HW Disease and Pregnancy As a community health nurse working with high-risk populations and individuals infected with the human immunodeficiency virus, I applaud the comprehensive and sensitive series focusing on HIV, pregnancy, and the implications for nurse clinicians (March/April 1992 JOG”). I am appalled, however, by the number of primary-care practitioners who have not incorporated HIV risk assessment into their practice. Our research site conducted a pilot study of 35 women currently using cocaine, opiates, or amphetamines. They are either smokers and/or intravenous users. Data show that all had Pap tests since 1987, most within the past year. They had given birth to a total of 80 children. Nineteen had been treated for a sexually transmitted disease since 1987. Their choice of health-care providers for “female health problems” were private health-care providers ( n =141, hospitals ( n = 4 ) , correctional institutions ( n = l ) ,and public clinics ( n = 16). The clinics are staffed primarily by nurse practitioners. A drug history was not taken by 65% of the providers, and information about HIV was not given by 57% of providers. Of those who were asked about their drug-taking behaviors, 88% reported giving accurate information. Of those not asked, 80% stated that they would give the information or had volunteered it. The women in this study are at high risk for contracting HIV. They
are accessing the health-care system. The negligence of providers in failing to assess their clients’ risks and provide accurate information could be both tragic and costly. The March/April 1992 issue highlights the imperatives of assessment and early intervention for an optimal standard of care for these women and their children. Thank you! Patricia J. Wilson, CHES, MSN University of Alaska, Anchorage Center for Alcohol and Addiction Studies Anchorage, Alaska
Quality Assurance As subscribers to JOGNN, we expect the articles to familiarize us with the most current standards of practice in nursing, as is typical of your publication. We were disappointed in your decision to publish “Organizing Quality Assurance in a Maternal-Child Health Division” . (January/February 1992 JOG” This article focused exclusively on process and structure outcomes rather than interdisciplinary patient outcomes, which are now required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The new standards regarding quality assurance were published in the 1991JCAHO
T h e JOCNN editor welcomes readers’ comments. Address letters to the editor, JOCNN, 409 12th St., S.W., Washington, DC 20024-2188. All letters should b e typed doublespace and signed by the author. Letters will be published at t h e editor’s discretion, and JOGNN reserves the right to edit all letters.
Accreditation Manual for Hospitals. Thus, we expected that any
subsequent articles would address changes in these standards. We hope that we can look forward to more timely quality assurance articles in the future. Vickie Meyer, RN Maternal-Child Health Quality Improvement Committee Santa Clara ValleyMedical Center San Jose, California
The autbor replies.
I understand the concern that articles be timely; however, JOG”
has high standards that require a lengthy process of peer review before an article is actually published. As the article noted, it was initiated in January 1990, before the 1991 standards were published. I have attended several conferences regarding the new JCAHO standards for nursing and quality improvement. Fortunately, our article is still helpful and accurate. The 10step process is alive and well and is incorporated into the new standards. I would encourage readers to use the information in the article and then build upon it. That is what we have done at Cabell Huntington Hospital. For example, in addition to the activities reflected in the article, we have implemented an interdisciplinary quality improvement team that deals with customer satisfaction in our maternity patients. If we are fortunate, perhaps you will see an article from us regarding our implzmentation of the new standards. Thank you for your interest in our article.
Susan Nine, RNC, CCRN, BSN Director Maternal Child Health Cabell Huntington Hospital Huntington, West Virginia