patient in Texas showing Ebola signs, in isolation

[PainRack]

Broomstick, information entered on EMR can be checked to see whether entries had been changed post entry, which helps to check against fraud.

Another pertinent factor is that if it had been entered into an EMR, any other person would had been able to easily read and note the triage nurse entry about travel history to Liberia, which spreads the blame further. ALTERNATIVELY of course, the travel history section might be something along the lines of "have you been to a foreign country recently? Y/N" and then someone didn't enter details to elaborate further, which make this a mistake.


LASTLY, EMR makes it much easier to create a system to prevent further such lapses, by making the travel history portion have a command prompt for Ebola or MERs-COV history....


Its much more fucking effective than an additional paper advisory asking staff/patients to identify if they had been overseas to Liberia in the last 3 weeks...

[Patroklos]

NPR reported that Liberia is threatening to prosecute him based on my lying on his travel questionnaire when leaving the airport there. Reports are he was knowingly interacting with very sick family members.

That brings up some interesting questions. Should patients who can directly and provably infected by another who did so through some sort of fraud to circumvent known quarantine procedures be able to pursue compensation? If you were this guy and knew you had acute exposure to Ebola would you do the same to ensure care in a modern Western facility vice a tent in the woods of Liberia?

[Knife]

Does anyone know if this hospital uses electronic medical records or if they are still doing everything on paper?

The ED's I know are still paper while the hospitals at large are EMR

[Tsyroc]

Does anyone know if this hospital uses electronic medical records or if they are still doing everything on paper?

The ED's I know are still paper while the hospitals at large are EMR

A more recent article I read stated that there was a glitch in the electronic record where the nurse entered the information and in the electronic record the physician viewed. Probably has something to do with the setup of the main screen for physicians. Supposedly the issue has been fixed now.

I am curious which system they are using.

[Grumman]

NPR reported that Liberia is threatening to prosecute him based on my lying on his travel questionnaire when leaving the airport there. Reports are he was knowingly interacting with very sick family members.

That brings up some interesting questions. Should patients who can directly and provably infected by another who did so through some sort of fraud to circumvent known quarantine procedures be able to pursue compensation? If you were this guy and knew you had acute exposure to Ebola would you do the same to ensure care in a modern Western facility vice a tent in the woods of Liberia?

He's a self-centered asshole. The situation in Liberia wouldn't be as bad as it is if people like him stopped acting like quarantine no longer applies once it's someone in your monkeyspace who got infected. It's an example of the prisoner's dilemma: everyone respecting the quarantine has a much higher chance of keeping your family alive than everyone acting like quarantine is for other people, because the former means your family is much less likely to get infected in the first place.

[Broomstick]

"Monkeyspace"?

Anyhow - yes, if he lied while exiting Liberia, breaking that nation's laws and endangering other people, he should be prosecuted. If he survives.

We need to make being a selfish asshole expensive and complying with public health and quarantine as painless and cheap as possible.

[PKRudeBoy]

I would guess he meant monkeysphere, which is another term for Dunbar's number, which essentially is the people you form close social relationships with.

[Grumman]

I would guess he meant monkeysphere, which is another term for Dunbar's number, which essentially is the people you form close social relationships with.

Yes, that's the word I was thinking of. Thanks.

[Tsyroc]

I found a couple of articles stating that the hospital uses the computer system Epic and has been fully electronic for at least a few years if not longer. They were claiming that they were the first hospital in the country to be fully electronic, which could be around a decade give or take a few years.

I was really curious about the system because nationwide most hospitals use one of two systems. The hospital I work at uses Epic and was one of the early adopters. We essentially helped build their pharmacy/order entry part of the program. We've been fully electronic for many years now and the physicians have been entering their orders directly into the computer for years now.


As a pharmacy technician I don't use the system all that much anymore so I'm that familiar with some of the features. I asked around a bit and the thought was that the reason the physician didn't see what the triage nurse put into the system in regards to the patient's travel is because the physician would have had to read through all of the nurse's notes to catch it.

The hospital is reporting that they fixed this "bug" in the system which probably means they changed a setting so a patient's travel details are more prominently displayed on the physician's side of things.

