June 18, 2008, 11:31 am

What’cha Gonna Do When They Come For You?

Did you catch this post from Grand Rounds by Peter over at Medical Pastiche?

Doctors weren’t the only ones getting targeted by the cigarette companies. Nurses were used to promote many products because nurses were trusted by the public.

It wasn’t that long ago (oh, mid 1980s) that the nurses in my coronary care unit would sit for report in the room behind the nurses station and smoke!

This was about 30 feet away from the patient’s rooms. And no one thought a thing of it. No need to go outside! And I don’t remember having a problem with it, although now I’d be hacking and coughing in that environment. I figured it was no different than me sitting down with my Snickers bar and cup of coffee.

My older colleagues tell stories of doctors actually smoking in patient’s rooms.

Hard to imagine.

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I came as close to having a heart attack as I ever want to be. I sat down to blog and couldn’t find my “Blog Folder”. Everything I “own” for this blog is in that folder. Three years of collecting nursing ephemera. My entire 50,000 word novel I wrote in 2006. My ideas. My “Blog Brain”!

Found it in the trash can! Just thinking of what could have happened if I had emptied that trash without thinking makes me syncopal.

Time to back up my stuff. After 14 years of using computers daily, you would think I’d know to do that already.

[Shiver]

Maybe I should back it up on my new iPhone 3G. (Compulsory Grand Rounds Theme inclusion! : D)

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The Joint Commission is on the prowl.

Rumor has it that they are coming ANY MINUTE! They’ve already been to some of the hospitals in our organization so that means THEY MUST BE COMING FOR US NEXT!

It’s ridiculous. The level of anxiety is bordering on neurotic. Signs, reminders, posters everywhere! Tiny little Joint Commission “encyclopedias” with everything we could possibly need to know. A four hour mandatory class to tell us what we already know from the last fifty thousand surveys we’ve lived through. Faxes coming through to warn us of what THEY want to know, what THEY are looking at, including how many times a nurse uses hand sanitizer going into a patient’s room.

What about those of us who sanitize coming out of the room so that we are bug-free when we go into the next room?

I draw the line at fliers placed two feet away from the front of the toilet. I mean really. Where are you supposed to go to get any peace?

Of course, when we thought they were amassing forces outside the front gates, all those posters and signs and reminders and booklets had to be put away because it would look bad if the Joint Commission thought we were actually preparing for their arrival.

We even have a script for the operator when the JC arrives. Geeze.

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Now, I’m not ticked off over the patient safety goals although the medication reconciliation form is ridiculous and having to write a written report every time a patient makes a move is a pain in the derrière.

But, in case you are not aware of what the JC requires to keep you, the patient/client/consumer safer, let me give you a few examples of what the JC looks for:

• IV trays behind locked cupboards. That’s so an errant angiocath won’t accidentally fly into your forearm. That’s so the syringes of normal saline won’t find their way into a highly lucrative street trade in salt water.

• Locked dirty utility rooms. That’s so you won’t be tempted to look in the biohazard bin and perhaps finger some blood-soaked old gauze or dripping chux. Plus, the sight of a commode might cause irreversible emotional trauma. And we cannot have patients stealing the urine dipsticks. Just because they look like a rainbow when you pee on them doesn’t mean they are yours to take.

• Locked clean utility rooms. That’s so you won’t be subjected to flying sterile instruments like a hemostat attaching to your fly or ring forceps trying to forcibly remove your tampon. You might mistake the backboard for a surfboard and try to hang ten from the gurney. You see, the JC only has your safety in mind.

• A locked medication room. This will keep you from wandering in to a space the size of a broom closet where you might pick up a vial, have it break in your hand only to have it be something you are allergic to. Lots of people try to find the med room, but only 2 can fit in at a time and you have to pass a bazillion employees to do it. But there is a chance you could accidentally find yourself face-to-face with a Pyxis machine and who knows when it will pull a HAL 9000 and go medieval on your heinnie!

Are you detecting a pattern here? The Joint Commission is fixated on locks. But that’s not the only thing they’ve mandated to keep you safe, here are a few more:

• No beverages at the nurses station. The JC is dedicated to making life as difficult for nurses as possible. It is their prime directive. Star Fleet has less regulations. Give them a beverage as they sit and chart at the desk and they actually have a moment of enjoyment. Nope, not gonna happen! Worse, they will demand to pee which will take them out of commission for 30 seconds and you, the patient, might need something right then!

• Multi dose bottles of medicine are now “one dose and toss ‘em” medications! Yep, although you are charged for the entire bottle of nitroglycerin that was used to assess its effect on your chest pain, you have been diagnosed with hemorrhoids instead. You don’t need to take the nitro home, so it gets tossed. Perfectly good nitroglycerin goes bye-bye. But thanks, you paid for it. That dose of Tylenol your baby got in the ER? It came from a bottle of Infant Tylenol that you are paying hospital price for (that means expensive). I’ll send it home with you, but technically, I’m not supposed to “dispense” medication.

That’s just a little taste of what the Joint Commission finds so important.

Oh, but it is going to get better. The newest patient care issue is skin care/integrity. Mark my word, the day is coming when we will have to strip every patient in the ER and mark every mole, every red spot and every freckle for posterity. Yes, that will be overkill when you come in for an infected toenail, but the JC cares not about practicality.

And you think I’m joking……..