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Hello JCAHO
2008-02-09 17:01:00
Hello JCAHO? Are you listening? Pay attention. I have been a nurse for over twenty years and I can say with confidence that all your mandates have done ABSOLUTELY NOTHING to improve patient care. Yes, that is right, billions of dollars and countless hours of time and energy spent with NO RESULTS.Except paperwork. Reams and reams and reams of paperwork. That is what they have done. Each mandate requires paperwork to prove that it is being carried out. And that is what they look for when they survey-paperwork. Oh yes and the top of the crash carts - God forbid they are dusty.But seriously. I spend about half my day on documentation. Half. Those six hours could be way better spent on patient care. I have to fill out a medication reconciliation form on anyone. Then if we give insulin there is the insulin flow sheet. If we give heparin there is an anticoagulation flow sheet. If we admit the patient there is a patient belongings sheet and a sheet to document what you told ...

Fast Track Woes
2008-02-08 03:34:00
I had the grave misfortune to have to work in Fast Track today. Bleah. 6 people needing stiches, 3 sprained ankle, 1 fractured metacarpal from punching a wall (learn anything?) 4 back pains, 3 migraines, 2 young women with UTI's, 4 small children with fevers, 2 small children with snotty noses, 2 people with rashes, 1 suture removal, 1 rabies prophylaxis and a partridge in a pear tree. It was boring, boring, boring, boring and I felt like the Vicodin dispensing queen. Oh, I forgot....2 MRSA abscesses and 2 dental pains.but by God, no one had to wait more than 27 minutes to get into a room. And....I passed out enough Dilaudid and Vicodin to guarantee my patient satisfaction scores should be stellar. My employee satisfaction, on the other hand, is in the toilet.

Friday Night in Triage
2008-02-07 04:14:00
19 year old female with complaints of nausea and fatigue. Diagnosis? Wants pregnancy test.23 yo female with low back pain after picking up a box. Diagnosis? Wants work excuse.Stab wound to the upper arm. Diagnosis? Pissed off girlfriend.Flu symptoms. Diagnosis? Wants work excuse.Family of three with cold symptoms.19 yo male with 'racing pulse.' Diagnosis? Lay off the Red Bull dude.93 yo granny who is weak and dizzy all over. Diagnosis? Urinary tract infection.17 yo male with excruciating back pain. Diagnosis? Wants Vicodin.87 yo male with shortness of breath - straight back to a bed with him, he turned out to be in pulmonary edema.2 year old male with shortness of breath. He looked even worse than the previous patient. Straight back to resus with him. Diagnosis? Epiglottits. Ended up getting tubed and going to PICU.6 day old female with fever. Straight back with her, she was septic and also went to PICU57 year old male with epigastric pain and heartburn. Seems ...
More About: Night , Friday , Triage

Methadone
2008-02-05 05:04:00
Why are we seeing 20 year old people with no history of trauma, cancer, congenital abnormalities or any significant medical findings on METHADONE for back pain?Why are said people also unemployed and collecting welfare or disability?WHAT IS WRONG HERE PEOPLE?
More About: Methadone

How to really impress your patients
2008-01-31 02:39:00
I was taking care of a nice woman who had a badly fractured wrist from slipping on the ice. We had sedated her and reduced and splinted the fracture and sent her home with her equally nice and attentive husband. They had just left the department and I was cleaning the room when I found her pain medicine prescription under the end of the gurney, they must have dropped it and not noticed. That was a nasty fracture and is going to hurt like a bastard tonight so I decide I will run out and see if I can catch them in the parking lot. I dash out the ambulance doors and spot them half way across the lot. I call them and they turn around just in time to see me hit my own patch of ice, fly up in the air and come down flat on my back, nearly knocking myself out cold.Great. Nothing like impressing your patients with your cool professionalism.
More About: Patients , Impress

Grand Rounds
2008-01-30 05:27:00
Grand Rounds is hosted by Kim at Emergiblog this week. She has chosen the Beatles as the theme so head on over there and check it out.
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Exciting news
2008-01-30 04:45:00
I've received a proposal of marriage!!!!!!!Of course he was about 60, toothless, reeking of alcohol and a complete stranger to soap and water but hey, at my age how picky can you be.
More About: News

Where do candy hearts come from
2008-01-29 04:46:00
OMG! I love this guy, what an imagination. And in case you ever wondered where candy hearts come from.....here's the answer.
More About: Candy , Hearts

