Happy Friday! Since I'm off, I'm still reading everything I can get my hands on (including stuff about drain cleaners).
The power of nursing, cultural influences, and changes ahead in 2014 were in the news this week.
How about an IV, Mrs. Park?
This NY Times article discusses the how IVs are used in the Asian community there and how infection rates related to them are having devastating results.
Changes in 2014
If you're like me and you can't keep up with everything changing due to the new healthcare laws, have a look here for more information.
The power of nursing
Sepsis may become a thing of the past in
ICUs if this tool is implemented according to CMAJ (Canadian Medical Association Journal). And yes, the power of nursing's
"hunches" are coming true, and they have the data (and a system) to back
it up. Wish Flo could see it now!
You can see how public service announcements can make a difference in this Stop Sepsis video:
Showing posts with label IV. Show all posts
Showing posts with label IV. Show all posts
Friday, December 27, 2013
Wednesday, April 24, 2013
They're back! Nuggets!
No, not those nuggets or even these nuggets, but good old nuggets of news carefully dug up by yours truly while I'm wasting time, er, waiting to do something at home or away.
Enjoy them one at a time or all at once!
One hell of a clinical day
This story from Medscape describes a clinical group that worked the Boston Marathon this year.
I want one!
This study from Medscape, discussed an emergency environment which tested the efficacy of ultrasound to get IVs in people who are tough sticks.
Glove it, doc
This article (from DailyRx) discusses a recent study with children where they had fewer HAIs (Hospital Acquired Infections) when their doctors wore gloves each time they examine patients.
Are you stressed?
Maybe you live in one of the states mentioned in this Atlantic article. I was surprised RehabLand wasn't included in the top five. Oh, well, we can't win 'em all. We've still got crime and chlamydia!
News you may not have heard about
I found out about the Kermit Gosnell story in my local paper when they mentioned him hiring teenagers to man his abortion clinic. No matter what side of this debate you are on, this story is unimaginably cruel, particularly for the women involved, maimed, mutilated or even dead, because of this man.
And that's what it's all about...
No, not that song, kids! However, patient engagement is a hot topic in the news lately. I like this article because Mayo Clinic acknowledges people may not learn everything they need in one try.
More to come...stay tuned! And that's what it IS all about...
Enjoy them one at a time or all at once!
One hell of a clinical day
This story from Medscape describes a clinical group that worked the Boston Marathon this year.
I want one!
This study from Medscape, discussed an emergency environment which tested the efficacy of ultrasound to get IVs in people who are tough sticks.
Glove it, doc
This article (from DailyRx) discusses a recent study with children where they had fewer HAIs (Hospital Acquired Infections) when their doctors wore gloves each time they examine patients.
Are you stressed?
Maybe you live in one of the states mentioned in this Atlantic article. I was surprised RehabLand wasn't included in the top five. Oh, well, we can't win 'em all. We've still got crime and chlamydia!
News you may not have heard about
I found out about the Kermit Gosnell story in my local paper when they mentioned him hiring teenagers to man his abortion clinic. No matter what side of this debate you are on, this story is unimaginably cruel, particularly for the women involved, maimed, mutilated or even dead, because of this man.
And that's what it's all about...
No, not that song, kids! However, patient engagement is a hot topic in the news lately. I like this article because Mayo Clinic acknowledges people may not learn everything they need in one try.
More to come...stay tuned! And that's what it IS all about...
Saturday, October 8, 2011
Thank you for smoking
Dear Patients,
Yes, I'm not talking about the movie, I'm just talking about what I see at the Hotel Rehab.
By spending lots of money on cigarettes, you are, in a roundabout way, financing my house, car and Bubba's college education. Thanks so much.
Here's how.
1. Smoking impairs wound healing, according to studies. You sign a contract at the Hotel saying you won't smoke, so what do you expect, when I see you out on the front lawn, with your visitors and your IV pole, talking and taking long drags?
And BTW, some of those studies mentioned above say that smokers get impaired absorption and effectiveness of some drugs, too. Dr. Z will not give you the flap of your dreams if you're not compliant.
2. And word to the wise, Mr. S.: Don't be lying to that person who's calling you to help you, and who needs you to be abstinent of tobacco.When note after note says you were outside smoking, who do you think he/she's gonna believe? (He/she can read our notes)
3. And if either one of you two idiots smoke outside my window again, I can and will water my plant on the windowsill. That darned gravity is crazy on the second floor.
Cheers, love and good wishes (you may want to wear a raincoat),
RehabRN
Yes, I'm not talking about the movie, I'm just talking about what I see at the Hotel Rehab.
