A place to think, to write without getting my chair jostled or my elbow knocked or my charts shifted.
Most of my ERs have been short on desk space. Chairs are at a premium. If you are charting and you get up to answer a call light, by the time you get back your charts are stacked and shoved to one side with someone else’s derriere warming the seat cushion.
Imagine a U-shaped “nursing” station. The EDMD desk takes up 33%. The unit secretary takes up about 33% This leaves the remaining 34% to divide between 3 – 4 nurses at any given time. And an ER tech. And any primary docs that show up.
It gets pretty cozy in there.
The NP/PA gets to have the little desk around the corner. The one with the computer. Not that I’m jealous.
Medication rooms have become sacred locations.
One is not to speak while engaged in the preparation of medication.
One is not to speak to anyone engaged in the preparation of medication.
It’s for safety. It helps prevent medication errors.
Signs are posted.
Do not disturb.
Silence is golden.
It’s a great policy, given the hectic atmosphere of an ER. Having quiet, uninterrupted time to focus on medications is a godsend.
In the med room.
So why are they saying we should prepare/draw up the medication at the bedside?
Have you ever heard what goes on at the bedside?
It’s something like this:
“Hello, Mrs. Jackson! I have medication here for your pain and something for your nausea.”
“What are you giving her?”
“She wants water.”
“It’s cold in here!”
“Can I have a blanket,too?”
“Are you calling her primary doctor? Is he coming in? When will he be here? What do you mean he isn’t on the way?”
The patient hasn’t even spoken yet.
“I’ll be giving you some Zofran for nausea and some Dilaudid for pain control. Do you have any allergies?”
“Zofran never works.”
“OMG, they are giving you Dilaudid? Grandma had hallucinations on that!”
“Are you sure you aren’t allergic to that? Wasn’t it something with a “d”?”
“She has a high threshold for pain medications, she’ll need more.”
The patient informs me that she has no allergies.
“What level is your pain right now?”
“It’s a 10. It’s more than a ten! Tell ’em it’s a 10, Betty!”
“Oh Betty, tell the truth, it’s much more than a four!”
“Be careful, Betty, you don’t want to get addicted!”
“Grandma hallucinated on that stuff!”
The patient has informed me her pain level is at a 4/10. I turn to draw up the medication.
“How long is she going to be here?”
“What’s wrong with her?”
“Can we use a cell phone in here?”
“Ooops, there goes my cell phone!”
“NO BABY, I CAN’T TALK NOW, MY AUNT BETTY IS IN THE ER AND I HAVE TO BE QUIET, COS SHE IS LIKE, IN PAIN, AND SHIT, AND THEY ARE GIVING STUFF THAT WILL MAKE HER HALLUCINATE LIKE GRANDMA! NO…BUT….THAT AIN’T WHAT I SAID….WELL F*** YOU, TOO!
“Jolene, take that outside right now!”
“Oh man, we are going to be here that long? I was hoping to get home before the game starts.”
“Will she be admitted?”
“We can’t take her home.”
And yadda, yadda, yadda; ad infinitum.
The bedside in an ER is not a place of peace and quiet; ERs can be chaotic places.
It is our duty to maintain patient safety in medication administration in all scenarios.
But if it has been shown that preparing medications in a quiet environment without distractions results in fewer medication errors, doesn’t it make sense that the majority of this preparation should be done in the quietest, least distracting location?
Like the med room.
Instead of at the bedside?