Nurse of the Week: At 83, Mercy Kallal is Still a “Nurse’s Nurse”

Nurse of the Week: At 83, Mercy Kallal is Still a “Nurse’s Nurse”

In the Covid era, we often hear (and can’t help but understand) that older nurses, resources exhausted by their pandemic ordeal, are retiring early.  Nurse of the Week Mercedes “Mercy” Kallal, RN, however, has been a nurse for over half a century now and at 83 years old she just isn’t ready to hand in her stethoscope. She tried once, about a dozen years ago, but even after working the Covid-19 frontlines—in her 80s, mind—there’s no evidence that Kallal might be running out of steam.

By now, it’s hard to imagine the post-anesthesia care unit (PACU) at New Jersey’s Jefferson Washington Township without the diminutive RN (Mercy is barely five feet tall). Fortunately, Kallal finds her work so meaningful that she’s in no hurry to hang a “Gone Fishing” sign on her door. “As long as I am mentally and physically able, I would love to dedicate my remaining life to taking care of patients … and help[ing] people,” she told the Philadelphia Inquirer.  The Daisy Award winning RN seems to thrive on helping staff as well as patients; she’s the first person they call when someone needs a holiday or evening off, and the hospital even lauds her willingness to “help… younger co-workers balance life and work.” Jefferson Washington VP of Operations Autum Shingler-Nace happily describes Mercy as “A nurse’s nurse.”.

“What the heck is this? I was supposed to become a nun.”

This does not mean that Kallal is an ascetic lady-with-a-lamp who lives only for her patients. She has been a widow for years, but always has plenty to do. When off duty, she loves to travel, hit some casinos, and watch horse races. To wind down, she works in her garden.

Nonetheless, nursing truly is the life calling of this small gambler. In fact, Mercy’s husband entered her life as one of her patients.

Mercedes Mercy Kallal RN.After Arthur Kallan was discharged from the hospital, the feisty little nurse who had cared for him loomed large in his mind. Initially, when her former patient began to call and said that he missed her, Mercy was nonplussed, to say the least. The devout Roman Catholic recalled, “I thought, ‘What the heck is this? I’m supposed to become a nun.’ But we started dating.” In fact, the match worked out so well that she acquired her fondness for horse races from her patient-turned-spouse.

Kallal’s nursing career began in the Philippines, where she graduated from nursing school, and ventured to the United States in 1969. When she and a few fellow grads landed in Philadelphia, the newly arrived nurse says, “They put me in charge of 32 patients, and when I asked why, they said it was because I had a big mouth… I didn’t know the idiomatic expression, so I took it literally.”

After that, the nurse gravitated to Newark. Apparently, her mouth was not quite the right size yet for New Jersey (there is a checkpoint when one enters the state), so before long Mercy returned to Philly and picked up a range of nursing experience, including a VA hospital, a nun-managed nursing home, and finally, the heart transplant unit at Temple University, where she settled for two and a half decades.

“We keep thinking she’ll slow down a bit, but she keeps picking up more shifts.”

As she completed her 25th year at Temple, though, Mercy decided that she had had enough and DID retire… for a bit less than a year.

It was a delight to indulge in nearly 11 months of travel, but her savings began to dwindle, and now in her 50s, she still had an overabundance of energy and nursing beckoned to her once more. Widowed and living alone with no immediate family in the US, she took stock and thought it was time to work again “before I become a pauper,” and besides, “I live[d] by myself now. How much can you clean?”

By this point in her life, Kallal’s mouth must have been just the right size for NJ and the hospital now operating as Jefferson Washington Township was a mere 5-minute drive from her home (another reason she’s everyone’s go-to when someone needs to be covered). Into her 70s by then, Mercy began by taking things slowly and worked part-time, but that didn’t last for long. As a PACU co-worker told the Inquirer, “We keep thinking she’ll slow down a bit, but she keeps picking up more shifts.”

Patients, Mercy is not here for your careless risks

Since then, in addition to becoming known for her willingness to cover shifts whenever possible, Kallal is the unofficial PACU Health Martinet. She does not hold back when patients are disruptive, abusive, or take dangerous risks, and co-workers have been known to shamelessly throw particularly difficult charges on their Mercy. Her view: “I’m very strict and I explain to the patient that this is the way it has to be. You have to listen to your nurse.” But she adds, “And before they leave, they give me a hug and a kiss.” The kind-but-firm Philippine-born RN also meets any misguided obstinacy over masking or vaccination head-on—or something like that: ”I tried to explain getting vaccinated to one patient and she just looked at me like I had two heads. But at least I did my job as a nurse.”

