March 19, 2007, 12:54 pm

My Mind Is Going, Dave…


Just in case you are unfamiliar with one of the Greatest. Movies. Ever. Made., this is a photo of HAL, the computer from the Stanley Kubrick classic, “2001: A Space Odyssey”.

You know, I’ve seen that movie about fifty times and I still don’t get the ending.

It seems that, just like poor HAL in the film, my mind is going.

I missed the deadline for Grand Rounds.

I never miss the deadline for Grand Rounds.


I blame Jazzercise.

If I hadn’t been dancing and sweatin’ to the likes of Gwen Stefani and Taylor Hicks, I would have been home writing a treatise on the ramifications of HIPAA or some other important topic.

Maybe it’s better I didn’t remember the deadline.


Back in the days of yore, nurses actually mixed the IV piggyback medications for their patients.

They took the medication from the cupboard, diluted it with the appropriate dilutant and injected it into the appropriate IV solution.

They labeled the bag with the patient’s name, the date, the time and the medication/dosage on a big honking florescent orange medication sticker that went right on the front of the bag, big as life.

One day it was decided that medication errors could be reduced if the pharmacy made the scheduled piggyback medications and delivered them to the floors.

This meant a great savings of time for the nursing staff. They could simply compare the big medication label to the medication record, then against the patient’s name band and hang the medication.


Lo and behold, it came to pass that a facility in a galaxy far, far away did not feel this was enough.

They required the nurse to highlight the patients name on the medication bag.

In flourescent pink.

Yes, pink.

And then they required the nurse to circle the name of the medication and the dosage on the big honking florescent orange medication sticker.

With a Sharpie.

Only a Sharpie.

A black Sharpie.

It then came to pass that the wise old wizards of medication administration policy at this facility in a galaxy far, far away decided that this policy should be practiced in the emergency department.

And so, in the middle of :

  • Saving lives
  • Treating migraines
  • Reattaching amputated digits
  • Relieving the agony of kidney stones
  • Running patients to the cardiac cath lab
  • Hydrating every case of vomiting in the county
  • Dropping “extreme fevers” of 101 degrees
  • Placing NG tubes in GI bleeders or the owners of bowel obstructions
  • Cleaning up “incontinent” patients who are able to tell you that they are going to have diarrhea approximately ten seconds before producing said excrement


  • Retrieving lost tampons…

…the emergency department nurses must now, for every single IV med, even if the bottle is hanging off the bottom of the bag in one of those “Addvantage” things:

  • Place a patient name sticker on the bag
  • Highlight it in pink
  • Write the date, time, medication, and dosage on a big honking florescent orange medicine label and………..

Something tells me if this facility in a galaxy far, far away has the time to nit-pick about the color of the highlighter used, they must have very few problems, indeed.

Oh, except for the nurse upstairs who was upset that their patient wasn’t fully undressed in the ER.

So, how was your night?



  • beth

    March 19, 2007 at 2:18 pm

    Pink highlighters, orange fluoresent stickers and black sharpies? It sounds to me like a diabolical plot to keep ER nurses from doing their job. Either that or you are about to be punked.

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  • Mother Jones RN

    March 19, 2007 at 3:55 pm

    These sharpie-pen-policies were obviously written by someone who yearns to work for JCAHO, the same people who brought us the med reconciliation form. But, then again, who are we to judge the intelligence and insight of this paper pushing bureaucratic. We are just lowly bedside nurses who do the bulk of the work.


  • Mel

    March 19, 2007 at 4:34 pm

    Obviously, better than yours thanks. I’ll just sit here quietly and be grateful for the co-worker who won’t speak to me because she went to management over a request from me and I won what I didn’t even realize was a fight.

  • N=1

    March 19, 2007 at 4:52 pm

    How I remember making IV additives. First thing I did after getting report was making rounds on all 23 patients (I worked nights), and then retiring to the med closet/room to make dozens of the things – for the entire shift, so that I could pop the ones that needed it into the fridge, and retrieve the rest to get them hung somewhat near their ordered times. Ye gads and little fishes!

    (And Kim – guess who visited my blog last week – JCAHO! They can’t get me now – I don’t work for anyone! Carrie, from NeoNurseChic reminded me that they like to be called Joint Commission. I get out of joint with them, that’s for sure.)


  • Melissa

    March 19, 2007 at 8:59 pm

    It sounds like you have the same problem we do, too many people in middle management without enough to do.

  • scalpel

    March 20, 2007 at 12:00 am

    Outstanding rant.

    I hate pencil pushing meddlers.

  • Steve

    March 20, 2007 at 1:42 am

    Has ANY of these blithering idjits ever proved that marking and labeling and such has ACTUALLY saved a life?!?!?!?? I mean aren’t we suppose to be practicing “EVIDENCE BASED PRACTICE”????? When are we (the sensible nurses) going to find our cajones and challange some of this fal-der-al?

  • Not Nurse Ratched

    March 20, 2007 at 5:52 am

    You have solved a mystery for me! JustCallMeJo left a fab comment on my blog the other day about what to have in your scrub pockets, and I have been wondering ever since what the black Sharpie was for. 🙂

  • Sharon from NY

    March 20, 2007 at 6:35 am

    I already knew that Bureaucratic BS runs rampant in medicine; however THAT is an amazing example of it! And btw Kim, I’m VERY glad to find out that I am NOT the only person who has seen “2001” many, many times and still has NO idea what the heck the ending is supposed to mean! I do, however, more and more often, have “my mind is going Dave” days! (now THAT part I got! LOLOL) Hope today is better for you!

  • greenie

    March 20, 2007 at 7:10 am

    I love this site. Your observations and comments about what you have to deal with and go through give me valuable information as a student. Less book stuff, more real life 🙂
    I just wanted to say I saw your letter to the ed. in the AJN about National Nurse. I was like “hey, I know that nurse!” It was cool.
    Keep doin what you do best

  • may

    March 20, 2007 at 9:37 am

    i pray that the gods of preventing medication errors will not hover in my galaxy and make this same thing happen. i already have a headache asking my patients their name every two hours as it is…

  • marachne

    March 20, 2007 at 11:57 am

    A friend of mine almost quit when, because of impending Joint Commission appearance, they put locks on the medicine refrigerators. In a locked med room. Involving no narcotics/class III drugs.

    It is amazing to me how places (i.e. bureaucrats) freak out around Joint Commission, allowing good sense to fly out the window.

  • Steve

    March 20, 2007 at 4:54 pm

    The fridge that we use to keep oral contrast in…the one that is by the nurses station…nope…can’t keep contrast in there any longer. Jcaho says. Its a med don’t yeah know….can’t let that fridge be pilfered!!!! Egads what would happen to society if we let loose a large quantity of berry flavored contrast!!!

  • Dawn

    March 21, 2007 at 1:24 pm

    Daisy, Daisy, give me your answer doooooooo

    My girls loved that part of the movie, otherwise they had a hard time sitting through it.

    My unit decided to try a one-day trial of putting yet another piece of paper on the patient’s roomdoor, whereby if the patient needed to see OT/PT, Social Services or God-Knows-Who, the nurse could just put a mark on the appropiate space. Yup, just what we needed, more paperwork.

    Lasted exactly one day.

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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