Confidentiality issues with ED domestic violence research

Confidentiality issues with ED domestic violence research

JOURNAL OF EMERGENCYNURSING Reply T h a n k you for your letter. I a p p r e c i a t e your concern a n d agree "consideration" or "possible cont r a...

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JOURNAL OF EMERGENCYNURSING

Reply T h a n k you for your letter. I a p p r e c i a t e your concern a n d agree "consideration" or "possible cont r a i n d i c a t i o n " could b e u s e d in this context. Your c o n c e r n t h a t this s t u d y w a s d o n e u s i n g large doses a n d laboratory a n i m a l s m a y be valid b u t m o s t initial r e s e a r c h projects u s e this model. A d v a n c e d Cardiac Life Support g u i d e l i n e s do r e c o m m e n d lidocaine as the first a n t i a r r h y t h m i c to u s e in t h e t r e a t m e n t of v e n t r i c u l a r t a c h y c a r d i a a n d ventricular fibrillation, b u t t h e s e g u i d e l i n e s a s s u m e t h e p r a c t i t i o n e r will take into c o n s i d e r a t i o n all inform a t i o n available. If a p a t i e n t w i t h a k n o w n c o c a i n e overdose e x p e r i e n c e s ventricular t a c h y c a r d i a or v e n tricular fibrillation, t h e p r a c t i t i o n e r m a y choose to modify his or her approach, or it m a y explain a failure of this d r u g to b e effective. If w e are a w a r e of a possible p r o b l e m w e c a n e v a l u a t e the r i s k / b e n e f i t i n e a c h

case.--Linda D. Jackson, RN, CEN, Galveston, Indiana Latex vial stoppers--A growing concern

Dear Editor. I h a v e read the informative articles on latex allergy in your April issue, a n d in other sources, with great interest. A l t h o u g h I no longer work in emerg e n c y n u r s i n g , the p r o b l e m of latex s e n s i t i v i t y has crossed over to m y specialty field of diabetes. Two r e f e r e n c e s in the journal Diabetes Care 1,2 d i s c u s s t h e problems p e r s o n s w h o are t r e a t e d w i t h i n s u l i n m a y have, b e c a u s e latex is p r e s e n t in m o s t s y r i n g e p l u n g e r s a n d vial stoppers. I d e c i d e d to i n v e s t i g a t e the latex c o n t e n t of t h e n e e d l e - f l e e i n s u l i n delivery s y s t e m t h a t m y comp a n y m a n u f a c t u r e s , t h e A c t i v a A d v a n t a J e t (HealthMor P e r s o n a l Care Corp.). I f o u n d t h a t t h e r e w a s no latex in t h e product, b u t t h e n I t u r n e d m y a t t e n t i o n to vial stoppers. To d r a w i n s u l i n into t h e device, a small, latex-flee, plastic a d a p t e r is i n s e r t e d into t h e vial a n d left i n place. This a d a p t e r t h e n a t t a c h e s to t h e jet i n j e c t o r for l o a d i n g the m e d i c a t i o n . B e c a u s e t h e r e is n o n e e d l e to "core" bits of latex, I w o u l d a s s u m e less latex w o u l d b e carried to t h e user. I tried to c h e c k t h e c o n t e n t of t h e vial s t o p p e r for t h e saline s o l u t i o n w e u s e for t r a i n i n g p u r p o s e s . T h e c o m p a n y w a s helpful a n d s e n t m e t h e r e q u e s t e d data but I was unsettled by the information. Basically, t h e r e are four f o r m u l a t i o n s of vial stoppers: t h r e e w i t h 0% n a t u r a l rubber, b u t o n e w i t h 18.9%. The m a n u f a c t u r e r could n o t tell m e w h i c h s t o p p e r m a t e r i a l w a s u s e d w i t h w h i c h p a r t i c u l a r vial, so I h a d no w a y of d e t e r m i n i n g t h e s t o p p e r c o n t e n t of the p a r t i c u l a r vial I w a s u s i n g . I h a d two c o n c e r n s :

First, t h e r e s e e m e d to b e no e a s y m e t h o d of determ i n i n g or r e q u e s t i n g t h e n o n q a t e x - c o n t a i n i n g vials. S e c o n d , if t h e y c a n b e m a d e totally latex flee, w h y a r e n ' t all of t h e m latex flee? W h y c o n t i n u e to s e n s i tize people n e e d l e s s l y ? Recently a c u s t o m e r called to learn more a b o u t our injector. Her doctor t h o u g h t she m i g h t b e allergic to t h e insulin, so s h e w a s trying different t y p e s / b r a n d s / p r e s e r v a t i v e s . After q u e s t i o n i n g , t h e c u s t o m er m e n t i o n e d t h a t she w a s k n o w n to have a latex sensitivity, b u t n o one h a d ever m e n t i o n e d t h a t it could c a u s e a p r o b l e m with her i n s u l i n a d m i n i s t r a t i o n . Obviously, this p r o b l e m is affecting, a n d will cont i n u e to affect, all s e g m e n t s of health care a n d n u r s ing. History should h a v e t a u g h t us t h a t i g n o r a n c e is n o t bliss, a n d t h a t it is b e t t e r to b e proactive t h a n reactive. W h a t e v e r your specialty or role, you n e e d to e d u c a t e a n y o n e you c a n a b o u t latex s e n s i t i v i t y a n d t h e critical a t t e n t i o n it deserves.--Jaye Sengewald,

RN, MSN, CDE, Morris, Illinois References 1. Towse A, O'Brien M, Twarog F, Braimon J, Moses A. Local reaction secondary to insulin injection. Diabetes Care 1995;18:1195-7. 2. MacCracken J, Stenger P, Jackson T. Latex allergy in diabetic patients. Diabetes Care 1996;19:184.

Confidentiality issues with ED domestic violence research

Dear Editor: We are p r e s e n t l y in the p r o c e s s of a t t e m p t i n g to s c r e e n w o m e n 14 years a n d older for e v i d e n c e of d o m e s t i c violence. Our p r e s e n t format is i n a d e q u a t e , possibly b e c a u s e confidentiality a n d a n o n y m i t y are issues. We w o u l d like to initiate this p r o c e s s d u r i n g triage, yet m a i n t a i n confidentiality a n d provide ass i s t a n c e if n e e d e d . It w o u l d b e a p p r e c i a t e d if w e could hear from your readers h o w this is performed at other institutions, a n d w h a t format t h e y find to b e efficient.--Martina Petersen, RN, BSN, CEN,

Westchester Medical Center, Valhalla, N Y 10595; E-mail: [email protected] corn Memories of an emergency nurse who attempted to "get away from it all"

Dear Editor: We left P h o e n i x on S a t u r d a y to "get a w a y from it all" b y h i k i n g the G r a n d C a n y o n . My paralegal co-hikers left b e h i n d their work at the c o u n t y a t t o r n e y ' s office a n d I left the h u s t l e a n d b u s t l e of a b u s y E D / t r a u m a n u r s i n g p o s i t i o n b a c k in Phoenix.

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