Nurse Practitioner Ahead Of The Game In Treatment Of MRSA

Nasal carriers of S aureus infection have a high risk for healthcare-associated infection 3 to 6 times that of noncarriers, and more than 80% of healthcare-associated S aureus infections are endogenous. Although intranasal application of mupirocin ointment has been shown to prevent invasive infection in patients receiving dialysis, the results with surgical patients have been controversial. The authors proposed that adding skin cleansing with chlorhexidine gluconate soap would improve outcomes of S aureus infection in hospitalized patients.

The above study was conducted recently and printed January 7, 2010, issue of the New England Journal of Medicine. Ask my patients what I've been doing for the last two years in my office. I learned that regimen from the hospital where I worked as a floor nurse from the surgical group. This is not something that most providers know by now.

The area that I work here in North Florida is a hotbed of MRSA and almost daily I get patients in with complaints of chronic boils and spider bites. I still have to shake my head over the continued misunderstanding of the process of bacterial resistance. This is the main reason that I stress to all of my patients the need to finish an antibiotic and to only take one if it's indicated. Too many want instant results and ask for an additional antibiotic before the first one has had time to take effect.

The regimen that I have used for the last two years is Hibaclens body wash daily x 10 days while on antibiotics and Mupricion ointment to nares twice daily x 7-10 days. Usually the MRSA is reactive to Septra DS or Cipro. In some rare cases, Rifampin or Tetracycline is used for resistant strains. Hand washing is so important and teaching patients to wipe off grocery carts. The first place people often go after discharge from a hospital is to Walmart. We all know that insurance companies are requiring much shorter stays and people are still contagious.

Protect yourself through education and proper use of antibiotics out there!

Change of Shift is Up at Emergiblog

Change of Shift is up at Emergiblog! Get it while it's hot! Here's a link to the page where you can find the current edition and all of the past!

Using Nurse Practitioners To Reduce Emergency Room Waiting TImes

I keep seeing articles regarding the wait times of the Emergency rooms and questions regarding suggestions of solutions for the problem. Nurse practitioners working in the Fast Tracks have sped things up tremendously. Of course, there are things that show up in Fast Tracks that are more critical than they appear, so we don't just see the easy stuff. The idea that Nurse Practitioners should only see colds, diarrhea and sprains irritates the many of us who have the schooling and diagnostic skills to do emergent care. Nurse practitioners are specializing in emergent and critical ICU care, as well as those of us who work in primary care offices. Just ask Diary of A New Emergency Room NP.

The main reason for emergency room waits is the sheer volume of patients who come in for non-emergent care. If people would go to their primary care providers for things that aren't emergencies, then the wait times would go down. Too often people go in for cold symptoms and are not in distress. The wait times are not all that bad considering that we live in a country with a great health care system. Why are we turning into such a "gimme gimme, fix it now!" society? If you lived in a third world country, you may have to wait camped outside for days and may never get to see a medical provider at all. I would never consider going to the emergency room unless I thought it were a truly emergent issue. Some nurses, like Kim from Emergiblog, have got to be saints for putting on their smiles and not actually making a patient's cold symptoms into respiratory distress by putting a pillow over their heads! Just kidding!! I can't imagine working like a dog trying save a child's life after a car accident and then having to go into a room where someone has back pain that is chronic for years and just wants pain meds and a note off of work for Monday.
Kudos those nurses who can work in that scenario daily without losing their ever loving minds.

Some of the problems reside around the fact that a lot of patients have no insurance. They are not sure where to go so the ED is the first place they head to. I work for a rural office that does a sliding fee payment schedule and often the local ED sends patients to me for follow up. I make sure that my patients understand that I am on call for my patients 24 hours and that they need to call the office triage nurse (who will call me) BEFORE they go their local emergency rooms for problems. We also do same day scheduling. This makes it easier for patients to come in when they are sick and not have to wait until they are so far gone that the ED is their only option for relief. I explain to patients with no insurance that I can save them thousands of dollars.

Before most people get into the screaming game of patients who don't have insurance can't afford 90.00 to 160.00 for an initial visit, lets start looking at the ones who show up COVERED in gold jewelery and talking on cellphones. If the patient has to choose between paying the cost of a test or the cost of the office visit, I tell them to pay the test fee first. We can always work out a payment plan. Most offices who just carry insurance have some kind of system for patients who can't afford things and as long as they don't get abused, will keep them in place.

So, when you get cranky having to wait for several hours in an emergency room when you only have a non-emergent issue, remember that the doctors, nurses, and nurse practitioners are trying to save lives and it may be someone you love in there one day taking up all their time.