RANT
2008-01-29 04:11:00
Today I get this ambulance. I'm trying to triage the patient and I am going to put her on the monitor, only someone has taken my monitor cable (I guess they think they are more important) so I have to go find one, I look in all the usual drawers but I can't find one so I go room to room, finally in the tenth room I find two so I take the extra. I start back to the room, looking for a thermometer but all the wall-mounted holders are empty so back I go on the room to room search until I finally find one. I go back to the room, put my patient on the monitor and get a temp. I put her information in the computer and go to get her a warm blanket only to find the blanket warmer AND the linen cart empty. This is the part where I lose it a little.JUST ONE TIME, ONE MEASLY LITTLE TIME I WOULD LIKE TO HAVE THE BASIC FREAKING EQUIPMENT I NEED TO DO MY JOB.ARRRRGGGGGHHHH!!!!!
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Your Diagnosis Might Be.........
2008-01-27 18:04:00
Fever, Chills, Muscle aches, Coughing, fatigue.......You might have the flu.Guess what? Antibiotics don't help the flu - it's a virus. You are going to be sick for a week or so. Drink lots of fluids and take some Tylenol and stay in bed until you feel better.And next year get a flu shot.Don't come to the ER and demand antibiotics, they won't help. Yes you'll feel better after a 10 day course, you'd feel better after 10 days anyway. Fever and feeling like shit does not constitute an emergency. Sorry. You'll be much more comfortable in your own bed than sitting on a hard waiting room chair for several hours.Don't go to work and infect everyone you work with. You are not that important. The flu can, and does, kill thousands of people every year.This post does not constitute medical advice
More About: Diagnosis

Leave it to California
2008-01-27 17:31:00
Anyone who has seen the Body Worlds or Universe Within exhibits knows what an amazing exhibit it is. Donated bodies, in various stages of dissection and plasticized give us a never before seen view of the wonders of the human body.Bad language follows.Well leave it to the state of California to fuck it up. Assemblywoman Fiona Ma (D-San Francisco) has introduced a bill to ensure that the people who donate their bodies have consented to be gawked at by the public. Sadly, said bill was passed by 50-4 in the assembly and is now on its way to the Senate.How much is this folly costing state tax payers? No wonder Arnold has to cut funding to State Parks, Schools and Libraries to balance the budget when our elected officials are spending millions of dollars with this CRAP! It is often embarrassing to say you live in California.That being said, I saw the Universe Within exhibit when I was visiting another state, DO NOT MISS the opportunity to go. It was the most amazing thing that I ha...
More About: Leave

GOD BLESS OUR TROOPS
2008-01-27 00:51:00
You stay up for 16 hours He stays up for days on end. You take a warm shower to help you wake up. He goes days or weeks without running water. You complain of a 'headache', and call in sick.. He gets shot at as others are hit, and keeps moving forward. You put on your anti war/don't support the troops shirt, and go meet up with your friends. He still fights for your right to wear that shirt. ...
More About: Troops , God Bless

Ack! This is terrible.
2008-01-26 22:56:00
This is terrible. No excuse. None. And the hospitals response? 'It's not worthy of a lawsuit.' Grrrr. They threw this woman's dead child in the laundry! Lawsuit? I wouldn't be happy until nothing was left of the hospital but a pile of smoldering rubble and the idiots that made statements like that were tarred and feathered.h/t At Your Cervix

It's Raining, It's pouring, ERnursey soon will be snoring!
2008-01-26 00:39:00
Raining, raining, raining, raining. Sigh. I have a stretch of days off and a bunch of outside projects to do and it is supposed to rain every single day. Currently it is raining so hard that my front walk is covered with two inches of water.So. Fire? Check. Jammies? Check. Old movie? Check. Hot cocoa? Check.having a reasonable excuse to be lazy? Priceless.
More About: Snoring , Raining

Something is a little off
2008-01-25 02:05:00
ER nurses see a large variety of patients. Young, Old, happy, angry, sad, crazy and everything in between. Sometimes we don't realize at first that the person isn't quite what they seem.One day I received an elderly woman by ambulance and I was examining her. She was complaining of lower abdominal pain. I listened to her bowel sounds which were normal. She said she moved her bowels regularly with no constipation. I asked her about her urination, did it hurt to go? Did she have frequent urges, any odor to the urine? No, no and no. I palpated her abdomen and did not note any focal tenderness.I asked her if anything made the pain worse and she holds out a closed fist and says "here." Without thinking I hold out my hand and she drops a dried up, black thing that sort of looked like a piece of stick, but not quite. I am standing there looking at it thinking to myself "what the hell is that?" So I ask, and she tells me that she masturbates everyday with a banana and that is t...

