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My Last Shift
2008-04-28 06:33:00
I signed into the computer 42,784 times because every time I stop to answer a family question or answer the phone it logs me off. 10111 of those times I typed my password, which is a combination of numbers and letters - some capitalized, wrong and had to do it again.The computer I was using froze up or crashed a total of 14 times requiring a reboot which takes two or three minutes each time. That is about a half-hour of wasted time.So tell me again how much this EMR is going to streamline documentation and increase my job satisfaction.
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Munchausen's by Proxy
2008-04-26 03:40:00
Unfortunately I've seen a lot of child abuse working in the ER. Munchausen's by Proxy is a rare form where a parent or caregiver induces illness in their child. Here is one example.It can go on for a long, long time before someone starts to suspect. The child's caregiver seems to be very concerned and loving, not the typical picture of the abuser.I was involved in a case where an infant was repeatedly brought to the ER for vomiting and failure to thrive. The baby was repeatedly hospitalized for hydration and the symptoms would quickly improve. After awhile the nurses noticed that the child would have vomiting after the mother came and did the feeds, even that at first didn't cause any suspicion. It took almost twenty admissions before someone became suspicious enough to put the baby in a room with a camera and monitor the mother. She was found to be putting a substance in the babies bottle that turned out to be ipecac. Twenty admissions and untold ER visits with blood dra...

More public health issues
2008-04-24 06:08:00
Parents, if you suspect your child has chicken pox do not bring them to the ER or, for that matter, your pediatricians office. If you do, you will expose a lot of people who shouldn't be exposed - people with weakened immune systems for which chicken pox can be fatal, Pregnant women, the elderly and other children.treat fever if your child is uncomfortable, give them plenty of fluids, oatmeal baths or calamine lotion for itching. It is an emergency if your child can't keep down fluids, if they are lethargic, complain of a bad headache or stiff neck, seizures, have difficulty breathing or the rash involves an eye. Also seek medical attention if the pox appear infected.If you do feel you need to seek medical attention, please call ahead to the ER or pediatricians office and let them know you are coming so we can properly isolate your child, chicken pox is EXTREMELY contagious.
More About: Health , Public , Issues , Public Health

