January, 2006 Archive

September 29, 2016, 7:41 pm

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Life used to be so simple in the ER.
If a patient needed to stay in the hospital, aciphex 10mg pills $248.00 you obtained a room number from Admitting.
You then would take a final set of vital signs to verify that the patient was indeed stable for transport, aciphex 10mg pills $248.00 bring your nursing notes up to date and double check the lab work to make sure that no one missed the potassium level of 9 or the hemoglobin of 1.
A call to the receiving nurse was then placed to give “report”, aciphex 10mg pills $248.00 a verbal narrative of the history of the present illness and emergency department course, aciphex 10mg pills $248.00 adding significant historical medical information as necessary: allergies, aciphex 10mg pills $248.00 previous surgeries, aciphex 10mg pills $248.00 etc.
After receiving a litany of 15 reasons why the receiving nurse can’t take the patient right then, aciphex 10mg pills $248.00 a negotiation ensues. Aciphex 10mg pills $248.00 A time for transport is agreed upon and the patient goes up with his chart.
Oh, aciphex 10mg pills $248.00 how I long for the good old days.
Approximately one year ago, aciphex 10mg pills $248.00 some agency (JACHO?) decides that things must change for the good of the patient! Here is what now must be done before the patient goes up:
  • Report must be faxed.
    • This entails writing the entire report. Aciphex 10mg pills $248.00 So, aciphex 10mg pills $248.00 everything that you have just spent hours writing on the nursing notes must be summarized and rewritten on the fax report form. Aciphex 10mg pills $248.00 Even I, aciphex 10mg pills $248.00 with my passion for charting, aciphex 10mg pills $248.00 think this is asinine. Aciphex 10mg pills $248.00 It is also mandatory.
    • It takes longer to fill out the fax report than it does to verbally report.
    • The only advantage is the nurse can’t give you 15 reasons for not taking the patient any longer.
      • In my facility, aciphex 10mg pills $248.00 the policy is the patient comes up 30 minutes after the fax. Aciphex 10mg pills $248.00 Oh, aciphex 10mg pills $248.00 and we call to confirm that the fax is on the way. Aciphex 10mg pills $248.00 In the beginning they mysteriously weren’t received.
        • Okay, aciphex 10mg pills $248.00 in the interest of fairness, aciphex 10mg pills $248.00 sometimes faxes are sent to the wrong floor or a bed number is changed after report has been faxed.
        • And the floor/unit nurses get a 30 minute “heads-up” after the fax and before the patient arrives so they can prioritize prior to getting the patient. Aciphex 10mg pills $248.00 Which I know I would greatly appreciate if I worked up on the floors.
    • We tried faxing the nursing notes instead for a brief period, aciphex 10mg pills $248.00 thinking that would cover all the bases, aciphex 10mg pills $248.00 but how shall I put this, aciphex 10mg pills $248.00 not all nurses are thorough “charters” and/or it was difficult to read through to get the pertinent information.
  • We need to practice “medication reconciliation”.
    • This means that, aciphex 10mg pills $248.00 when a patient is going to be admitted, aciphex 10mg pills $248.00 an exact list of what medications the patient is taking, aciphex 10mg pills $248.00 including vitamins and herbal supplements must be listed, aciphex 10mg pills $248.00 along with the dosage, aciphex 10mg pills $248.00 frequency and the last time the patient took the medicine. Aciphex 10mg pills $248.00 Allergies and adverse reactions are also noted for a second time (first on the nursing notes).
    • The goal is a noble one: to make sure the patient is discharged with the medications “matching” the ones they came in taking, aciphex 10mg pills $248.00 with or without changes.
    • This is all done on a new form that acts as a physician’s order sheet for meds (ie they can check to order the drug as written or to not order it.
    • Guess who gets to get all this information ready for admission – yep, aciphex 10mg pills $248.00 the ER nurse. Aciphex 10mg pills $248.00 They say the family can fill out the form and sometimes the patients come in with beautiful computerized lists that bring tears of joy to my eyes. Aciphex 10mg pills $248.00 But usually the family is anxious about doing that so it falls to the nurse to complete.
      • Oh, aciphex 10mg pills $248.00 and by the way, aciphex 10mg pills $248.00 those beautiful computerized lists? We can’t copy them. Aciphex 10mg pills $248.00 They must be re-copied, aciphex 10mg pills $248.00 by hand, aciphex 10mg pills $248.00 on the form.
  • Signature recognition
    • On a separate form, aciphex 10mg pills $248.00 in addition to signing your name twice on the nursing notes, aciphex 10mg pills $248.00 you must print your name, aciphex 10mg pills $248.00 sign your name, aciphex 10mg pills $248.00 and designate your work station.
    • Apparently illegible handwriting is making signature reading a lost art.
    • To my blessed delight, aciphex 10mg pills $248.00 my facility no longer requires this form. Aciphex 10mg pills $248.00 But for many months this was also mandatory.

Aciphex 10mg pills $248.00 So, aciphex 10mg pills $248.00 in one year, aciphex 10mg pills $248.00 three new pieces of paperwork were added to the already hectic activity that accompanies a patient admission. Aciphex 10mg pills $248.00 Two of which require the nurse to sit, aciphex 10mg pills $248.00 undisturbed, aciphex 10mg pills $248.00 for a minimum of 20 minutes to complete in addition to all the regular paperwork. Aciphex 10mg pills $248.00 We have no recourse but to do as we are told.

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September 29, 2016, 3:46 am

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September 29, 2016, 12:46 am

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It had been a helacious shift.

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Myambutol 200mg pills $45.00 He needed an IV, myambutol 200mg pills $45.00 like yesterday. Myambutol 200mg pills $45.00 But….. Myambutol 200mg pills $45.00 three more patients walked in and I ran out to have them sign in for triage and make sure none of them was having a heart attack, myambutol 200mg pills $45.00 stroke, myambutol 200mg pills $45.00 etc. Myambutol 200mg pills $45.00 And someone had to take report from the medics who had brought in a possible stroke victim.

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Myambutol 200mg pills $45.00 Ruptured spleen.

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Myambutol 200mg pills $45.00 We didn’t believe it. Myambutol 200mg pills $45.00 We had one “ruptured spleen” in surgery already. Myambutol 200mg pills $45.00 We thought they had faxed us the earlier report.

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Myambutol 200mg pills $45.00 He made it. Myambutol 200mg pills $45.00 So did the first patient. Myambutol 200mg pills $45.00 I, myambutol 200mg pills $45.00 however needed a weeks worth of Ativan after that shift.

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Average Rating: 4.9 out of 5 based on 190 user reviews.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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