By spending lots of money on cigarettes, you are, in a roundabout way, financing my house, car and Bubba's college education. Thanks so much.
Here's how.
1. Smoking impairs wound healing, according to studies. You sign a contract at the Hotel saying you won't smoke, so what do you expect, when I see you out on the front lawn, with your visitors and your IV pole, talking and taking long drags?
And BTW, some of those studies mentioned above say that smokers get impaired absorption and effectiveness of some drugs, too. Dr. Z will not give you the flap of your dreams if you're not compliant.
2. And word to the wise, Mr. S.: Don't be lying to that person who's calling you to help you, and who needs you to be abstinent of tobacco.When note after note says you were outside smoking, who do you think he/she's gonna believe? (He/she can read our notes)
3. And if either one of you two idiots smoke outside my window again, I can and will water my plant on the windowsill. That darned gravity is crazy on the second floor.
Cheers, love and good wishes (you may want to wear a raincoat),
RehabRN
Tuesday, May 31, 2011
Shake it up
I shook up the assignments when I worked last. I'm sure I'll hear about it again for ages. Why, you ask? I needed to get things done quickly once I arrived, so I did the assignment at home. I did not account for the people who worked the weekend, just as the boss regularly does.
Everyone did get a reasonable assignment, though. I balanced every one's patients so no one had anything impossible. As the leader, I had the lightest assignment, because I got the assignment to be the troubleshooter for everyone. Thankfully, the day was steady and not crazy. Our on-call doc kept me busy, when patients weren't thinking of some things for me to do.
Here's a list of some of the oddball items for the day:
1. One patient was doubled over in his chair and discovered by our chief when he was going to the elevator. Said patient was helped up, then got an order that he needed a strap to get up. He begged me to find something. I looked and looked all over the unit and I finally found one...in my car (I use it with a couple of elderly relatives I occasionally transport.)
He thanked me with a large piece of chocolate cake his wife brought him from one of the local premium bakeries. Yum!
2. Since our doc saw him doubled over, he figured he might need some labs. I drew those, then put in an IV after our super nurse, Mike, the old ICU nurse couldn't get him. Turns out this patient has a secret. His hand veins are the best...and hurt the least. I got one in his hand on the first stick (because couldn't get one in the one of the several monsters on his upper arms).
3. And finally, one patient had an urgent request: he wanted a backgammon board. I scoured the games section of the rec room and didn't find one. I did find him some dominoes, and left a message for the rec therapy people so they can fulfill his "urgent" request when they come back.
Only time will tell how the rest of the week goes, so stay tuned!
Everyone did get a reasonable assignment, though. I balanced every one's patients so no one had anything impossible. As the leader, I had the lightest assignment, because I got the assignment to be the troubleshooter for everyone. Thankfully, the day was steady and not crazy. Our on-call doc kept me busy, when patients weren't thinking of some things for me to do.
Here's a list of some of the oddball items for the day:
1. One patient was doubled over in his chair and discovered by our chief when he was going to the elevator. Said patient was helped up, then got an order that he needed a strap to get up. He begged me to find something. I looked and looked all over the unit and I finally found one...in my car (I use it with a couple of elderly relatives I occasionally transport.)
He thanked me with a large piece of chocolate cake his wife brought him from one of the local premium bakeries. Yum!
2. Since our doc saw him doubled over, he figured he might need some labs. I drew those, then put in an IV after our super nurse, Mike, the old ICU nurse couldn't get him. Turns out this patient has a secret. His hand veins are the best...and hurt the least. I got one in his hand on the first stick (because couldn't get one in the one of the several monsters on his upper arms).
3. And finally, one patient had an urgent request: he wanted a backgammon board. I scoured the games section of the rec room and didn't find one. I did find him some dominoes, and left a message for the rec therapy people so they can fulfill his "urgent" request when they come back.
Only time will tell how the rest of the week goes, so stay tuned!
Friday, August 20, 2010
Me and Angelina Jolie
Now for something completely different...
I nearly coughed my coffee all over my laptop on this latest "news". I am SO glad I now have something in common with Angie and this other starlet.
What's up with Jen and Angelina? (from shine at Yahoo!)
P.S. If you have those on our unit, and crap in the arms, we'd go straight there for IVs and blood draws.
I nearly coughed my coffee all over my laptop on this latest "news". I am SO glad I now have something in common with Angie and this other starlet.
What's up with Jen and Angelina? (from shine at Yahoo!)
P.S. If you have those on our unit, and crap in the arms, we'd go straight there for IVs and blood draws.
Tuesday, July 20, 2010
Countdown
At the end of the week, I will get a long weekend away from the Hotel with my boys. It's not much, but I'll take every single second of it.