Public Health Issue
2008-04-23 05:09:00
Dear Nurse Practitioner, The next time you think you have a child with measles please do not tell the mother to go to the ER where she and said child will sit with 200 other people in the lobby for several hours to be seen for the "rash" because mom isn't very fluent in English. When it is discovered that said child does have the measles public health becomes involved to try to track down all the people who may have come in contact with the child while sitting in the lobby, a rather daunting and time consuming task.So consequently public health is not happy, the ER staff is not happy and all the people who had to have a dose of immune globulin are definitely not happy.Great job.In the future, if you suspect a communicable disease please contact public health where you will find a nurse on call, 24/7 to guide you in how to handle things without causing a public health disaster.Your friendly ER staff, some of which now have sore asses
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Grand Rounds
2008-04-23 04:57:00
Grand Rounds is hosted (hostessed?) by Val Jones MD this week. Head on over.
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A Nation that can't say NO
2008-04-21 04:50:00
When did we become a nation that can't say no?From infancy the parents are taught the extreme importance of bolstering a child's self-esteem. Don't ever tell them they are bad because it will give them bad self-esteem. Children today have no rules, they are never made to behave and grow up to be horrible little brats who can 'do no wrong' in their parents eyes.So from early childhood the sense of entitlement has become well instilled.In my job I see it all the time. A patient calls an ambulance because they have an ear ache. The ambulance must go, they must transport the patient to the hospital. The EMS crew cannot tell the patient that they don't have an emergency and to find their own ride. They are not allowed to even educate the patient that it is inappropriate to call an ambulance for an earache. God forbid we upset the patient or make them unhappy.So off to the ER they go. Is the ER allowed to tell the patient they don't have an emergency or that it is inappropr...
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A little faux pas
2008-04-17 05:24:00
A post on nurse K's blog reminded me of a funny thing that happened one time (in sort of a dark, sick way.)It was the weekend in upstate NY and it was hazy, hot and humid. Peoples tempers rose in direct correlation to the heat index and we were experiencing a sharp upswing in shootings, stabbings and assaults.It was 8 pm and the ER was slammed to the rafters, all hallway beds full, two gunshot wounds in the trauma bays and a code going on in the critical section. There were about a thousand cops, nurses, residents, attendings and ancillary staff running around the ER in barely controlled chaos.The code was called. Before we could even get our breath we got the call that there was a five car pile up on the interstate with approximately 10 criticals and 5 minors. Since we were the trauma center we knew we'd get at least three of the most critical. The problem was that there was nowhere to put them.Out of desperation we quickly did post mortem care on the code patient. There wa...
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Dear staffing office
2008-04-16 05:55:00
If you ever call me at 4 pm on Monday afternoon and tell me you didn't 'get to' finding some staff for nights on MONDAY when they are going to be three nurses short......I will have a psychotic episode.Don't say I didn't warn you.
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Whooping Cough
2008-04-16 04:55:00
The baby was 9 months old, his birth weight was 8 lbs 5 ounces. At six months he weighed just shy of 20 pounds. Today he weighed 15 pounds - he was a skeleton and he was dying.Mom had brought him in after treatment by his naturopath had failed. Constant coughing had made it impossible for him to take in adequate nutrition and starvation, coupled with a raging bacterial pneumonia were conspiring to shortly end his very short life.We worked feverishly. Intubation, IV boluses, major antibiotics, vasopressors. All futile.At 9:03 pm, after 30 minutes of cardiopulmonary resuscitation we pronounced him dead.This boy had pertussis. His mother choose not to vaccinate him. I won't enter that debate. Anyone who has ever watched a child die or become permanently disabled from a preventable illness supports vaccination.From Pkids.org:Babies may bleed behind the eyes and in the brain from coughing.The most common complication is bacterial pneumonia. About 1 child in 10 with pertu...
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Red Flag
2008-04-15 05:24:00
When you have had 47 ER visits this year and they are all for back pain, migraine and dental pain...........IT'S KIND OF A RED FLAG!And in case you are wondering what causes ER overcrowding, this is one of the reasons.
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feeling sorry for myself?
2008-04-14 03:38:00
I got to feeling sorry for myself the other day.Then I was surfing the 'net and read about people in other countries that live in one room shacks, dirt floors, no running water or plumbing and having to cook over an open fire on the floor.Kind of puts things into perspective doesn't it?
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This is what nursing is
2008-04-14 03:02:00
Go read this incredibly powerful, moving story of caring for a dying man and his family. Caring for the patient is only part of the job.
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Six Word Meme
2008-04-11 15:39:00
My friend, Whitecoat Rants, has tagged me for a meme.Here are the rules:1. Write your own six word memoir.2. Post it on your blog and include a visual illustration if you want.3. Link to the person that tagged you in your post and to the original post if possible so we can track it as it travels across the blogosphere.4. Tag at least five more blogs with links.5. Leave a comment on the tagged blogs with an invitation to play.I'm not tagging, feel free to play.My six words are......A day without a book.....SUCKS!
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No Death with Dignity Here
2008-04-11 04:24:00
This picture speaks a thousand words.
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More on the idiocy that is JCAHO (with a little Press-Gainey thrown in)
2008-04-11 04:12:00
A couple of great anti-JCAHO rants today.The first is found at MDOD, 911 Doc you are my hero.Then for a little bit more check out this post at Respiratory Therapy 101.As much as I hate the idiocy that is JCAHO, what really is frightening me is the talk that reimbursements are going to be tied to patient satisfaction scores. I can see how that is going to be..."I want a prescription for Vicodin." says the patient that was in two days ago for the same bullshit complaint. "OK" says the poor doctor who has been threatened with his job if he doesn't keep patient satisfaction scores up.Doctors and nurses will be leaving the profession in droves. Perfect.
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Dear Doctor
2008-04-09 05:33:00
If you come out of a patients room and walk past the supply cart and come all the way out to the nurses station to write an order to give the patient a urinalI WILL BE TEMPTED TO CHOKE THE LIFE OUT OF YOU.It is not beneath you to hand the patient a urinal.
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READ THIS
2008-04-07 06:09:00
Eloquently said.
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Nursing 101
2008-04-07 05:25:00
I know I sound like a hardened old bitch but I actually work very hard to make sure that my patients are as clean, dry, wrinkle free and comfortable as possible. When I went to nursing school we were taught how to be a nurse which is a lot more that being able to read EKG's and titrate drips. The high tech stuff is important, it's what makes our patients get better but it won't mean a thing to them if they are laying in a pile of wrinkled linen with no blanket.So in case you missed nursing 101:keep the linens wrinkle free. Have you ever been sick and laying in a damp wrinkly bed, it makes you feel worse. When your patient comes back from a test is in the rest room, take 5 seconds and straighten out and tuck in the sheet. If it is damp, throw it in the linen hamper and grab a new one.Keep them warm. ER's are cold and the patients are scantily clad. Bundle them up. I am a 50ish, post-menopausal in full hot-flash city but when I had to go to the ER I was freezing! Those wa...
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Have you ever wondered........
2008-04-06 04:42:00
Have you ever wondered why a woman with a complaint of vaginal discharge comes to the ER with her three kids? I mean, what does she think we are going to do with them during the pelvic?Have you ever wondered why the men who are all pierced and tattoo'd are the ones most likely to vagal out when getting stitches?Have you ever wondered why all the mandatory meetings are scheduled at 1pm which is the equivalent of 1 am to the night shift?Have you ever wondered why your boss will call you in on your day off because you didn't complete some form but won't let you know you have a subpoena waiting until you come back from your stretch of days off and find out you missed a court date?Have you ever wondered if your patients really think you believe them when they tell you their Vicodin prescription blew out the window of their car/got stolen by their girlfriend/got eaten by the dog?Have you ever wondered what your patients home looks like when they come in with filthy hair and clothes? (...