[PainRack]

A more recent article I read stated that there was a glitch in the electronic record where the nurse entered the information and in the electronic record the physician viewed. Probably has something to do with the setup of the main screen for physicians. Supposedly the issue has been fixed now.

I am curious which system they are using.

Glitch my ass.

What this means is that they didn't have an intergrated worksheet but rather, have seperated nurse and physician entries. It's still common practice in ED but the reasons why inpatient wards have moved away from this is because Drs don't read the nursing entry.

Now, docs still don't read the entries but they can browse through it when they noticed something funny, like what did anybody do when Patient A spiked a fever .

True event:d I had a physician enter orders for 5 days asking for caregiver training for a stroke patient, not noticing my subsequent entry that caregiver training was done and nurse led assessment that they were effective, to arrange for demonstration of showering...

But then again, every other nurse ignored my entry and one joker even had the nerve to ask me if I was correct. I snapped back at her to go fucking ask the patient(10 day shifts are the bomb)

[dragon]

patient dies

Thomas Eric Duncan, a man with Ebola who traveled to the United States from Liberia, died Wednesday morning at Texas Health Presbyterian Hospital in Dallas, the hospital said.

He had been in critical condition after being diagnosed with the virus in mid-September. People who have had contact with the Liberian national are being monitored for symptoms.

Some members of Duncan's family have been isolated and are being monitored -- their temperatures taken twice daily -- to make sure they are not symptomatic. The U.S. Centers for Disease Control and Prevention said that as of Tuesday, they had not shown any symptoms.

Several who have had contact with him were moved to a secure location Friday.
Did Duncan know he had Ebola?
U.S. to check travelers for fevers

After word of the death, CNN correspondent Gary Tuchman went to a Dallas apartment where Duncan's family members were previously and spoke with the adult daughter of Duncan's partner.

The daughter, Youngor Jallah, is not considered to have come into contact with Duncan. She was crying and declined to speak, though she did say the family had received a call from the hospital and knew that Duncan had died.

It has just been a little over a week since Duncan began receiving treatment for the virus. Those days have been an "enormous test of our health system," said Dr. David Lakey, the commissioner of the Texas Department of State Health Services.

"For one family it has been far more personal," he said in a statement. "Today they lost a dear member of their family. They have our sincere condolences, and we are keeping them in our thoughts."

He vowed that health care workers will continue to try to stop the spread of the virus "and protect people from this threat."

The Ebola virus can live in dead bodies, the CDC says, and it can be transmitted after death if the body is cut, body fluids are splashed, or if the body is handled. Only personnel trained in handling infected human remains, wearing protective gear, should touch or move Ebola-infected remains, the agency says. An autopsy should be avoided, it says, but if one is necessary, the CDC should be consulted.

Airport screenings

News of the death of the first Ebola patient diagnosed in the U.S. comes as a federal official told CNN that airports in the United States will begin taking the temperatures of arriving passengers who have flight itineraries originating from West African countries where Ebola is concentrated.

The screenings will begin this weekend or next week, according to the source, who has direct knowledge of the screenings.

Among the countries considered to be in the so-called Ebola zone are Guinea, Sierra Leone, Liberia and Nigeria.

The new measures at U.S. airports come a day after Dr. Thomas Frieden, the director of the CDC, told reporters that devising travel guidelines was in the works but nothing had yet been finalized enough to announce.

Can you catch Ebola on a plane?

The Ebola virus can spread through contact with bodily fluids -- blood, sweat, feces, vomit, semen and saliva -- and only by someone who is showing symptoms, according to the CDC.

People with Ebola may not be symptomatic for up to 21 days.

Symptoms generally occur abruptly eight to 10 days after infection, though that period can range from two to 21 days, health officials say.

Air travelers must keep in mind that Ebola is not transmitted through the air, said Dr. Marty Cetron, director of the CDC's Division of Global Migration and Quarantine.

"There needs to be direct contact frequently with body fluids or blood," he stressed.

Cases in Europe

Meanwhile, Frederic Vincent, a spokesman for the European Commission, told CNN on Wednesday that there have been eight confirmed cases of Ebola in European countries. There is one case in the United Kingdom that has been treated and the person has recovered; one case in France like that; two cases in Germany in which patients are receiving treatment; and three cases in Spain: two deceased Spanish missionaries and a nurse's assistant who is being treated.

