According to the US Department of Labor Essay Example for Free

According to the US Department of Labor Essay

Antibiotics Before Cultures in Septic Suspected Patients

Antibiotics Before Cultures in Septic Suspected Patients No More Waiting Antibiotics Before Cultures in Septic Suspected Patients Shannin Pierce Introduction Identifying the Issue September, 21 2013 was an abnormally busy day at Northeast Clark Hospital. At 6:45 AM, 63 year old Mr. Davis Jones, present to the emergency department with a fever of 102.6, heart rate of 110 beats per minute, and a respiratory rate of 22. His blood pressure is 91/63. He is weak and lethargic. His wife tells staff that during the past week he has been sleeping more than usual and not eating or drinking much. She suspects he has come down with the flu that has been going around. Mr. Jones is sent to a room and asked to put on a gown and informed that the doctor will be right in to see him. At 7:00, the night shift nurse reports off the dayshift nurse of all of her patients, but fails to inform the dayshift nurse that Mr. Jones has yet to have cultures collected. At 7:15, the dayshift nurse checks on Mr. Jones who is comfortably sleeping in the hospital bed with his wife by his side. Vital have not changed since admission. She continues to the next patient. At 7:30 AM she rechecks on Mr. Jones and realizes that he has yet to have cultures drawn and collects the supplies. Cultures are collected at 7:45 AM and sent to the lab. At 8:00 lab results show WBC 16,000. The nurse reports the findings immediately to the attending physician, who orders intravenous (IV) antibiotics and fluids. Pharmacy sends up the antibiotics at 8:30 AM and the nurse begins infusion at 8:45 AM. At 9:00 AM, Mr. Joness blood pressure drops to 58/42, heart rate soars to 160 beats per minute, and he is unconscious and unresponsive. The staff frantically rushes to infuse IV fluid into Mr. Jones but he goes into cardiac arrest. All resuscitation attempts are made, but at 9:45, Mr. Jones is pronounced dead. Sepsis and bloodstream infections have become a major cause of hospitalization and death in the United States. In these situations it is a standard protocol to collect blood cultures before administration of antibiotic, however, this can often delay the treatment needed to reduce the chance of death of patients with septicemia. With new advances in culture collection technology, blood culture collection containers now contain antimicrobial removal media, which makes it no longer necessary to delay treatment of antibiotics in order to wait for untreated blood specimens to be collected. By using the antimicrobial removal media enriched blood collection containers for all patients with suspected sepsis, antibiotic treatment can be initiated faster, hospital stays will be shorter, cost of care will be decreased, and fewer people will die due to septicemia. Analysis of the Current Situation Currently, standard protocol for septic suspected patients is for blood cultures to be collected from two different ventipuncture sites before the initiation of any antibiotic therapy using aseptic technique. It is also recommended that antibiotic therapy be initiated within one hour of onset of septicemia. According to a research study by Anand Kumar (2006), every hour of delay in antimicrobial therapy result in an increase in mortality of 7.6%. While the majority of hospital facilities strive to achieve the goal of cultures and antimicrobial therapy within the one hour time frame, the reality is that very few are actually successful. It is estimated that only about 12% of patients actually receive the antimicrobial therapy within the first hour (Daniels, 2011). To make matters worse, emergency departments struggle with overcrowding. According to hospitalstats.org, the median emergency department wait time in the Clark County Valley is 3 hours 25 minutes (Hospital Stats, 2014). Identifying the signs and symptoms of sepsis is a huge barrier to providing timely treatment. Another huge problem with the standard protocol for cultures before antibiotic therapy is that 50% to 82% of patients presenting to the emergency or intensive care facilities with suspected septicemia have already been given an antibiotic before admission and culture collection (Zadroga et al., 2013). However, with the initiation of facilities using antimicrobial removal resin blood culture containers, such as BACTEC PLUS, many of the barriers to providing timely care to septic suspected patients can be overcome. BACTEC PLUS has been proven to recover 95.1% of bacterial pathogens in blood culture samples with therapeutic levels of antimicrobial agents present, and 100% of strains in control bottles (Flayhart, Borek, Wakefield, Dick, Carroll, 2007). Leading Change It is estimated that 20,000 people die worldwide every day from sepsis (Daniels, 2011). While the use of blood culture analysis is and always will be one of the most important evidence-based microbial