More Idiocy from the Governator
2008-04-05 04:20:00
Oh yeah, and medi-cal reimbursements are going to be delayed, half a month in July and the whole month of August.Since over half of our income comes from Medi-cal payments imagine what that is going to do to our hospital.
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Change of Shift
2008-04-04 06:25:00
Change of Shift is hosted by the fabulous Nurse Chapel (of Star Trek fame) via Nurse Ratched. How I envy nurse Chapel, working in a time when all you have to do is run the scanner over the patient and it tells you what is wrong with them, no more 4 hour workups!
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California Follies
2008-04-04 03:31:00
California is going to cut Medi-cal reimbursements to physicians 10%. Medi-cal reimbursements already lag behind most of the rest of the country which means that most doctors and almost all the specialists refuse to accept Medi-cal. For instance, in our area if a medical patient breaks their wrist, the only orthopedic surgeon that will take care of them is 2 hours away. It also means that my hospital, which is largely Medi-care, Medi-cal patients is finding it increasingly difficult to get specialist to be on call for the ER. It also means that up to 1/4 of the patients we see every day are Medi-cal with no primary care physicians.Our Governor is an IDIOT.Many more dollars could be spent if the program had some sort of limits and oversite.Every day in my ER we see patients who have been in the ER 4 or more times a month for non-emergent issues. Many of them are at the other hospitals in the surrounding areas when they are not at our place. This abuse costs the program gazilli...
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Go and Read This
2008-04-02 05:12:00
The April fool that isn't a fool at all, it's all too real. Sadly.
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Hospitalists
2008-03-31 06:18:00
In our ER we love the hospitalists. Here is how getting a patient admitted used to go.ER doc talking to patients primary care: "I have your patient Debra Peel here, she has fallen and needs to be admitted for ORIF of her right hip.PCP: Well.....thanks for calling me but I don't really admit any more, why don't you get her admitted by Ortho.ER doc talking to Ortho on call: I have a patient here who is 67 and fell today in her driveway. She has a femoral neck fracture that will need repaired.Ortho Doc: Why don't you have her primary admit and we'll consult for the fracture.ER Doc: She doesn't really have any medical problems, only takes one pill for her BP which seems to be well controlled. And besides, her doc is Dr. X, he doesn't admit.Ortho Doc: Well we prefer to just consult, why don't you call the on call?ER Doc talking to medicine on-call Doc: I have a patient who needs to be admitted for a hip fracture. I've talked to ortho and they requested we call you and ...

