News Director: Maureen Shawn Kennedy, MA, RN E-mail: [email protected] No Place Like Home—For Fatal Medication Errors A steep rise in deaths points to a need for intervention. eaths caused by mixing elderly patients in clinical settings. coauthor. She notes that antide- prescription medications These results suggest that “more pressants or painkillers like Dwith alcohol or street research should be devoted to codeine can cause major prob- drugs—especially in patients’ middle-aged patients and domes- lems when taken with alcohol. homes—have increased dramati- tic settings,” write the authors. These results show that nurses cally over the past 22 years, Over the 22 years of the must more closely evaluate pa- according to findings from the study, services have shifted from tients’ ability to manage medica- first large-scale U.S. study of inpatient to outpatient care, tions, screen them more often out-of-hospital medication use. many drugs once administered in for alcohol and drug abuse, and Researchers at the University hospitals are taken at home, and educate them more thoroughly. of California, San Diego, exam- more drugs once given only by Nurses “are in a good position ined nearly 50 million death cer- prescription are available over to give patients clear directions tificates filed between 1983 and the counter. All of these factors about drug use,” Barker says, 2004, focusing on those citing can make it easier for people to “and point out the dangers of medication error as the cause of mix medications with alcohol or combining drugs or drinking death. Fatal medication errors street drugs—which many peo- alcohol with drugs.”—Carol overall rose 361% from 1983 to ple don’t know “can be a serious Potera 2004 and were classified into mistake,” says epidemiologist Phillips DP, et al. Arch Intern Med 2008; four categories: Gwendolyn E. C. Barker, a study 168(14):1561-6. • type 1: at home, involving alcohol or street drugs or both (rose a staggering 3,196%) • type 2: at home, not involving alcohol or street drugs (rose 564%) 8 Arab countries formed a nurses’ union at a July nursing conference in Amman, • type 3: not at home, involving Jordan, reported the Kuwait News Agency. Ten Arab countries were represented at alcohol or street drugs or both the conference. Mohammed Hatamlah, the dean of the Jordanian nurses’ union, (rose 555%) noted that Arab nurses of both sexes think nursing has enjoyed less progress in Arab • type 4: not at home, not countries than other disciplines have. The new Arab Union of Nurses will confront involving alcohol or street the profession’s problems in order to advance and regulate nursing in their countries. drugs (rose only 5%) By way of comparison, in the 8 New HIV and AIDS recommendations are available from the World Health same period deaths from alcohol Organization, which launched a guide, Priority Interventions: HIV/AIDS Prevention, or street drug use alone—not Treatment, and Care in the Health Sector, at the 15th International AIDS Conference combined with medication in Mexico City in August. Continual updates to the guide will reflect the latest recom- error—rose 41%, deaths from mendations. The authors intend the guide to help countries provide universal access to medication adverse effects rose HIV prevention and services by 2010. To print out a copy of the guide, go to 33%, and deaths from surgical www.who.int/hiv/pub/guidelines/2008priorityinterventions/en/index.html. error rose 43%. Increases in fatal medication errors were found in 8 Nurses’ bill of rights endorsed at AIDS conference. Recognizing that many nurses, all age groups except children especially those in developing countries, are at high risk for HIV, the Association of ages nine and younger. Adults 40 Nurses in AIDS Care and Physicians for Human Rights issued a joint call to action to 59 years old showed the great- at the 15th International AIDS Conference in August. Calling upon world leaders to est increase, whereas those older provide for the health needs of nurses and other health care workers and to enact than 60 showed the smallest. policies and programs to ensure the health and safety of nurses in the workplace, the Before this study, most research statement is available at http://actnow-phr.org/campaign/nurses_health_rights. on medication errors focused on [email protected] AJN M November 2008 M Vol. 108, No. 11 19 For HIV-Positive Mothers: To Breastfeed or Not to Breastfeed? New research supports it where other risks are higher. hould HIV-positive mothers of infants born to 3,016 breast- reducing vertical transmission of living in underdeveloped feeding HIV-positive women in HIV, say the two studies under- Scountries choose optimal Malawi who