testing procedures for determining diagnosis of septicemia, the need to wait for cultures to be drawn before administering life saving antimicrobial therapy is unnecessary. Patients with suspected septicemia need to be receiving antimicrobial therapy within the one hour time frame, whether or not cultures have been drawn. It needs to become standard protocol that the antimicrobial therapy be initiated in that one hour time frame, and move away from the standard being cultures first. To initiate this change, it is proposed that implementation of antimicrobial therapy be initiated immediately in septic suspected patients. The Process of Change Change will being in the emergency department. All medical staff, including physicians, nurses, LPNs, CNAs, and technicians will be informed of the change to take place by having multiple conferences and training sessions over a period of time, no less than four weeks, with a minimum of three different time slots occurring near shift change to accommodate all shifts for all employees to be able to attend. All attending staff will sign an agreement contract, including the understanding of the new policy to be implemented. Once they have been fully informed and have had the opportunity to express all misunderstanding and concerns with the new policy, implementation of the policy in the department will ensue. The emergency department will be fully stocked with BACTEC blood collection containers. Quality control agents will monitor compliance of the policy to record all valid data associated, including time frames of initiation of the antimicrobial agent and blood culture analysis using the antimicrobial removal media. Most importantly, infection control will assess the outcome of patients with confirmed septicemia and will closely evaluate the new treatment plan to verify if the policy is proving to be helpful in improving the outcome of patient survival rates. Impact of Change If outcomes are positive, the facility can being to implement the policy, following the same steps already stated, to more departments and continue to evaluate the effectiveness of the policy on each department until the entire facility is using the policy. In order to initiate the change it will take a team effort. All staff will need to comply in ensuring that all septic patients are receiving the antimicrobial therapy within the one hour time frame, regardless if cultures have been drawn first or not. This will be imperative for analysis as to if the new policy is effective in reducing the mortality rate of septic patients. Conclusion Sepsis infections are going to continue to be a major cause of hospitalization, but with new protocols including ensuring administration of antibiotics in septic suspected patients within the one hour time frame of onset regardless if cultures have been collected first, we can reduce the chance of death for these patients. As medical staff, we need to use the advances in culture collection containers like BACTEC to initiate faster treatment, which will make hospital stays shorter, decrease cost of care, and most importantly, save more lives. References Daniels, R. (2011). Surviving the first hours in sepsis: getting the basics right an intensivist’s perspective. Journal of Antimicrobial Chemotherapy, 66(2), ii11-ii23. Retrieved from http://jac.oxfordjournals.org/content/66/suppl_2/ii11.full#ref-36 Flayhart, D., Borek, A., Wakefield, T., Dick, J., Carroll, K. (2007). Comparison of BACTEC PLUS blood culture media to BacT/Alert FA blood culture media for detection of bacterial pathogens in samples containing therapeutic levels of antibiotics. Journal of Clinical Micrbiology, 45(3), 816-821. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829095/?report=reader Hospital Stats (2014). ER wait times in Clark County hospitals. hospitalstats.org. Retrieved from http://www.hospitalstats.org/ER-Wait-Time/Clark-County-NV.htm Kumar, A., Roberts, D., Wood, K., Light, B., Parrillo, J., Sharma, S. (2006, June). Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine, 34(6), 1589-1596. Retrieved from http://cel.webofknowledge.com/InboundService.do?product=CELSID=2DqQrrN9uYLqpUXhgpgUT=000237884300001SrcApp=Highwireaction=retrieveInit=YesSrcAuth=HighwirecustomersID=HighwireFunc=FrameIsProductCode=Yesmode=FullRecord Uzodimma, C., Njokanma, F., Ojo, O., Falase, M., Ojo, T. (2013, ). Bacterial isolates from blood cultures of children with suspected sepsis in an urban hospital in Lagos: a prospective study using BACTEC blood culture system. The Internet Journal of Pediatrics and Neonatology, 16(1). Retrieved from http://ispub.com/IJPN/16/1/1623 Zadroga, R., Williams, D., Gottschall, R., Hanson, K., Norberg, V., Deike, M., Hansen, G. (2013). Comparison of 2 blood culture media shows significant differences in bacterial recovery for patients on antimicrobial therapy. Oxford Journals Clinical Infectious Diseases, 56(6), 790-797. Retrieved from http://cid.oxfordjournals.org/content/56/6/790.full

