is working to identify, seek out and destroy drug-resistant infections in hospitals and in the community. And Farley believes this goal is best accomplished by translating sound nursing science into evidence-based nursing education and practice. In an overview of the epidemiology, presentation, and treatment of drug-resistant infections in the Journal of the American Academy of Nurse Practi-tioners, he notes that the spread of methicillin-resistant staphylococcus aureus (MRSA) has evolved from a hospital problem into a community and public health concern about which clinicians-including nurse practitioners-need to be increasingly cognizant. Gleaned from a review of 40 years of research, he highlights current thinking about MRSA risk factors, the skin and soft tissue infections hallmark of community-acquired MRSA, and current best practices in diagnosis and treatment, providing a unique roadmap to understand, recognize and potentially prevent MRSA transmission. With prevention on his mind, Farley and colleagues from The Johns Hopkins Hospital and School of Medicine assessed the effectiveness of two rapid MRSA screening tools among newly arrested men in correctional facilities. Their findings in the Journal of Clinical Microbiology suggest more research is needed on currently available rapid molecular assays to determine if they are sufficiently sensitive for use as screening tools for infection control decision making and clinical treatment. Farley highlights the importance of effective quick assays in a just-released study of MRSA colonization among newly arrested men in Baltimore City. The data, reported in the American Journal of Infection Control, found a nearly 16% MRSA rate, significantly higher than earlier estimates of community-based MRSA.
-Teddi Fine
On average, one medication error occurs each day for each patient hospitalized in the U.S. That translates to 1.5 million preventable negative drug effects each year. These errors most often occur at the point of drug administration-the last line of defense-with responsibility falling squarely on nurses and the patients in their care. That is why Johns Hopkins University School of Nursing researchers Jo M. Walrath, PhD, RN, and Linda E. Rose PhD, RN recommend ways in which nurses can better work with patients to strengthen their partnership to halt medication errors. In a descriptive, exploratory study published in the Journal of Nursing Care Quality, Walrath and Rose found that acute care patients vary widely in their understanding of and involvement in assuring the safety of their medication regimen. Nurses are well-versed in administering medications using the five "rights" (right drug, right patient, right dose, right route, and right time). By taking this process one step further-verbalizing the five "rights" to the patient during drug administration-nurses can raise patients' awareness of and encourage their ongoing engagement in the process. Walrath says "As nurses, we need to really hear and act on our patients' concerns about their medication regimens and continuously encourage them to full participation." Rose adds, "We cannot afford either to disregard what our patients are saying about their medications or to adopt a 'one size fits all' strategy." By adopting the strategies outlined in their article, Walrath and Rose posit that nurses are uniquely positioned as the safety net to catch medication errors before they become potential patient tragedies. -TF  Adoption of research-proven best practices in health care is slow and far from universal. Despite advances in knowl-edge and practice, little more than half of all patients are receiving recommended general medical care. Nowhere is the need for adoption of best practices in care more urgent than in the intensive care unit (ICU) where the difference between best practice and the current practice in many settings can be lethal.
According to Johns Hopkins University School of Nursing faculty member Cheryl R. Dennison, PhD, RN, ANP, and a team of critical care physicians and researchers, a known-effective, lung-protecting ventilation technique-low tidal volume ventilation (LTVV)-is far from the norm in ICUs treating patients with critical lung injuries. As part of the Improving Care of Acute Lung Injury Patients study, the team assessed patient- and ICU-related factors that might contribute to the use of LTVV among over 200 lung-injured patients on ventilators. Reporting in Critical Care Medicine (May 2008), Dennison and colleagues found that only half of patients received LTVV, even though it has been advocated as a best practice for over seven years. One ICU-related factor-the presence of a protocol for LTVV use-was most strongly associated with the actual implementation of this lung-saving best practice for acutely ill ventilated patients in the ICU. Dennison cautions, "The existence of protocols and guidelines helps, but it doesn't guarantee that patients will receive evidence-based interventions. For that to occur, we need to effect system- and provider-level change at the basic teaching and practice levels and include all members of the treatment team." -TF Emergency room nurses can help save lives by being on the lookout for signs of attempted strangulation among women victims of intimate partner violence (IPV). Based on an analysis of medical examiner, police, and emergency room records spanning 11 cities over a six-year period, attempted strangulation was found to increase sevenfold the risk of becoming a subsequent homicide victim. In the October 2008 issue of the Journal of Emergency Medicine, faculty members Jacquelyn C. Campbell, PhD, RN, FAAN; Nancy Glass, PhD, MPH, RN; and Phyllis W. Sharps, PhD, RN, FAAN; and other researchers report that women victims of completed or attempted intimate partner homicide were far more likely than other abused women to have a history of strangulation. In fact, prior non-fatal strangulation was reported in 45 percent of attempted homicides and 43 percent of homicides of IPV victims. "Strangulation has only recently been identified as one of the most lethal forms of domestic violence," says Glass, co-author and Johns Hopkins University School of Nursing associate professor. "When abusive partners use strangulation to silence their victims, their actions exert a form of power and control that can have serious physical and psychological effects on victims with a potentially fatal outcome." In addition to suggesting further research on this high-risk group of abused women, the authors recommend improved ER nurse and physician capacity to recognize and treat the soft tissue injuries associated with attempted strangulation. Glass cautions, "This serious, potentially lethal, offense needs to be accurately and fully documented for possible future court action. Further, as nurses, it's our responsibility to help safeguard the future health of these vulnerable women, as well as to recognize and treat their current injuries and trauma."
-TF
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