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Although staff did not have any knowledge of being observed by the data collector, implementing the NIZ may have increased their awareness of medication preparation, possibly accounting for at least part of the differences in the data from before to after implementation of the NIZ. Further studies with a longer run-in time and measurement of data across several time points after implementation of the NIZ would provide greater information about the patterns of effects of the NIZ over time.

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The results of this pilot study suggest that an NIZ can reduce interruptions during medication preparation. The study design could be expanded to include observation of medication preparation on general medical-surgical units and during all shifts to determine if reductions in interruptions would be similar to the reductions seen in this pilot study.

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Nurses are primarily responsible for medication safety in intensive care units.

National initiatives are calling for an increase in medication safety.

Use of No Interruption Zones around medication preparation areas was derived from the “sterile cockpit rule” of the aviation industry.

Clinical Scenario

Mr N, a 55-year-old man, was admitted to the intensive care unit (ICU) for hypotension due to sepsis. Despite fluid replacement, his condition remained hemo-dynamically unstable, so treatment with vasopressors was started. At the central medication area, the nurse preparing an intravenous infusion of norepinephrine (Levophed) was interrupted by another nurse. After finishing the conversation, the nurse could not remember if she had placed 4 mg or 8 mg of norepinephrine into the 250-mL bag of normal saline. A nurse knows remixing a new bag is the safest solution, but also considers other dilemmas such as admitting to a medication error, charging the patient twice for the same medication, or taking extra time to start over. How frequently does this clinical scenario occur in the ICU? Do interruptions during the critical task of medication preparation contribute to medication errors?

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Special thanks to Kimberly Kotora and Jane Dus for the continued support they provide to bedside nurses in their efforts to improve care.

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To purchase electronic or print reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, [email protected] .

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Occidental College is...
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NCAA Division III (with football)
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1600 Campus Rd
Los Angeles, CA 90041
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oxy.edu
From Occidental College

Occidental College's beautiful campus in Los Angeles serves as a springboard for putting theory into practice. In more than 40 majors and minors, students benefit from a small-classroom environment with stimulating faculty. Our distinctive approach offers a chance to explore new ideas, and the academic rigor on campus is enhanced by internships and partnerships across L.A. Consciously collaborative, our students seek to embrace difference and make a difference in the world. Occidental is reinventing the liberal arts and sciences for a new generation of problem solvers, creators, and thinkers.

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Default parameter values are evaluated from left to right when the function definition is executed. This means that the expression is evaluated once, when the function is defined, and that the same “pre-computed” value is used for each call. This is especially important to understand when a default parameter is a mutable object, such as a list or a dictionary: if the function modifies the object (e.g. by appending an item to a list), the default value is in effect modified. This is generally not what was intended. A way around this is to use None as the default, and explicitly test for it in the body of the function, e.g.:

Default parameter values are evaluated from left to right when the function definition is executed.

Function call semantics are described in more detail in section Calls . A function call always assigns values to all parameters mentioned in the parameter list, either from position arguments, from keyword arguments, or from default values. If the form “ *identifier ” is present, it is initialized to a tuple receiving any excess positional parameters, defaulting to the empty tuple. If the form “ **identifier ” is present, it is initialized to a new ordered mapping receiving any excess keyword arguments, defaulting to a new empty mapping of the same type. Parameters after “ * ” or “ *identifier ” are keyword-only parameters and may only be passed used keyword arguments.

Parameters may have annotations of the form “ : expression ” following the parameter name. Any parameter may have an annotation even those of the form *identifier or **identifier . Functions may have “return” annotation of the form “ -> expression ” after the parameter list. These annotations can be any valid Python expression. The presence of annotations does not change the semantics of a function. The annotation values are available as values of a dictionary keyed by the parameters’ names in the __annotations__ attribute of the function object. If the annotations import from Jil Sander Lightweight Long Sleeve Top Shop Limited Edition Sale Online Top Quality For Sale Discount Wiki f0mkvi6
is used, annotations are preserved as strings at runtime which enables postponed evaluation. Otherwise, they are evaluated when the function definition is executed. In this case annotations may be evaluated in a different order than they appear in the source code.

It is also possible to create anonymous functions (functions not bound to a name), for immediate use in expressions. This uses lambda expressions, described in section Lambdas . Note that the lambda expression is merely a shorthand for a simplified function definition; a function defined in a “ def ” statement can be passed around or assigned to another name just like a function defined by a lambda expression. The “ def ” form is actually more powerful since it allows the execution of multiple statements and annotations.

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Welcome to Fortaleza

Considering its isolation, Fortaleza is a surprisingly large and sprawling place. It’s one of Brazil’s biggest cities, and an economic magnet for people from Ceará and beyond. It’s also a magnet for tourists from Brazil and overseas, who come for its beaches and party atmosphere, and for the spectacular smaller beach spots, rolling dunes and fishing villages they can get to from here. Some city beaches are reasonably attractive and the nightlife is definitely a lot of fun.

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The city stretches 20km along the coast and up to 10km inland. Centro is the oldest part of town; it is a lively area to wander round by day, with many busy streets full of small stores, though it lacks any specific attractions of note. The bus station is 4km south of Centro and the airport is 2km further south. The main areas of interest are east of Centro. First is Praia de Iracema, a tightly packed nightlife, restaurant and accommodation zone, with no beach worth mentioning. Then there’s Meireles, a middle-class beach suburb with many upscale places to stay, 2km to 4km east of Centro. South of Meireles, another middle-class suburb, Varjota, is home to many of Fortaleza's best restaurants. East of Meireles is the port area, Mucuripe, beyond which the coast veers southward and leads down to the city's best beach, the 5km-long Praia do Futuro, starting some 8km east of Centro.

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Top sights in Fortaleza

1
Praia do Futuro

Fortaleza

2
Centro Dragão do Mar de Arte e Cultura

Fortaleza

3
Praia do Meireles

Fortaleza

4
Centro de Turismo

Fortaleza

5
Memorial da Cultura Cearense

Fortaleza

6
Museu de Arte Contemporânea

Fortaleza

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Ponte dos Ingleses

Fortaleza

8
Igreja da Sé

Fortaleza

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