There is also a case in which a Norwegian staffer with Doctors Without Borders is being treated, he said.

Also in Spain, health officials said four more potential Ebola cases -- in addition to the nurse's assistant -- are under observation.

The nurse's assistant said that she had no idea how she had contracted the virus, but a doctor treating her said that she may have been exposed while she removed her protective suit.

Dr. German Ramirez said the assistant, who is in isolation at Madrid's Carlos III Hospital, had told him it was possible that a part of the suit -- possibly the gloves -- touched her face.

Cases in West Africa

The globe's largest outbreak of Ebola has killed more than 3,400 people in Guinea, Liberia and Sierra Leone. Since March, more than 7,400 people have contracted Ebola in those nations, according to the World Health Organization.

The CDC is tracking the latest cases in the region.

NBC News freelance cameraman Ashoka Mukpo was diagnosed with Ebola in Liberia on Thursday. He left Liberia on a specially equipped plane Sunday and was headed to Nebraska, the network reported.

Frieden said Tuesday that battling the virus will be a "long, hard fight."

"The virus is spreading so fast," he said, "that it's hard to keep up."

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[Broomstick]

I was sorry to hear that, I was hoping Mr. Duncan would pull through, yesterday they were reporting some positive signs but, alas, this is a nasty disease.

Jesse Jackson, Sr. has taken advantage of Mr. Duncan's illness and death to get his face on national news again. Said there had been an attempt to criminalize Duncan.

Is it evil of me to wonder when the lawsuit against the hospital will be filed?

[Chardok]

I don't think so. When I'd first heard this guy had been infected and was in the U.S. I thought "If this guy dies and no one else (who came to america does), there's going to be a firestorm of people saying "oh, so the BLACK guys dies and all the WHITE people live somehow?! CUNSPEARACY!"

[Mange]

I just heard that a British national has died from Ebola in Macedonia.

EDIT:

(Reuters) - A British man showing symptoms of the Ebola virus died in Macedonia on Thursday and authorities said they had sealed off a hotel where he stayed, keeping another Briton and hotel staff inside.

Reuters

[Irbis]

That Spanish nurse case is worrying - if someone with full knowledge of disease and protective gear got infected, something went really wrong or virus had found new way of attacking.

[Broomstick]

Or, bring human, she made a mistake.

Honestly, that is the most likely explanation - she made a mistake, probably in removing her hazmat gear. Self-contamination from carelessness when removing protective gear does happen, and is the most likely reason for this sort of thing.

[Irbis]

That is what I meant by something going wrong.

Though, I still can't imagine how you can be careless when you're explicitly told you will catch Ebola if you do relatively simple task wrong. And that was a nurse attached to a single case, what would have happened in bigger, more exchausting outbreak?

[Mange]

That Spanish nurse case is worrying - if someone with full knowledge of disease and protective gear got infected, something went really wrong or virus had found new way of attacking.

I read in a Swedish paper that the nurse reported touching her face with her glove after she had changed the patient's adult diaper and cared for him.

[Ace Pace]

Though, I still can't imagine how you can be careless when you're explicitly told you will catch Ebola if you do relatively simple task wrong.

This single sentence is the root cause of large amounts of misunderstandings. Complex systems, such as healthcare procedures, are built around minimizing mistakes due to "carelessness". Checklists, oral procedures and so forth. Healthcare professionals for example fuck up all the time, in part due to the lack of formalized procedures.

In any complex system, people will make multiple mistakes. A resilient system will protect against accidents, but even so people will still fuck up in complex and novel fashions.

If you want to contain scary problems like Ebola, asumming hospitals will be perfect will not help you.

[Broomstick]

Though, I still can't imagine how you can be careless when you're explicitly told you will catch Ebola if you do relatively simple task wrong.

Exhaustion and stress would be top reasons. Hazmat gear is not pleasent to wear from the start and only grow more uncomfortable with time. Sweat and moisture builds up, it's hard to shed heat.