Inclusion :: essays research papers

Educational Psychology Inclusion What a society feels about it’s diverse membership, particularly about citizens who are different, is expressed in the institutions of that society. A close look at the major institutions of our society the schools, the legislatures, and the courts should tell us a lot about the place of exceptional children in our society. In the category of exceptional children one would find a list of any and every child that requires education in academic matters as well as life skills. These children must work at things that average society takes for granted. Out of this group of exceptional children has risen a disability that is drawing more and more attention known as Down Syndrome. The obvious reason for Down Syndrome children to come to the forefront is their parents. By this I mean that studies have shown that a couple with two or more college degrees among them are more likely to have a Downs baby then that of a couple of high school drop outs. This odd occurrence has lead to more affluent families to give birth to one or more Downs babies. The limitations facing a Downs child will affect the child’s whole life and it is the environmental circumstances around him that determine how he fares in life. Included in these circumstances are his family and their unity and maybe most importantly his level of education. In our society education plays a big part in all we do and this serves no difference for the Downs child. As we look back in time, we find that the notion of educating every child to achieve his or her greatest potential is a relatively new concept. The current use of the term exceptional is itself a reflection of the radical changes in societies views of people whom differ from the norm. The world has come along way from the Spartans’ practice of killing infants who did not meet their standards of normalcy, but the journey has been slow, moving from neglect and mistreatment, to pity and overprotection and finally to acceptance and integration to the fullest extent possible. The phrase "Acceptance and integration into society to the fullest extent possible† has been the topic of the most heated arguments in education today. The term integration has grown to include such devices as inclusion and mainstreaming. Although the U.S. has come a long way from the 1850’s when 60 percent of people living in poor houses would today have been classified as exceptional.

THE WOMENS REVOLUTION :: essays research papers

From the American Revolution to the Civil War there were several developments that molded the lives of American women. There were cults formed that supported domesticity. The women of the south, both black and white were very similar to those of the north. The women had gotten roles that they had never faced before. When the men left for war the women took control of many things including, the farms, the businesses, etc. Just because men went to war that did not mean that the women did not go as well. In many cases the women joined their male relation in the Patriot camps. With many tasks to be completed while the men were gone women were just trying to become free and have rights of their own. Whether they were successful or not was something that they did not want to think about.   Ã‚  Ã‚  Ã‚  Ã‚  The lives of women were being completely controlled by the men all around them. The women were tired of it and just wanted this to end. The social roles between both the men and women were changing. They still had the typical rights in both politics and within the family. In 1837 women were now accepted into colleges and universities. The first schools that allowed this to begin were Oberlin which was located in Ohio; and Mt. Holyoke which was located in Massachusetts. Mt Holyoke was an all women school, where as Oberlin was both men and women. Around this time changes took place in the middle-class families. The normal role of the woman of the house was to contribute economically, but now they were to strictly stay home and take on a number of domestic activities. This meant they were to keep the house looking perfect, clean, relaxing, etc. Women that worked outside of their homes were looked at as low-class. They worked in factories and mills, but had much more horrible circumstances.   Ã‚  Ã‚  Ã‚  Ã‚  The women of the south had taken on roles that were very like the roles that the middle-class women of the north possessed. They too were at home wives. They served as their husband’s attendant and looked after the children. Along with being similar to the north, they were also very different. The women had significant importance to the men; the men played a defense role for the women. Many white women in the south lived on a farm and had little or no contact with the â€Å"public world†.

