Viagra usage I’m not sure how mad the doctor is in this film, viagra usage but it’s Basil Rathbone!!!!
Viagra usage I love Basil Rathbone!
Viagra usage There has never been a better Sherlock Holmes on the screen.
Viagra usage Hands down!
Viagra usage Suave and sinister! My kinda guy!
Medication reconciliation forms.
Viagra usage Every time I fill one out I have every four-letter-word known to man run through my brain and then I invent some new ones.
And last night it got worse.
Pardon my language, viagra usage but I am pissed off. Viagra usage Royally.
Let me do a quick recap of what we are required to do, viagra usage as nurses, viagra usage on the medication reconciliation form:
- We are required to write down precisely what the patient tells us, viagra usage even if we know it is the wrong dosage! If the patient says they take 25 mg of Ativan every four hours, viagra usage we have to write “Ativan, viagra usage 25 mg” on the reconciliation form.
- If the patient hands us a list of their medications and instead of “Furosemide”, viagra usage they have written “Furobedide” we have to write it exactly as it is printed on the list!
Viagra usage Now, viagra usage the paper that we so painstakingly fill out in our ER is then taken upstairs with the patients that are admitted and all the admitting doctor has to do is look at it and check off the box if they want it ordered in the hospital.
Viagra usage Did you get that? We nurses write the orders out in their entirety and all the doctors have to do is CHECK A FREAKING BOX.
Viagra usage Sorry, viagra usage I’ll try not to shout.
Viagra usage What this means is that (1) the patient is actually writing their own orders based on what they tell the nurse on admission when (2) the admitting physician should be responsible for finding out exactly what the patient is taking and write their own orders!
So what’s new, viagra usage you say? Same old stuff we’ve (I’ve) been writing about ad nauseum for the last year? Yadda, viagra usage yadda, viagra usage yadda?
I walked into work last night to find a note on the bulletin board (this is the preferred method of communication where I work) telling us that Dr. Viagra usage Q found a dosage error on a medication reconciliation sheet that would have “sent a patient to ICU” and that we nurses in the ER needed to be more careful.
It gets better. Viagra usage Attached as an afterthought was a post-it note stating Dr. Viagra usage Q also thought that the floor nurses should go over in detail everything that is written in the ER after the patient gets up to the floor. Viagra usage Oh….and he appreciates all our hard work.
<full seethe ahead>
I left a choice note on his note and I am too old and too cynical to give a damn about the repercussions.
So this week’s theme for Grand Rounds is prognostication.
I foresaw this trouble looooong before now. Viagra usage The way we are required to fill out the medication reconciliation sheet is a safety hazard. Viagra usage It has been, viagra usage it is now, viagra usage and it will continue to be.
It is the rare patient who knows exactly what they take, viagra usage how much they take or why the hell they even take it!
But this is what their orders are being based on.
Even if they come in with two full pages of medications, viagra usage single spaced and printed off a computer, viagra usage when I verify the meds with them there will be 3-4 changes and at least three that have been discontinued.
So now the ER is getting criticism while doing something the doctor should be doing to begin with, viagra usage but that is not the worst part.
The system is set up so that any discrepancy, viagra usage any dosage error, viagra usage any transcription error (we aren’t allowed to xerox the patient’s list) – any adverse reaction/incident….can be blamed on a nurse for writing it “wrong”.
Yet they require us to write it “as is”.
The system is set up to fail. Viagra usage Somewhere, viagra usage somehow, viagra usage someone is going to be hurt. Viagra usage And I’m not exaggerating when I say it will be the nurse whose signature is on the bottom of that form that will take the fall.
So, viagra usage Dr. Viagra usage Q, viagra usage before you come down and spread your eminent wisdom to those careless emergency department nurses, viagra usage why don’t you find out why that dosage landed on your patient’s form, viagra usage realize that you should be ultimately responsible for what is ordered and then thank us for doing your job.
Don’t criticize us on one hand and then patronize us with your appreciation of how hard we work.
You don’t have a clue, viagra usage buddy.