To read the full story—and see more pithy Mercy quotes—click here.

ENA Presents Lantern Award to 29 Emergency Depts

ENA Presents Lantern Award to 29 Emergency Depts

On Wednesday, the Emergency Nurses Association announced that 29 emergency departments are being honored with the prestigious ENA Lantern Award – the only award dedicated to showcasing EDs for their outstanding work.

“These emergency departments are doing so many remarkable improvements and initiatives and they deserve to be honored for their work,” said ENA President Jenn Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC. “I look forward to meeting some of these emergency nurses in Denver and celebrating them for their incredible achievement.”

Emergency Nurses Association Lantern Award.The ENA Lantern Award was created to recognize emergency departments that demonstrate exceptional and innovative performance in leadership, practice, education, advocacy, and research. When applying, emergency departments share stories that highlight their commitment to care, and the initiatives put in place that improve the well-being of nursing staff. Applications are reviewed and recipients are selected by the ENA Lantern Award Committee.

There are many noteworthy accomplishments from this year’s honorees including improved collaboration between nurses and physicians; developing new flow areas in response to the COVID-19 pandemic; creating a simulation program to help emergency nurses better prepare for pediatric patients, and undertaking a significant quality improvement project to create a more age-friendly emergency department.

The 2022 ENA Lantern Award recipients are:

  • Advocate Good Shepherd Hospital Emergency Department – Barrington, Illinois
  • Bethesda North Hospital Emergency Department – TriHealth – Cincinnati, Ohio
  • Children’s Healthcare of Atlanta at Scottish Rite Emergency Department – Atlanta, Georgia
  • Chilton Medical Center Emergency Department – Pompton Plains, New Jersey
  • Clement J. Zablocki VA Medical Center Emergency Department – Milwaukee, Wisconsin
  • Cleveland Clinic Medina Hospital Emergency Department – Medina, Ohio
  • Golisano Children’s Hospital of Southwest Florida Emergency Department – Fort Myers, Florida
  • Good Samaritan Hospital Emergency Department  TriHealth – Cincinnati, Ohio
  • Gulf Coast Medical Center Emergency Department – Fort Myers, Florida
  • Huntington Hospital Reichert Emergency Department – Huntington, New York
  • Inspira Medical Center Vineland Emergency Department – Vineland, New York
  • Lenox Health Greenwich Village Emergency Department – New York, New York
  • Lenox Hill Hospital Emergency Department – New York, New York
  • Maine Medical Center Emergency Department – Portland, Maine
  • Mather Hospital Northwell Health – Emergency Department – Port Jefferson, New York
  • Monmouth Medical Center Emergency Department – RWJBarnabas Health – Long Branch, New Jersey
  • Nemours Children’s Hospital, Delaware – Emergency Department – Wilmington, Delaware
  • Northern Westchester Hospital Emergency Department – Mount Kisco, New York
  • Penn Presbyterian Medical Center Emergency Department – Philadelphia, Pennsylvania
  • Scripps Memorial Hospital La Jolla Emergency Department – La Jolla, California
  • Seattle Children’s Hospital Emergency Department – Seattle, Washington
  • St. Elizabeth Healthcare Fort Thomas Emergency Department – Fort Thomas, Kentucky
  • Staten Island University Hospital North Emergency Department – Northwell Health – Staten Island, New York
  • Staten Island University Hospital Prince’s Bay Emergency Department – Staten Island, New York
  • The Children’s Hospital at Saint Peter’s University Hospital Pediatric Emergency Department – New Brunswick, New Jersey
  • The Valley of Hospital’s David F. Bolger Emergency Department – Ridgewood, New Jersey
  • University of Kansas Health System Emergency Department – Kansas City, Kansas
  • USC Verdugo Hills Hospital Emergency Department – Glendale, California
  • Yale New Haven Children’s Hospital Emergency Department – New Haven, Connecticut

The 2022 ENA Lantern Award recipients will receive a physical award to display in their emergency department as a visible symbol of their commitment to quality, safety, and a healthy work environment. Each will be recognized during ENA’s annual conference – Emergency Nursing 2022 – in Denver, Colorado in the association’s Hall of Honor. Additionally, each emergency department’s award-worthy efforts will be spotlighted in ENA’s member magazine, ENA Connection. Learn more here.