How to become a successful business person Essay

1. Have knowledge about business Choose a business school Master business fundamentals Accumulate knowledge through real business activities 2. Develop our interpersonal skills Explanation: Interpersonal skills help us to interact well with people. Furthermore, we need these skills to manage our employees and negotiate deals or contracts effectively. As a result, we will become a successful manager. 3. Have passion on doing business Explanation: It is an essential element with all of people who do business because it motivates us to achieve the success. 4. Seek guidance of a mentor Explain: Build relationship with a successful businessperson who has the same career because he or she can give us useful advices about business. Especially, if the person is a member of our family, he or she can give us business strategies. Therefore, you will have more opportunities to become a successful businessperson. Conclusion: It is hard to become a successful businessperson. However, we should try our best to achieve what we want. Paragraph To become a successful businessperson is not easy, but there are some of basic methods to help us to achieve it. Firstly, we have to have knowledge about business through enrolling in a business school. Furthermore, we must master the business fundamentals from the school and accumulate knowledge through real business activities. Secondly, one of the most important methods is to develop interpersonal skills. As we know, Interpersonal skills help us to interact well with people. Moreover, we need these skills to manage our employees and negotiate deals or contracts effectively. As a result, we will become a successful manager. Third method is to have passion  on doing business. It is an essential element with all people who do business because it motivates us to achieve the success. Generally, without passion, nothing can be achieved. Finally, we should seek guidance of a mentor. We can build relationship with a successful businessperson who has the same career because he or she can give us useful advices about business. Especially, if the person is a member of our family, he or she can give us business strategies. Therefore, you will have more opportunities to become a successful businessperson. To summarize, it is hard to become a successful businessperson. However, we should try our best to achieve what we want.