were treated pro- score the belief that the odds nutrition for their infants by phylactically with antiretroviral favor breastfeeding for HIV- breastfeeding? Or should they risk drugs: the control group received positive mothers who otherwise malnutrition to minimize HIV a single dose of nevirapine plus would have no choice but to put transmission? Two recent studies zidovudine for the standard one- their infants at risk for malnutri- offer renewed support for breast- week treatment period, and the tion or infection from contami- feeding in “low-resource” areas. other two groups received the nated water or bottles. In one study, Kumwenda and control regimen for the standard “Here, in the first six months colleagues examined three groups week and further antiretroviral of life, the 4% to 5% transmis- therapy for 14 weeks, one sion rate associated with HIV group with nevirapine and the isn’t that high compared with other with nevirapine and zidovu- the 8% to 9% of children dying dine. After nine months, the two of diarrhea and pneumonia, irre- groups on the extended regimen spective of HIV,” says Bland. had significantly lower rates of But in countries where infant postnatal HIV-1 infection (5.2% mortality rates are low, the bal- and 6.4% in the single- and dual- ance would favor avoidance of prophylaxis groups, respectively) breastfeeding. than the control group (10.6%). Denese Gomes, an NP at In the second study, Kuhn the Infectious Disease Clinic and colleagues recruited 958 at Virginia Commonwealth HIV-positive mothers in Zambia University Medical Center in to determine whether the recom- Richmond, puts these findings mended practice of early wean- into context when discussing ing helps reduce postnatal HIV mothers in developed countries. transmission. One group (n = In the United States, she says, 481) was encouraged to wean “even if an HIV-positive woman their infants abruptly at four has an undetectable viral load at months; 69% stopped within the time of delivery, we don’t five months, most within two advocate breastfeeding. We have days of beginning weaning. The every resource in this country to other group (n = 477) was provide adequate and safe nutri- encouraged to breastfeed as long tion, so the risks of getting HIV l l e as they wanted; the median far outweigh the danger” of r r a F duration was 16 months. No malnutrition or other infection. s i n e significant differences in HIV- Ultimately, says Bland, “there D / free survival at 24 months were is no blanket policy for every- s s e r P found between the two groups one.” Clinicians tailoring recom- d e t (68% and 64%, respectively), mendations must take into a i c o suggesting no benefit in early account the potential for drug s s A weaning. resistance in both mother and Zelda Dlamini feeds her two-month-old baby Banele a bottle These results support efforts infant, their access to medical of formula at their home in Soweto, South Africa, on March 8. to develop guidelines for this care, and social norms.—Sibyl New U.S. funded studies indicate that the risk of a baby con- tracting HIV through breast milk is lower than the health risks of region. Marie-Louise Newell and Shalo, BSN, RN being denied its nutritional and protective benefits, particularly Ruth Bland at the Africa Centre in poor countries where mothers don’t have sure access to for Health and Population Kumwenda NI, et al. N Engl J Med 2008; clean water with which to prepare formula. 359(2):119-29; Kuhn L, et al., for the Zambia Studies in Somkhele, South Exclusive Breastfeeding Study. N Engl J Med Africa, whose work focuses on 2008;359(2):130-41. 20 AJN M November 2008 M Vol. 108, No. 11 http://www.nursingcenter.com Eye Contact and Autism Study links reduced eye contact with social disability in autistic children. uring the first few months of life, infants focus on Dthe faces of their care- givers, learning the cues of social interaction through eye contact. But children with autism tend to focus less on the eyes, suggesting that they learn a different means of socialization early on. t s In a study conducted by the o P m Yale Child Study Center in New i T , Haven, Connecticut, researchers o i d a attempted to determine whether R c i l the amount of eye contact made b u by children with autism was dif- P a t o s ferent from that of other children e n n and whether that measurement i M could be used to predict levels of / s s e social disability. Among 66 two- r P d e year-olds studied, 15 had autism t a i c or autism spectrum disorder, 36 o s s were normally functioning, and A 15 had developmental delays Caitlyn Wheeler, right, takes part in an exercise intended to help kids with Asperger’s syndrome that did not include autism.