This sucks the life out of me
2008-01-24 06:00:00
my last patient of the day has had 107 ER visits to our ER in the last three years. That is just my ER, a friend that works across town told me he is a frequent flyer there also. His visit history reads; back pain, dental pain, arm pain, pain, pain, pain. If you take the time to go through the charts he has been told 8 times in the last three hears that he will be given no more narcotics and yet on the very next visit he will be give a 'script for Vicodin. We are contributing to his slow death.This is not why I went into nursing. I did not intend to be turned into a drug dealer. I don't like it and it sucks the life out of me. We are not doing these people any favors, just the opposite in fact.Tonight played out like this:He came in with acute narcotic withdrawal. He ran out of Methadone three days ago and he had a visit to our ER that day for dental pain for which the NP gave him 20 Vicodin. Obviously he has used those all up, he sits in the triage room vomiting into a ba...
More About: Life , Sucks

Another example of VA care
2008-01-22 05:20:00
I worked in a trauma center years ago and the residents also covered the VA hospital up the hill from us.One evening the neurosurgery resident was in the ER placing a ventriculostomy and a Codman drain on a patient with a head injury so I was holding his beeper and answering his pages.First I get one from the VA. A nurse up there is calling to say she needs him to come and verify NG tube placement on a patient she had placed a NG tube in. WTF????? For the uninitiated, an NG tube is a naso-gastric tube. It is a long, flexible tube that is inserted through the nostril, down the throat, into the esophagus and the end sits in the stomach. It can be used to suction stomach contents out or the put tube feedings and meds into the stomach. Placement is checked to make sure it isn't in the lung as putting formula etc. in the stomach is NOT good. This is a nursing task. You check by injecting some air and listening for a gurgle over the stomach and by aspirating some stomach contents...
More About: Care

Ahem....Attention Staffing Office
2008-01-22 05:16:00
Attention, staffing office. If I am in charge and the ER is holding 10 admits and we have every other bed full and 8 people in the hall and 37 people waiting in the lobby to be seen - some of which have been there for more than six hours and there are 12 more people waiting to be triaged and I call you because a night shift nurse called in sick and you tell me that you are busy staffing the floors but you will "try to get to it." It will cause me to have a psychotic break.'k? Thanks.
More About: Office , Staffing , Attention

More Governmental Stupidity
2008-01-21 05:44:00
Just when I thought the government could not aggravate me any further I came across two posts at The Happy Hospitalist.Medicare, in their infinite wisdom (NOT) have come up with the brilliant idea that if you are a medicare patient and are ready for discharge and you feel you don't want to be discharged you can challenge the decision and it will be reviewed by some doctor somewhere who is employed by the government (the same idiot's that brought you JCAHO.) How does that work in practice? About as badly as you might expect.The second post deals with the VA. I have come to realize that the VA system is a colossal monument to waste, obstruction of any progress and stupidity. It is like every joke about bureaucracy every coined. Let me give you one example. I recently had a patient in the ER who had been discharged from our facility three days prior with CHF. The VA does not accept prescriptions by outside doctors so when a patient is discharged he needs to call his doctor at th...
More About: Stupidity

Waiting and Patient Satisfaction Scores
2008-01-20 02:49:00
In their ceaseless quest to garner more business, hospital administrators have turned to the emergency room as their latest battleground. The focus has turned away from caring for the emergently ill and turned to churning as many people through as fast as possible. Often times we feel like the focus is on quantity first, quality second.Hospitals spend untold millions every year on patient satisfaction surveys, the scores are used as a yardstick to measure the quality of care. The sad truth is the way the surveys are set up the information they gather is useless. In the ER they survey the patients who are discharged home, usually comprised of the low acuity and fast-track patients. These people used to have to wait longer while the sicker patients were tended to. Nobody likes to wait so they would be unhappy and thus the satisfaction scores would suffer.This would be the point that someone should look at the study and say, "hmmmm, that was a poorly designed study. Let's try a...
More About: Satisfaction , Waiting , Patient , Scores

The Family Visit
2008-01-18 16:18:00
I pull the next triage ticket and realize it is a group of 3 - mom and two kids with colds. I sigh and mentally feel defeated before I even start.I bring them in the room, Mom and five kids. It takes a long time to get them triaged, the kids are brats - opening drawers and running around screaming while mom sits there oblivious. I get them all done and start to usher them out the door when the mom decides that "as long as we're here, might as well get the other two checked out two." even though they have no complaints.In the 45 minutes I spent triaging this family, none of which were suffering anything other than mild coughing and snotty noses, 4 more people had signed in and had been waiting with more serious complaints than 'colds.'
More About: Family , Visit , The Family

ER's Have Longer Waiting Times
2008-01-17 05:15:00
So there is a study out that shows that ER's are suffering from increased wait times and the problem is going to get worse.Duh. Really? How much did that study cost? Any ER staff member could have told you that for free.ER's are closing, ER visits are increasing. The population is aging, the economy is collapsing. More primary care physicians are refusing to take Medicaid patients. JCAHO and CMS are coming up with more idiotic and burdensome regulations requiring ER staff to spend more and more time on redundant paperwork. Litigation is making doctors gun-shy so they are ordering longer work-ups.There is a nursing shortage so inpatient beds are not able to be filled.Once again, duh. What did you think was going to happen. It's only a matter of time before our system crashes.H/T Whitecoat Rants
More About: Times , Waiting