Philosophy Vocabulary Essay

Individual:? single separate.? ? Existentialism:? a? philosophical? theory? or? approach? that? emphasizes? the? existence? of? the? individual? person? as? a? free? and? responsible? agent? determining? their? own? development? through? acts? of? the? will.? ? Consequentialism:? the? doctrine? that? the? morality? of? an? action? is? to? be? judged? solely? by? its? consequences.? ? Nihilism:? the? rejection? of? all? religious? and? moral? principles,? often? in? the? belief? that? life? is? meaningless.? ? Absurdity:? the? quality? or? state? of? being? ridiculous? or? wildly? unreasonable.? ? Hedonism:? the? pursuit? of? pleasure sensual? self? indulgence.? ? Objectivism:? the? belief? that? certain? things,? especially? moral? truths,? exist? independently? of? human? knowledge? or? perception? of? them.? ? Individualism:? the? habit? or? principle? of? being? independent? and? self? reliant.? ? Determinism:? the? doctrine? that? all? events,? including? human? action,? are? ultimately? determined? by? causes? external? to? the? will.? Some? philosophers? have? taken? determinism? to? imply? that? individual? human? beings? have? no? free? will? and? cannot? be? held? morally? responsible? for? their? actions.? ? Society:? the? aggregate? of? people? living? together? in? a? more? or? less? ordered? community.? ? Oppression:? prolonged? cruel? or? unjust? treatment? or? control.? ? Altruism:? the? belief? in? or? practice? of? disinterested? and? selfless? concern? for? the? well? being? of? others.? ? Utilitarianism:? the? doctrine? that? actions? are? right? if? they? are? useful? or? for? the? benefit? of? a? majority.? ? Biopower:? is? a? term? coined? by? French? scholar,? historian,? and? social? theorist? Michel? Foucault.? It? relates? to? the? practice? of? modern? nation? states? and? their? regulation? of? their? subjects? through? â€Å"an? explosion? of? numerous? and? diverse? techniques? for? achieving? the? subjugations? of? bodies? and? the? control? of? populations†.? ? Totalitarianism:? state? is? a? concept? used? by? some? political? scientists? in? which? the? state? holds? total? authority? over? the? society? and? seeks? to? control? all? aspects? of? public? and? private? life? wherever? possible.? ? Reciprocity:? the? practice? of? exchanging? things? with? others? for? mutual? benefit,? especially? privileges? granted? by? one? country?or? organization? to? another.? ? Socialism:? a? political? and? economic? theory? of? social? organization? that? advocates? that? the? means? of? production,? distribution,? and? exchange? should? be? owned? or? regulated? by? the? community? as? a? whole.? ? Communism:? a? political? theory? derived? from? Karl? Marx,? advocating? class? war? and? leading? to? a? society? in? which? all? property? is? publicly? owned? and? each? person? works? and? is? paid? according? to? their? abilities? and? needs.? ? Capitalism:? an? economic? and? political? system? in? which? a? country’s? trade? and? industry? are? controlled? by? private? owners? for? profit,? rather? than? by? the? state? ? Neoliberalism:? the? resurgence? of? ideas? associated? with? laissez? faire? economic? liberalism? beginning? in? the? 1970s? and? 1980s,? whose? advocates? support? extensive? economic? liberalization,? free? trade,? and? reductions? in? government? spending? in? order? to? enhance? the? role? of? the? private? sector? in? the? economy.? ? Neoconservatism:? relating? to? or? denoting? a? return? to? a? modified? form? of? a? traditional? viewpoint,? in? particular? a? political? ideology? characterized?  by? an? emphasis? on? free? market? capitalism? and? an? interventionist? foreign? policy.? ? Anthropocentrism:? the? belief? that? human? beings? are? the? central? or? most? significant? species? on? the? planet,? or? the? assessment? of? reality? through? an? exclusively? human? perspective.? ? Utopianism:? an? imagined? place? or? state? of? things? in? which? everything? is? perfect.? The? word? was? first? used? in? the? book? Utopia? (1516)? by? Sir? Thomas? More.? ? Deontology:? the? study? of? the? nature? of? duty? and? obligation.? Ontology:? the? branch? of? metaphysics? dealing?with? the? nature? of? being.? ? Epistemology:? the? theory? of? knowledge,? especially? with? regard? to? its? methods,? validity,? and? scope.? Epistemology? is? the? investigation? of? what? distinguishes? justified? belief? from? opinion.? View as multi-pages TOPICS IN THIS DOCUMENT Epistemology, Philosophy, Truth, Capitalism, Karl Marx, Classical liberalism, Communism, Political philosophy RELATED DOCUMENTS A Closer Look on the Effects of Reading to the Vocabulary Range of Readers and Non-Readers †¦ words. These words are called vocabulary words. Reading helps people improve their word range. Readers tend to search for the meaning of an unfamiliar word which improves their vocabulary. Readers are also able to widen their vocabulary when they use context clues. Readers have different vocabulary range. Most of the people have the impression that a bookworm have a wide range of vocabulary. But, in reality, not all†¦ 580   Words | 7   Pages READ FULL DOCUMENT Powerful Ways of Widening Vocabulary †¦ TS: I have learned four simple ways on which we can expand our vocabulary. I. Exercise wide independent reading. A. Through books B. Through magazines C. Through newspapers II. Keep tools for learning vocabularies handy. A. Such as pocket dictionaries B. Such as thesauruses C. Such as vocabulary notebooks III. Create a deep interest in word consciousness and awareness. A. By engaging in word play B. By†¦ 580   Words | 4   Pages READ FULL DOCUMENT Difficulties in Teaching Vocabulary †¦ language vocabulary. Two further distinctions in vocabulary are required to complete our model. We need to distinguish between a common core vocabulary known to all the members of a language community and specialized vocabularies, known only to special groups. We are of course primarily interested in the common core vocabulary.

Arts & academic Essay

First of all, I have the diligence, determination, and aptitude to take on an Arts degree and make the most out of it. In such a large university, the ability to interact with peers and mentors both on academic and social levels is of also prime importance for survival. I am fortunately blessed with exceptional communication and interpersonal skills that allow me to be able to interact well in diverse groups. I can speak out my mind politely and explain my thoughts clearly and comfortably to make my peers and mentors understand my ideas accurately. However, the quality in me that I believe above all else would make me a success in a university Arts program is my strong vision of what I intend to be in life. This vision of mine has guided me throughout my education, keeping me in track with what I want out of life. My vision gives me an exact sense of personality, and through it I derive meaning and originality. I know what I want and I know that I have what it takes to make it happen, and that will eventually make me a success in your Arts program.