Nurses of the Week: ED Nurses Brave Sewer in Daring Kitten Emergency Rescue

Nurses of the Week: ED Nurses Brave Sewer in Daring Kitten Emergency Rescue

Our Nurse of the Week column celebrates the New Jersey nurses who saved Trenton last month. (In the interest of full disclosure, the rescuee’s name is “Trent,” but he was named for Trenton, New Jersey, so these nurses absolutely “saved Trenton”).

The nursing profession has always attracted people who have an innate urge to help, and hardly a week passes without news about some nurse who stopped on a dime to aid people (or kittens) in almost every imaginable setting. Trent the Emergency Kitten.So, when an off-duty nurse buying veggies sees someone collapse at their neighborhood grocery store or witnesses a devastating auto accident en route to work, we assume they will take charge, ensure that help is forthcoming, and attend to the most pressing needs of any injured or endangered party.

It is easy to take this for granted—to say, “oh, nurses are always doing that!” However, the fact that such events are so common attests to the extraordinariness of a profession where on the clock or off, going out of one’s way to save and help others is the norm—and while in most cases those “others” are human, nurses will on occasion branch out and save members of more advanced species such as felis catus.

The ED nurses at Capital Health Regional Medical Center in Trenton New Jersey have no plans to enter the veterinary field, but their versatile skill set was put to good use on the last Sunday night in May. That evening, as incoming and outgoing staff converged during a shift change, casual exchanges of shop talk and gossip trailed off when a series of distressed feline mews and squeaks emerged from a sewer at the back of the nearby ambulance bay.

It was a Kitten Emergency! A small boy cat was in trouble mere yards from the ED, but could not escape the sewer to reach the waiting room. Apparently, the imperiled kitten had sufficient lives in his account or plenty of good karma to his credit — because his “Kitten Emergency!” call managed to penetrate a roomful of trauma nurses, EMTs, and other ED personnel.

Placing their own spin on the firefighter tradition of rescuing cats stranded in trees, 15 Capital staffers formed an ad hoc Kitten Emergency! Rescue Unit (KE!RU) to extract the poor boy from his noisome confinement.

Having prepared by scavenging rescue equipment such as blankets, cat food, and turkey leftovers from the previous shift, the KE!RU team worked for nearly 2 hours to open the sewer grate and coax the frightened, stinky little boy to emerge. When they had calmed the kitten enough to venture further, ED trauma nurse, educator, and experienced hospital squirrel rescuer Heather Hendrickson, BSN/RN swaddled him in a towel and placed him in the hands of her colleague, nurse practitioner Celeste Shamma, NP, BSN/RN.

As they comforted the shaken boy kitten and assisted him with his toilette, the KE!RU team named him “Trent” (in honor of Trenton, NJ, the city in which he experienced his dramatic rescue).

Trent has now settled in a pleasant, safe, loving, and not at all smelly home. His sewer adventure and rescue by the KE!RU was fortuitous not only for Trent but also for a staff RN who had been looking to adopt an animal. In a local interview, Hendrickson said that her fellow RN had recently “been scammed by a breeder when trying to get a kitten for her family, so it seemed like this was meant to be.”

And, just as firefighters seem to resume cat-in-tree rescue duty when a wildfire season ends, let’s hope that this outstanding hospital kitten rescue is a similar bellwether for nurses who have been fighting the pandemic.

For a video story on Trent—complete with plaintive squeaks and yowls—see the Channel 6 site in his name city.

In the Wake of Uvalde, Trauma Surgeons Share Experience of Mass Shootings with Congress

In the Wake of Uvalde, Trauma Surgeons Share Experience of Mass Shootings with Congress

When Dr. Roy Guerrero, a pediatrician in Uvalde, Texas, testified before a U.S. House committee Wednesday about gun violence, he told lawmakers about the horror of seeing the bodies of two of the 19 children killed in the Robb Elementary massacre. They were so pulverized, he said, that they could be identified only by their clothing.

In recent years, the medical profession has developed techniques to help save more gunshot victims, such as evacuating patients rapidly. But trauma surgeons interviewed by KHN say that even those improvements can save only a fraction of patients when military-style rifles inflict the injury. Suffering gaping wounds, many victims die at the shooting scene and never make it to a hospital, they said. Those victims who do arrive at trauma centers appear to have more wounds than in years past, according to the surgeons. Originally published in Kaiser Health News.