Some days are better than others. I was cruising into an uneventful end to my stint on the late shift recently when the quiet was replaced by pandemonium.
First, one patient spikes a ridiculous temp. Said patient's had problems before so we call our MD on call. Get orders. Rush about doing tasks. All is good, even if we have to harass some of our night pharmacists to get what we need.
Next, patient #2 does the same thing. Patient #2 has more pre-existing issues the MD worries about, so we call MD, get orders to have local MD see patient, and he doesn't show up. Nor does he call our MD or do whatever she asked me to ask him. Nope. He says "wait until tomorrow." Our MD is pissed. We had an issue getting the labs to this doc, so with some luck, we managed to do it (not everything is automated at the Hotel) and MD orders an IV.
What does this mean? I get to call pharmacy again and listen to the deep sighs when I tell them I have a stat order. It's as if they've never gotten one. I am so glad I'm not right there to see their faces. I really hate that "Oh, I can't do this because I don't want to do it" entitlement attitude, because I'm a crappy poker face and my thoughts aren't hidden for long.
Charge nurse got everything done because, for the most part, we worked as a team. I just wish all of our team would have cooperated without the attitude.
Outside of that, my grad class is almost done and for a short class, it's had it's share of drama, too, especially for my entire team. Every single solitary one of us has had something going on this semester that's been distracting, even life-threatening. My favorite team member, T., has problems now that may mean she won't be back next semester. I hope they can get resolved. I will miss working with her if she's not around.
Now, back to the grind, and on to the rest of the week. Stay tuned.
Some days are better than others. I was cruising into an uneventful end to my stint on the late shift recently when the quiet was replaced by pandemonium.
First, one patient spikes a ridiculous temp. Said patient's had problems before so we call our MD on call. Get orders. Rush about doing tasks. All is good, even if we have to harass some of our night pharmacists to get what we need.
Next, patient #2 does the same thing. Patient #2 has more pre-existing issues the MD worries about, so we call MD, get orders to have local MD see patient, and he doesn't show up. Nor does he call our MD or do whatever she asked me to ask him. Nope. He says "wait until tomorrow." Our MD is pissed. We had an issue getting the labs to this doc, so with some luck, we managed to do it (not everything is automated at the Hotel) and MD orders an IV.
What does this mean? I get to call pharmacy again and listen to the deep sighs when I tell them I have a stat order. It's as if they've never gotten one. I am so glad I'm not right there to see their faces. I really hate that "Oh, I can't do this because I don't want to do it" entitlement attitude, because I'm a crappy poker face and my thoughts aren't hidden for long.
Charge nurse got everything done because, for the most part, we worked as a team. I just wish all of our team would have cooperated without the attitude.
Outside of that, my grad class is almost done and for a short class, it's had it's share of drama, too, especially for my entire team. Every single solitary one of us has had something going on this semester that's been distracting, even life-threatening. My favorite team member, T., has problems now that may mean she won't be back next semester. I hope they can get resolved. I will miss working with her if she's not around.
Now, back to the grind, and on to the rest of the week. Stay tuned.
Friday, July 31, 2009
The story of my day
I have always liked words. The dictionary was my friend as a kid. I always liked to look up obscure words so I could use them in my spelling sentences....when I had to do them (I got out of this homework frequently through some other endeavors...)
As I finally got a minute last shift to start documenting, I thought about what was really happening and a couple of words came to mind.
While I ran myself hither and yon the first four hours, I really wasn't idle (my first word), but I'd suspect some of the chitchat here and there was. As I'm running around, I don't mind speed chatting or bantering with the patients as I hang all of my patients IVs for the shift. My night--come in, run an IV, stop, flush, run another IV of Vancomycin, stop, flush, hold and run another IV, and so on, like a bad TV commercial. I can't get too in-depth.
Unfortunately, sometimes oncoming report is a little too idle. We have some nurses who will give you the new orders list (we write one as we take things off) and your report the same way every time and it's complete. A couple of our people are new and they still haven't learned how to give report, so they tend to engage in idle chatter and miss the big stuff. Like the blood cultures ordered three hours before end-of-shift that have to be done today or the 102 temp that the patient getting blood just spiked near the end of his transfusion, or the report on the patient who returned from acute. It wasn't a big deal for anyone else, but it was for me, since I was his nurse.
Eventually, the last four hours drifted into the idyll category. Our neighborhood isn't exactly pastoral, but sometimes, it is pretty, just before dark, and this night, it was exceptional. The sky was a pinkish-red that glowed as the sun set. I only noticed it because I had a minute to look out the window when I called my husband. It made me think of that old saying, "Red at night, sailor's delight." My patients, including the returning one, were quiet and happy. They got all their nightly pills and drifted off to sleep. The only thing that broke the idyll was a fever in another patient, which required an all-hands fire drill to get all the labs pulled before the oncoming shift came.