And that was a nurse attached to a single case, what would have happened in bigger, more exchausting outbreak?

Well, something like 800-900 medical people have caught Ebola in the three affected African nations and around 400 have died... so there's your answer. Those people certainly do know the risks, they see people suffer and die every day, yet they, too make mistakes.

Granted, most didn't have as good of protective gear as people in Europe or the US, but the fact is in a real epidemic you do lose doctors, nurses, and other medical people.

[Irbis]

Exhaustion and stress would be top reasons. Hazmat gear is not pleasent to wear from the start and only grow more uncomfortable with time. Sweat and moisture builds up, it's hard to shed heat.

But the thing is, she only wore half of it, specifically to counteract that. With Ebola, you don't need airborne pathogen protection, after all.

Well, something like 800-900 medical people have caught Ebola in the three affected African nations and around 400 have died... so there's your answer. Those people certainly do know the risks, they see people suffer and die every day, yet they, too make mistakes.

Well, yes, but there is difference between two nurses for 50 Ebola patients and a dozen nurses in modern hospital plus fresh strictly one use gear for one patient. That's why it's worrying.

[Broomstick]

Exhaustion and stress would be top reasons. Hazmat gear is not pleasent to wear from the start and only grow more uncomfortable with time. Sweat and moisture builds up, it's hard to shed heat.

But the thing is, she only wore half of it, specifically to counteract that. With Ebola, you don't need airborne pathogen protection, after all.

How much experience do you have with protective gear?

My experience is for chemical hazards, and low-level ones at that, but double-gloving up to the elbow, goggles, protective aprons, and the rest, even if you don't need airborne protection, isn't fun and you sweat profusely at normal room temperatures. You can't drop the temps much because you have a seriously ill person in the room.

Full gear, even leaving air rigs aside, isn't comfortable. Sure, you do your best to make it fit as well as possible but there's no getting around it's more fatiguing than normal clothing.

Well, something like 800-900 medical people have caught Ebola in the three affected African nations and around 400 have died... so there's your answer. Those people certainly do know the risks, they see people suffer and die every day, yet they, too make mistakes.

Well, yes, but there is difference between two nurses for 50 Ebola patients and a dozen nurses in modern hospital plus fresh strictly one use gear for one patient. That's why it's worrying.

Laboratory workers have a long history of becoming ill or dead due to a momentary lapse. It's going to happen because medical personnel are human and sooner or later one of them slips up. Obviously, most of them don't, and you do whatever you can to minimize the chances of such events, but eventually it happens.

[Napoleon the Clown]

That is what I meant by something going wrong.

Though, I still can't imagine how you can be careless when you're explicitly told you will catch Ebola if you do relatively simple task wrong. And that was a nurse attached to a single case, what would have happened in bigger, more exchausting outbreak?

See, there's a lot of people who get careless about things even when they know the consequences. Nurses work exhausting hours under the best of conditions, so I can see how a mistake would be made.

[dragon]

nurse that treated patient tests positive

A health care worker in Dallas is the first person to become infected with the Ebola virus within the US. Reuters is among many outlets reporting that a nurse who treated an Ebola patient has now tested positive for the virus. That patient, Thomas Eric Duncan, contracted the virus in Liberia, but he travelled to the US while still asymptomatic. He was treated by the Texas Health Presbyterian Hospital before dying last week.

The newly diagnosed patient was one of the nurses involved in his treatment. According to the BBC, the nurse wore standard protective gear during the treatment: gown, gloves, respiratory mask, and face shield. Nevertheless, the individual began experiencing a low-grade fever and checked into the same hospital where he or she works; the patient has been kept in isolation since. Authorities are currently preventing anyone from entering the individual's apartment pending a decontamination.

Preliminary testing in Dallas indicates an Ebola infection; confirmatory tests from the Centers for Disease Control are pending.

At a news conference, Dan Varga of Texas Health Resource said that it wasn't clear what had gone wrong with the preventative measures to allow this individual to become infected. Health authorities are currently analyzing the care given to Duncan in an attempt to understand what might have happened.

Healthcare authorities continued to stress that the chances of infection are extremely low for anyone who has not had direct contact with an Ebola patient

.

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