But, the doctors added, the weapons used aren’t new. Instead, they said, the issue is that more of these especially deadly guns exist, and these weapons are being used more frequently in mass shootings and the day-to-day violence that plagues communities across the nation.

The doctors, frustrated by the carnage, are clamoring for broad measures to curb the rise in gun violence.

Weeks after the Uvalde school shooting, what steps the country will take to prevent another attack of this magnitude remain unclear. The House on Wednesday and Thursday passed measures aimed at reducing gun violence, but approval in the Senate seems uncertain at best.

Many physicians agree something substantial must be done. “One solution won’t solve this crisis,” said Dr. Ashley Hink of Charleston, South Carolina, who was working as a trauma surgery resident at the Medical University of South Carolina in 2015 when a white supremacist killed nine Black members of the Mother Emanuel African Methodist Episcopal Church. “If anyone wants to hang their hat on one solution, they’re clearly not informed enough about this problem.”

The weapons being fired in mass shootings — often defined as incidents in which at least four people are shot — aren’t just military-style rifles, such as the AR-15-style weapon used in Uvalde. Trauma surgeons said they are seeing a rise in the use of semiautomatic handguns, such as the one used during the Charleston church shooting. They can contain more ammunition than revolvers and fire more rapidly.

Overall gun violence has increased in recent years. In 2020, firearm injuries became the leading cause of death among children and adolescents. Gun-related homicides rose almost 35% in 2020, the Centers for Disease Control and Prevention reported in May. Most of those deaths are attributed to handguns.

study recently published by JAMA Network Open found that for every mass shooting death, about six other people were injured. Trauma surgeons interviewed by KHN said the number of wounds per patient appears to have increased.

“I feel we are seeing an increase in the intensity of violence over the past decade,” said Dr. Joseph Sakran, a trauma surgeon at Johns Hopkins Hospital in Baltimore. He cited the number of times a person is shot and said more gun victims are being shot at close range.

Survival rates in mass shootings depend on multiple factors, including the type of firearm used, the proximity of the shooter, and the number and location of the wounds, said Dr. Christopher Kang of Tacoma, Washington, who is president-elect of the American College of Emergency Physicians.

Several recent shootings have left few survivors.

The perpetrator of the Charleston massacre shot each of the nine people who were killed multiple times. Only one of those people was transported to the hospital, and, upon arrival, he had no pulse.

Last year, shootings at three Atlanta-area spas left eight dead — only one person who was shot survived.

The chaos at a mass shooting scene — and the presence of an “active” shooter — can add crucial delays to getting victims to a hospital, said Dr. John Armstrong, a professor of surgery at the University of South Florida. “With higher-energy weapons, one sees greater injury, greater tissue destruction, greater bleeding,” he added.

Dr. Sanjay Gupta, a neurosurgeon who is chief medical correspondent for CNN, wrote about the energy and force of gunshots from an AR-15-style rifle, the type also used in the recent mass shooting in Buffalo, New York. That energy is equal to dropping a watermelon onto cement, Gupta said, quoting Dr. Ernest Moore, director of surgical research at the Denver Health Medical Center.

Medical advances over the years, including lessons learned from the battlefields of Iraq and Afghanistan, have helped save the lives of shooting victims, said Armstrong, who trained U.S. Army surgical teams.

Those techniques, he said, include appropriate use of tourniquets, rapid evacuations of the wounded, and the use of “whole blood” to treat patients who need large amounts of all the components of blood, such as those who have lost a significant amount of blood. It’s used instead of blood that has been separated into plasma, platelets, and red blood cells.

Another effective strategy is to train bystanders to help shooting victims. A protocol called “Stop the Bleed” teaches people how to apply pressure to a wound, pack a wound to control bleeding, and apply a tourniquet. Stop the Bleed arose after the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut, where 20 children and six adults were killed.

The CDC, which in the past two years has been able to conduct gun research after years of congressional prohibitions, has funded more than a dozen projects to address the problem of gun violence from a public health perspective. Those projects include studies on firearm injuries and the collection of data on those wounds from emergency rooms across the country.