How about just telling people no?
2008-03-30 05:42:00
30 PEOPLE ARE RESPONSIBLE FOR 2400 AMBULANCE CALLS.Why is this allowed to continue? In the article it goes on to say that they are going to go out and visit the top offenders and 'work with them gently to curb the inappropriate calls.'C'mon. If someone calls an ambulance over 100 times in one year, do you really think they are going to listen? When did we become the nation that can't say no. I'm sorry but unless you are paying the bill and you don't have an emergency then the EMS crew should be able to tell you no. And if you persist then the legal system should become involved.A lot of the chronic ambulance abuses are the habitual drunks that pass out in public. They cost you BILLIONS of dollars every year. If you can't control yourself to this degree then you should be institutionalized until you can. We need to get back the ability to say no.h/t Kevin
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Triage
2008-03-29 04:38:00
How many times today did someone tell me they were having back pain, dental pain, extremity pain, head ache and so on? Lots.How many of them took some sort of pain killer to see if it made the pain better? None.Apparently I am not the only one this bothers.I'm not suggesting Tylenol for obvious deformity of a limb, thunderclap headache or the like but if I have some sort of musculo-skeletal pain or headache I try something OTC and see if it goes away. My initial thought is not "must go to the ER for this headache I've had for an hour."c'mon people.
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My How the Times Have Changed
2008-03-28 04:01:00
When I was a child Lucy and Desi, a married couple, weren't allowed by TV censors to sleep in the same bed so they had twin beds.Tonight on TV I have been subjected to several erectile dysfunction, tampon, condom and how to talk about sex with your teen commercials. And it is 6pm, not midnight.Oh God, how I wished I lived back in the 1950's sometimes.
More About: Times , The Times

Hello JCAHO?
2008-03-28 01:48:00
Ahem. JCAHO, if you are really serious about making medication reconciliation work here is what you need to do - pay attention now, here is something you could do that REALLY WOULD IMPROVE PATIENT CARE.Create a national data bank that is immediately accessible by any health care provider that has all of a patients prescription information readily available. When a patient takes a prescription to a pharmacy it goes into the database, the pharmacist would also benefit by seeing what the patient is getting filled at other places, like the 120 Vicodin he filled across town yesterday. When a patient is given a sample his practitioner would have to hand enter the info into the data base.Until something like this is created, medication reconciliation will never work. So many patients either a)Have no clue what they take or b)lie about what they are taking or c)get meds from many different doctors filled at many different pharmacies. We simply do not have infinite time to call around t...

This is just appalling!
2008-03-27 06:31:00
"According to one Institute of Medicine study, nurses on medical and surgical units spend just 1.7 hours in a 12-hour shift on direct patient care. The rest of it? Filling out forms, chasing down supplies, collecting information ? much of it redundant."Read the full article here.

Of course, what was I thinking?
2008-03-27 04:31:00
These are the real things we can do to improve patient care:Have no drinks at the nurses station, after all - we never have time for a break so if we can't keep drinks handy we will become dehydrated and eliminate the need for those pesky trips to the bathroom that take the nurse away from her JCAHO mandated paperwork.Don't allow us to keep things we use frequently in patient rooms, like straight cath kits, because they have betadine in them - goodness knows there are scads of patients out there who will think nothing of opening those kits and sucking the betadine out of the swabs to either attempt to get high or kill themselves. It is so much better to make the nurses have to spend untold minutes running around the department looking for the needed supplies to do their jobs.Make our paperwork so cumbersome that nurses have to be hired away from the bedside to do nothing but review charts to ensure it is done correctly.Bolt closed all the cupboards under the sinks.Dust the top of...
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