So we left our coworkers with an idle, idyllic moment of their own, with sleeping patients, as we walked out the door into the cool of midnight.
More later...
As I finally got a minute last shift to start documenting, I thought about what was really happening and a couple of words came to mind.
While I ran myself hither and yon the first four hours, I really wasn't idle (my first word), but I'd suspect some of the chitchat here and there was. As I'm running around, I don't mind speed chatting or bantering with the patients as I hang all of my patients IVs for the shift. My night--come in, run an IV, stop, flush, run another IV of Vancomycin, stop, flush, hold and run another IV, and so on, like a bad TV commercial. I can't get too in-depth.
Unfortunately, sometimes oncoming report is a little too idle. We have some nurses who will give you the new orders list (we write one as we take things off) and your report the same way every time and it's complete. A couple of our people are new and they still haven't learned how to give report, so they tend to engage in idle chatter and miss the big stuff. Like the blood cultures ordered three hours before end-of-shift that have to be done today or the 102 temp that the patient getting blood just spiked near the end of his transfusion, or the report on the patient who returned from acute. It wasn't a big deal for anyone else, but it was for me, since I was his nurse.
Eventually, the last four hours drifted into the idyll category. Our neighborhood isn't exactly pastoral, but sometimes, it is pretty, just before dark, and this night, it was exceptional. The sky was a pinkish-red that glowed as the sun set. I only noticed it because I had a minute to look out the window when I called my husband. It made me think of that old saying, "Red at night, sailor's delight." My patients, including the returning one, were quiet and happy. They got all their nightly pills and drifted off to sleep. The only thing that broke the idyll was a fever in another patient, which required an all-hands fire drill to get all the labs pulled before the oncoming shift came.
So we left our coworkers with an idle, idyllic moment of their own, with sleeping patients, as we walked out the door into the cool of midnight.
More later...
Tuesday, January 13, 2009
Wax on, wax off
I'm not doing any waxing here or at work, but, I am off tomorrow. Yes!
Today was a busy day, even though we weren't saddled with the admissions of yesterday. Mr. AKA blew his IV at 0500 and I could not stick him because he'd already been stuck 7 times before I got to him. How many people did it take (and sticks) after that to get a working IV? Only 5 more tries with two veteran nurses. It was terrible. Why they didn't give him a PICC is beyond me. He was off fluids today, so I had to encourage PO fluids and he's still tired. I got him cleaned up finally, which was the first bath and shave he's had in a week. (The Washington folks were "short-handed" he said, so he didn't get a bath). I just can't stand to have people be dirty!
We had to feed him his breakfast, he nibbled at lunch and I had to really push him to drink. He drank more in the afternoon than he did all day. I checked him out again before I left and he was doing better. I still worry about him, though. He's been through a lot.
My other guy went off to his appointment, so all I had to do was get him cleaned up and ready for the pickup. That was a breeze. His neighbor, Yosemite Sam, got cleaned up in the shower today, since he agreed to let his nurse do that. He wouldn't agree to a total scrubdown, though, so she just had to shoot water into the crusty beard and rub.
I got all the rest of my work done with five minutes to spare. It was nice to stroll out on time.
More later...
Today was a busy day, even though we weren't saddled with the admissions of yesterday. Mr. AKA blew his IV at 0500 and I could not stick him because he'd already been stuck 7 times before I got to him. How many people did it take (and sticks) after that to get a working IV? Only 5 more tries with two veteran nurses. It was terrible. Why they didn't give him a PICC is beyond me. He was off fluids today, so I had to encourage PO fluids and he's still tired. I got him cleaned up finally, which was the first bath and shave he's had in a week. (The Washington folks were "short-handed" he said, so he didn't get a bath). I just can't stand to have people be dirty!
We had to feed him his breakfast, he nibbled at lunch and I had to really push him to drink. He drank more in the afternoon than he did all day. I checked him out again before I left and he was doing better. I still worry about him, though. He's been through a lot.
My other guy went off to his appointment, so all I had to do was get him cleaned up and ready for the pickup. That was a breeze. His neighbor, Yosemite Sam, got cleaned up in the shower today, since he agreed to let his nurse do that. He wouldn't agree to a total scrubdown, though, so she just had to shoot water into the crusty beard and rub.
I got all the rest of my work done with five minutes to spare. It was nice to stroll out on time.
More later...
Tuesday, September 30, 2008
Vacation...all I ever wanted!
Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
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