For some doctors, gun violence has fueled political action. Dr. Annie Andrews, a pediatrician at the Medical University of South Carolina, is running as a Democrat for a seat in the U.S. House on a platform to prevent gun violence. After the school shooting in Uvalde, Andrews said, many women in her neighborhood reached out to ask, “What can be done about this? I’m worried about my kids.”

Dr. Ronald Stewart, chair of surgery at San Antonio-based University Health, told KHN that the people shot in Uvalde had wounds from “high energy, high velocity” rounds. Four of them — including three children — were taken to University Hospital, which offers high-level trauma care.

The hospital and Stewart had seen such carnage before. In 2017, the San Antonio hospital treated victims from the Sutherland Springs church shooting that left more than two dozen dead.

Two of the four Uvalde shooting victims have been discharged, University Health spokesperson Elizabeth Allen said, and the other two remained hospitalized as of Thursday.

It will take a bipartisan effort that doesn’t threaten Second Amendment rights to make meaningful change on what Stewart, a gun owner, called a “significant epidemic.” Stewart noted that public safety measures have curbed unintentional injuries in car crashes. For intentional violence, he said, progress hasn’t been made.

 

  • KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Good Form: 7 Simple Tips for Following Hospital Dress Codes

Good Form: 7 Simple Tips for Following Hospital Dress Codes

While certain hospitals and healthcare facilities will enforce strict dress codes for their staff, others will allow their people to express themselves with pieces of any design and color from cute ciel blue scrubs to crazy and comical character scrubs – as long as they’re hygienic and identifiable. That said, the nature of the landscape demands a certain amount of mindfulness and even policy to ensure that each and every healthcare worker outwardly represents the seriousness of the role and is perceived positively by patients.

These common dress codes have created the standard image that has survived for centuries in most people’s minds of healthcare workers – and is what people expect and want to see! Healthcare workers have an ethical obligation to wear proper attire that befits their vocation and patients. But what are the benefits? And how do you achieve them and follow one of the strictest dress codes around?

Nursing rules and regulations apply to behavior as much as appearance, but both result in an overall professional image that commands respect and offers comfort through:

  • A hygiene and infection control perspective
  • The perception of professional ability (along with actual improved ability thanks to ease of movement, lack of clothing getting in the way, access to equipment from scrub pockets and more)
  • Ease of identification by colleagues and patients alike
  • The perception of being a close-knit and high-functioning organization and/or unit

Dress Comfortably

First and foremost, you’ll want to dress comfortably! This isn’t just a good idea but an actual part of your dress code. Especially on your first day before you fully understand your dress code, wearing something comfortable can help you settle into your new role and environment much more easily and inconspicuously, and will allow you to focus on your tasks and avoid unfortunate wardrobe malfunctions and distractions.

Play It Safe

While style and fashion are all about taking risks, your hospital dress code is not. If you’re considering wearing something questionable, opt for a safer choice or the addition of a cover-up. You can always establish what’s appropriate over time by watching what your colleagues wear, but it’s best to play it safe for your initial days on the job.

 Keep Your Options Open

Especially when you’re just starting out, you won’t always know what to expect in terms of temperature and tasks at your facility, and you won’t always know how a new brand of scrubs will feel for the day. Wearing layers is a great way to combat all of these challenges and give yourself options – plus, it looks great! For layering, pieces like warm-up jackets, vests, cardigans, undershirts and leggings are all excellent ideas for nurses.

Select Your Scrubs Mindfully

While some facilities may provide a scrub uniform, there is also a chance that you may have to purchase your own scrubs. You’ll want to actually go into stores and try them on – even if you decide to order them online after that in order to use coupon codes or take advantage of online-only sales! Because although most scrubs admittedly do look similar, they absolutely aren’t. Take your time when you try on scrubs and identify what materials, styles and fits you like best. After all, what’s a bit of time shopping when you’re going to spend all of your time from here on out in these scrubs? Sought-after brands like Dickies, Cherokee and Grey’s Anatomy™ scrubs are favorites for nurses for good reason and come highly recommended, so if you’re not sure where to start, this may be a good place!

At US Hospitals, a Drug Mix-Up Is Just a Few Keystrokes Away

At US Hospitals, a Drug Mix-Up Is Just a Few Keystrokes Away

More than four years ago, Tennessee nurse RaDonda Vaught typed two letters into a hospital’s computerized medication cabinet, selected the wrong drug from the search results, and gave a patient a fatal dose.