Ever Wonder Why Nurses Burn Out?
2008-01-16 05:28:00
The last two days have been simply dreadful. Critical patient after critical patient, stroke, MI, septic shock, major trauma, gunshot, head bleed and on and on and on. Running, running, running from bed to bed trying to keep everyone alive long enough to go to the ICU's and trying desperately to get everything done without making a mistake. Coming home to collapse exhausted in bed only to dream all night long that I am at work and everything is going to hell.We work short every day. The patients are sicker and sicker. Higher acuity, higher volume of visits with less staff to care for them. And now, the insurance companies are not going to pay for some things that only adequate staffing can prevent. When the hospitals aren't getting reimbursement what will they cut? Bedside staff of course, always the first to go when money is tight. Do you see where this is going?I'm overwhelmed and burnt out with no end in sight. I suspect a lot of my fellow nurses are right there with ...
More About: Nurses , Burn , Burn out

Heartbreaking
2008-01-15 05:21:00
Some patients really capture our hearts......and break them. For two excellent posts about this read these posts:Part 1Part 2Thanks, John for this story.
More About: Breakin

Blah
2008-01-14 04:43:00
I'm tired, the news is boring and nothing interesting happened at work. I can't even think of any exciting or interesting stories. I'll try again tomorrow. Sorry.For those of you in the snow belt - it was sunny and 67 here today.
More About: Blah

Medical Transcriptionists are Da Bomb
2008-01-13 06:28:00
You have to admire anyone that can hear this:Doctor dictating on the dictaphone: 40-year-old Female mumble, mumble, mumble, snort abdominal mumble mumble mumble mumble (hey hand me those labs) history of mumble, mumble, mumble gravida mumble, mumble please add Caucasian before female mumble mumble mumble (did you need something? OK give her 1 mg of Ativan PO)mumble diverticulitis mumbleAnd turn it into this:40-year-old Caucasian female with a two day history of RUQ abdominal pain occurring after meals accompanied by nausea, vomiting and diarrhea. The patient is gravida 4, PARA 3 currently pregnant 36 weeks. Previous medical history is negative except for one episode of diverticulitis occurring earlier in this pregnancy.I stand in awe of your talents.
More About: Medical , Bomb

Need a Gift for the ER Nurse in Your Life
2008-01-13 03:30:00
I want this for my birthday.
More About: Life , Gift , Nurse

Fast Track
2008-01-13 02:41:00
ER's across the country were experiencing high rates of patients leaving without being seen (LWOB)Instead of doing some investigation as to who and why they were leaving which would have showed them to be the non-urgent back pain, cold, dental pain, twisted ankle crowd who would leave after an hour or so because it really wasn't worth waiting, hospital administrators converted rooms to fast track rooms, took nurses and mid-level practitioners to staff them.so now, we can quickly see the back pain patient - usually in less than an hour or two. Then we capture that visit, usually funded by med-i-caid which probably pays $100 if that. While we are zipping the non-urgent patients through fast track the urgent patients are waiting longer and longer. We have made the triage process a complete travesty. It is not unusual in my ER to have five or more truly sick patients sitting in the lobby waiting for a room to open up, a room that now 'days is often full of an admitted patient hol...
More About: Fast , Track

Good news!
2008-01-12 04:59:00
These are probably not work safe but i have a little too much time on my hand and came across these:I've finally found a way to keep my glasses from sliding down my nose.And, I've found the man I want to be my son-in-law.That's my manicurist, second from the right.And for more choices when blowing your nose.....This just defies belief.For those of us who are a little saggy, this has possibilities.Ever bit your tongue? Now imagine how this felt.And my kids think I embarrass them.And for those that find a necklace is not enough.We're guaranteed not to ever get a job.
More About: News , Good News , Good

Medication Reconciliation
2008-01-12 04:32:00
I would so like to shoot whoever came up with the idea of the medication reconciliation process (yes I know it is JCAHO, but I want a specific individual.)Back in the good old days, before we went to the computer (that is supposed to speed things up, but don't get me started) I was very good at triage, usually I could triage someone with a complicated medical history and a lot of meds in about 5 or 10 minutes. Now, thanks to the computer and medication reconciliation, it takes me 2 to 3 times as long. The more we try to streamline, the slower things move.But wait, it isn't good enough to have to enter grandma's big ol' bag of meds during triage, now we have to generate a form with all those meds listed on it along with all the meds they received in the ER and....FIND THE ER DOCTOR and HAVE HIM SIGN IT and FAX IT TO THE PATIENTS FREAKING DOCTOR OR DOCTORS. ARRRRRGGGGGHHHHHHH!!!!!!!!!Whew, sorry. Bad day.So tell me JCAHO, since I have to now spend 20 to 30 extra minutes on pap...
More About: Medication , Reconciliation