Josie’s Story Terms and Storyline – Flashcards
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What is a skin graft?
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A surgical operation in which a piece of healthy skin is transplanted to a new site on the body.
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What is an EKG and what does it monitor?
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An electrocardiograph, it monitors heart rhythm, heart rate, and respiratory rate.
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What was the clip on Josie's finger and what was it for?
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A Pulsox Monitor, pulse oximeter monitor, it registers the level of oxygen saturation.
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Patients with burns become what?
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Hypermetabolic - their heart has to work extremely hard to pump blood and get oxygen, which is crucial in nourishing the body.
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When not enough oxygen is delivered to the body, what happens?
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The body takes longer to heal.
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What happens when the pulse oximeter monitor goes off?
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It detects a low oxygen saturation, signaling the nurse to give the patient supplemental oxygen, done by putting an oxygen mask up to the patients airway.
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Who is Monica?
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The patient-service coordinator.
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What does the Hopkins PICU stand for?
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Pediatrics Intensive Care Unit
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What is a shift change?
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The nurse who was about to leave would update the new nurse, debriefing her on each body system including cardiac, respiratory, and digestive.
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What was the phrase used to say Josie was clear of all infections?
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"Her blood cultures are all no-growth to date"
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When was Johns Hopkins opened?
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In 1889
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When was the Johns Hopkins University School of Medicine opened?
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In 1893
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What were some of the medical innovations Johns Hopkins quickly became known for?
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CPR, the use of rubber gloves during operations
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Johns Hopkins was the first...
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... teaching hospital in the country to establish the modern concept of a residency program that formally integrated teaching, research, and supervision by the school of medicine faculty
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Academic medical centers like Hopkins, as well as Yale, Duke, the Cleveland Clinic, and the Mayo Clinic operate as..
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.. systems in which care is delivered in a SILO- LIKE in form; individual specialty teams function separately from one another.
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What are some of the specialties?
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Surgical team, a pain management team, a respiratory team
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What is a limitation of the silo - like form?
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The fact that they operate somewhat independently can often lead to a breakdown in the flow of communication.
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What is the hierarchy of the silos
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Chief, attending physicians, fellows, residents, medical students
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What are some of the subspecialties the fellow is being trained in?
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Pediatrics, emergency medicine, cardiology
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Which part of the hierarchy is where the real hands on learning occurs and when most people quit?
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In the residency
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Who is the base of the hierarchy of the pyramid and are often short staffed?
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Nurses
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Who were the attending and fellows in the book and made up Josie's team?
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Dr. Charles Paidas, Dr. Amal Murarka, Dr. Milissa McKee
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What were the key traits Dr. Paidas possessed?
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Brilliance, the ability to make major split-second decisions, razor-sharp vision, and the steadiest of hands
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What book did Dr. Paidas remind Margaret of?
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Correlli's Mandolin
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What is Bacitracin?
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An ointment that keeps the skin from getting dry and guards against infection.
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Who is Jerome?
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The 13 year old mentally disabled boy who was Josie's roommate.
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What is wrong with hospital floors?
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There are germs everywhere and if they get into a patient it can be deadly. Hospital acquired infections kill tens of thousands of patients per year.
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What is morphine?
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A powerful narcotic that suppresses brain activity and decreases the patients level of consciousness which in turn decreases the level of pain.
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What happens when too much morphine is delivered?
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The brain checks out and the signals from the brain that tells the lungs to keep working doesn't get sent, causing the patient to suffocate.
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What is methadone?
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Similar to morphine but much weaker
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What is Narcan?
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A drug that is used for drug overdoses, primarily morphine or methadone, it competes with the brain receptors that accepts the methadone.
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What is the problem with Narcan?
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It has a very short half-life and can wear off in minutes, thus allowing the methadone to creep back into the brain receptors.
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Who is Brenda?
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A traveling nurse who can to Hopkins through an agency.
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What is cardiac arrest?
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A sudden, unexpected loss of heart function, breathing, and consciousness
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What happened to Josie after her cardiac arrest?
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She became brain dead. Her organs are beginning to shut down, her liver is no longer functioning, a matter of time before her heart shuts down.
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What does the body release in the face of crippling fear, pain or grief?
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Endorphins
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What is the first stage of the grieving process?
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Shock
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What does PR stand for?
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Public Relations
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What is a sentinel event?
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An event in which there has been an unexpected outcome resulting in death or serious injury.
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What did Josie die from?
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Severe dehydration and a methadone overdose
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What did the nurse say was her reason for adding in the methadone.