Vaught was prosecuted this year in an extremely rare criminal trial for a medical mistake , but the drug mix-up at the center of her case is anything but rare. Computerized cabinets have become nearly ubiquitous in modern health care, and the technological vulnerability that made Vaught’s error possible persists in many U.S. hospitals.

Since Vaught’s arrest in 2019, there have been at least seven other incidents of hospital staffers searching medication cabinets with three or fewer letters and then administering or nearly administering the wrong drug, according to a KHN review of reports provided by the Institute for Safe Medication Practices, or ISMP. Hospitals are not required to report most drug mix-ups, so the seven incidents are undoubtedly a small sampling of a much larger total.Originally published in Kaiser Health News.

Safety advocates say errors like these could be prevented by requiring nurses to type in at least five letters of a drug’s name when searching hospital cabinets. The two biggest cabinet companies, Omnicell and BD, agreed to update their machines in line with these recommendations, but the only safeguard that has taken effect so far is turned off by default.

“One letter, two letters, or three letters is just not enough,” said Michael Cohen, the president emeritus of ISMP, a nonprofit that collects error reports directly from medical professionals.

“For example, M-E-T. Is that metronidazole? Or metformin?” Cohen added. “One is an antibiotic. The other is a drug for diabetes. That’s a pretty big mix-up. But when you see M-E-T on the screen, it’s easy to select the wrong drug.”

A Five-Letter Fix: Making It Stick

Omnicell added a five-letter search with a software update in 2020. But customers must opt in to the feature, so it is likely unused in many hospitals. BD, which makes Pyxis cabinets, said it intends to make five-letter searches standard on Pyxis machines through a software update later this year — more than 2½ years after it first told safety advocates the upgrade was coming.

That update will be felt in thousands of hospitals: It will be much more difficult to withdraw the wrong drug from Pyxis cabinets but also slightly more difficult to pull the right one. Nurses will need to correctly spell perplexing drug names, sometimes in chaotic medical emergencies.

Robert Wells, a Detroit emergency room nurse, said the hospital system in which he works activated the safeguard on its Omnicell cabinets about a year ago and now requires at least five letters. Wells struggled to spell some drug names at first, but that challenge is fading over time. “For me, it’s become a bigger hassle to pull drugs, but I understand why they went there,” Wells said. “It seems inherently safer.”

Computerized medication cabinets, also known as automated dispensing cabinets, are the way almost every U.S. hospital manages, tracks, and distributes dozens to hundreds of drugs. Pyxis and Omnicell account for almost all the cabinet industry, so once the Pyxis update is rolled out later this year, a five-letter search feature should be within reach of most hospitals in the nation. The feature may not be available on older cabinets that are not compatible with new software or if hospitals don’t regularly update their cabinet software. RaDonda Vaught gave a patient a fatal dose from this vecuronium vial in 2017.

Hospital medication cabinets are primarily accessed by nurses, who can search them in two ways. One is by patient name, at which point the cabinet presents a menu of available prescriptions to be filled or renewed. In more urgent situations, nurses can search cabinets for a specific drug, even if a prescription hasn’t been filed yet. With each additional letter typed into the search bar, the cabinet refines the search results, reducing the chance the user will select the wrong drug.

The seven drug mix-ups identified by KHN, each of which involved hospital staff members who withdrew the wrong drug after typing in three or fewer letters, were confidentially reported by front-line health care workers to ISMP, which has crowdsourced error reports since the 1990s.

Cohen allowed KHN to review error reports after redacting information that identified the hospitals involved. Those reports revealed mix-ups of anesthetics, antibiotics, blood pressure medicine, hormones, muscle relaxers, and a drug used to reverse the effects of sedatives.

In a 2019 mix-up, a patient had to be treated for bleeding after being given ketorolac, a pain reliever that can cause blood thinning and intestinal bleeding, instead of ketamine, a drug used in anesthesia. A nurse withdrew the wrong drug from a cabinet after typing in just three letters. The error would not have occurred if she had been required to search with four.

In another error, reported mere weeks after Vaught’s arrest, a hospital employee mixed up the same drugs as Vaught did — Versed, a sedative, and vecuronium, a dangerous paralytic.

Cohen said ISMP research suggests requiring five letters will almost entirely eliminate such errors because few cabinets contain two or more drugs with the same first five letters.

Erin Sparnon, an expert on medical device failures at ECRI, a nonprofit focused on improving health care, said that although many hospital drug errors are unrelated to medication cabinets, a five-letter search would lead to an “exponential increase in safety” when pulling drugs from cabinets.

“The goal is to add as many layers of safety as possible,” Sparnon said. “I’ve seen it called the Swiss cheese model: You line up enough pieces of cheese and eventually you can’t see a hole through it.”

And the five-letter search, she said, “is a darn good piece of cheese.”

Vaught, a former nurse at Vanderbilt University Medical Center in Nashville, was arrested in 2019 and convicted of criminally negligent homicide and gross neglect of an impaired adult during a controversial trial in March. She could serve as much as eight years in prison. Her sentencing May 13 is expected to draw hundreds of protesters who feel her medical error should not have been prosecuted as a crime.

At trial, prosecutors argued Vaught made numerous mistakes and overlooked obvious warning signs while administering vecuronium instead of Versed. But Vaught’s first and foundational error, which made all other errors possible, was inadvertently withdrawing the vecuronium from a cabinet after typing just V-E. If the cabinet had required three letters, Vaught probably would not have pulled the wrong drug.

“Ultimately, I can’t change what happened,” Vaught said, describing the mix-up to investigators in a recorded interview that was played at her trial. “The best I can hope for is that something will come of this so a mistake like that can’t be made again.”

After the details of Vaught’s case became public, ISMP renewed its calls for safer searches and then held “multiple calls” with BD and Omnicell, Cohen said. ISMP said that, within a year, both companies confirmed plans to tweak their cabinets based on its guidance.

BD raised the default on Pyxis cabinets to a three-letter minimum in 2019 and intends to raise it to five in a software update expected “by the end of summer,” spokesperson Trey Hollern said. Cabinet owners will be able to turn off this feature because it’s “ultimately up to the health care system to configure safety settings,” Hollern said.

Omnicell added a “recommended” five-letter search through a software update in 2020 but left the feature deactivated, so its cabinets allow searches with a single letter by default, according to a company news release.

Perilous Typos: M-O-R-F-I-N-E

At least some hospitals must have activated the Omnicell safety feature because they’ve begun to alert ISMP to workflow problems — spelling errors or typos — made worse by requiring more letters. Omnicell declined to comment for this story.

Ballad Health, a chain of 21 hospitals in Tennessee and Virginia, activated the five-letter search while installing new Omnicell cabinets this year.

CEO Alan Levine said it was an easy choice to engage the safety feature after the Vaught case but that the transition has laid bare an unflattering truth: Lots of people, even highly trained professionals, are bad spellers. “We have people that try to spell morphine as M-O-R-F-I-N-E,” Levine said.

Ballad Health officials said one of the most common issues arose in emergency rooms and operating rooms where patients need tranexamic acid, a drug used to promote blood clotting. So many nurses were delayed at cabinets by misspelling the drug by adding an S or a Z that Ballad posted reminders of the proper spelling.

Even so, Levine said Ballad would not deactivate the five-letter search. Because of the pandemic and widespread staffing shortages, nurses are “stretched” and more likely to make a mistake, so the feature is needed more than ever, he said.

“I think, given what happened to the nurse at Vanderbilt, a lot of [nurses] have a better appreciation of why we are doing it,” Levine said. “Because we’re trying to protect them as we are the patient.”

Some nurses remain unconvinced.

Michelle Lehner, a nurse at a suburban Atlanta hospital that activated the five-letter search last year, said she believed hospitals would be better served by isolating dangerous medications like vecuronium, instead of complicating the search for all other drugs. Five-letter search, while well-intentioned, might slow nurses down so much that it causes more harm than good, she said.

As an example, Lehner said that about three months ago, she went to retrieve an anti-inflammatory drug, Solu-Medrol, from a cabinet with the safety feature. Lehner typed in the first five letters of the drug name but couldn’t find it. She searched for the generic name, methylprednisolone, but still couldn’t find it. She called the hospital pharmacy for help, but it couldn’t find the medication either, she said.

After almost 20 minutes, Lehner abandoned the dispensing cabinet and pulled the drug from a non-powered, “old school” medication cart the hospital normally reserves for power outages.

Then she realized her mistake: She forgot the hyphen.

“If this had been a situation where we needed to give the drug emergently,” Lehner said, “that would have been unacceptable.”