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When a person has been on methadone, the weaning must be carefully planned and monitored to avoid serious complications of withdrawal such as diarrhea and an upset stomach. These symptoms can lead to more serious complications such as convulsions and neurological damage.
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What is one the leading causes of deaths in our country?
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Medical errors
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What is To Err Is Human?
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A 2000 report by the Institute of Medicine
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What did To Err Is Human find out?
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Between 44,000 and 98,000 people a year die from medical errors, the equivalent of a jumbo jet crashing every day.
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What is The Joint Commission and what did they report?
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The nations premier health care safety and quality accreditation organization, it reported that over 70 percent of all sentinel events occur because of a break down in communication.
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Who is Dr. Peter Pronovost?
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An anesthesiologist whose father had died from medical errors.
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What is CUSP?
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The Comprehensive Unit- Based Program
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What is patient safety about?
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Communication
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What is the first step of CUSP?
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It was a six step program. The first step was to measure the hospital culture. Peter did this by using a patient safety culture survey at the unit level, asking questions such as: Is teamwork on your unit effective? Is staffing an issue? Does management address your patient safety concerns? A survey
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What is the second step of CUSP?
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Educate the caregivers on why safety is so important
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What is the third step of CUSP?
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Identify issues. How will the next patient be harmed?
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What is the fourth step of CUSP?
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Take those issues, prioritize them, and then use interdisciplinary teams to form projects to resolve them. Once those issues were resolved they became stories.
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What is the fifth step of CUSP?
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Share the stories - the lessons learned and the process changes that were made to improve safety and quality with other units and other hospitals.
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What is the sixth step of CUSP?
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Resurvey the unit
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What is The Josie King Pediatric Patient Safety Program?
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The two CUSP programs were implemented on the floors where Josie had been cared for.
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What are grand rounds?
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Held in most academic hospitals, typically hour-long sessions where information is shared, new procedures are taught, and new technology introduced. They are conducted by doctors, nurses, or executives and are meant to be educational and informative for the hospital staff.
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What is IHI?
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The Institute for Healthcare Improvement, an organization that works to improve quality and safety within out health care system. Cofounded in 1991 by Dr. Donald Berwick a pediatrician.
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What are the two greatest fears in life?
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Death and public speaking
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What is NPSF?
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National Patient Safety Foundation
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What is AHRQ?
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Agency for Healthcare Research And Quality
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What would the Patient Safety Group offer?
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A Web based project management tool that supported Peters CUSP program, called eCUSP.
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How long should one wait to make any life changes after the loss of a child?
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After the first year.
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Who is Jessica Sentillan?
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A 17 year old girl who died from medical errors at Duke University Medical Center
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What was Jessica Sentillans story?
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She had enlarged and weakened heart and lungs that were not functioning properly. She underwent a heart-lung transplant surgery but Jessica was a blood type O but the heart/lungs she received were type A
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What is the Swiss cheese effect?
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There are many holes, potential places for errors to get through. When all the holes line up, the errors get through the system and the patient dies
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What is Care for the caregiver?
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A research project to look for ways to help doctors and nurses who had been involved in a medical error to cope.
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What huge contributions has the Cleveland Clinic made to the world of medicine?
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Identifying carpel tunnel syndrome, developing the kidney dialysis machine, linking high blood pressure to heart disease, and greatly refining heart bypass surgery.
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What is the Cleveland Clinic known for?
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Fourteen years in a row, it was rated as the best heart hospital in the country.
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What is a nosocomial infection?
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An infection acquired in the hospital
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What is the MHA?
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The Michigan Health and Hospital Association, a group consisting of all the hospitals in the state of Michigan. A group consisting of all the hospitals in the state of Michigan.
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What did the MHA establish?
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A goal to eliminate medical errors in all of the ICU's, intensive care units, in the state. 127 teams formed a coalition, a 2 year program to be called the Keystone ICU project
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What were the results of the Keystone ICU project?
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1,578 lives had been saved, patients spent 81,020 fewer days in the hospital, and hospitals saved over 165 million dollars
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What was the rule in effect in NY at the time of Justin's death?
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Pecuniary loss rule: if a child dies of medical errors no award, or a severely limited award, would be granted, the reason was a child is of a lesser economic value.
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What was the reason the University of Michigan Health system found out to be the reasons why some patients sued after being affected by medical errors?
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People tended to sue when they had unanswered questions and felt that they were not being told the truth
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What are acute myocardial infarctions?
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Heart attacks
