August 16, 2008, 9:17 pm

Do-It-Yourself Medicine Shelf

Does your medicine cabinet look this neat?

Do you even have this many drugs?

My “medicine chest” is in my kitchen. Various and sundry medications and supplements share shelf space with Skippy Extra Chunky Peanut Butter, Smucker’s jelly, Starbucks coffee, Splenda, and CoffeeMate.

I’m ready for nasal congestion, runny nose, nausea, muscle spasms, inflammation, cough, insomnia, diarrhea, indigestion, allergic reactions, superficial boo-boos and headaches.

If I had the appropriate anatomical equipment,  I’d probably be prepared for erectile dysfunction.

And those aren’t even my prescription meds!

Oh, I don’t take them all, but just in case someone has a symptom, I am ready!

Better living through chemistry, that’s my motto!

******************************

Now that the asinine medication reconciliation sheet is an asinine intimate part of the medical record, it’s time to look past the inconvenience, the increase in paperwork and the loss of time at the bedside.

The bottom line is that when you are admitted to the hospital, you are writing your own prescriptions.

The medications you state you take, in the dosages you provide will be ordered, based on the medication form.

This is good, yes?

Only if you are dead certain of what you are saying. Only if you are not writhing in pain and are with it enough to remember all your medications. All of them. Only if you are absolutely certain of your dosages. Only if the list you “always carry” is up-to-date.

If not, then you run the risk of not getting your usual medications in the hospital, getting medications or dosages that were not part of your daily routine or new medications that interact with your old ones.

*****

The whole point of the med rec form is to provide continuity between your pre-hospital, in-hospital and post discharge medication regime.

This wasn’t necessary back in the days of “Marcus Welby, MD”, when your primary doctor followed you in the hospital. She knew you well, knew your family, knew your medical history. Your medical record was the chart in her office, to which she always had access.

Today, you will most likely be admitted by a hospitalist who will coordinate your care and have (possibly multiple) consultants who will deal with specific medical issues. These doctors may or may not know you, and they rely on what is written on the medication sheet to guide their ordering.

They will base your medications on that and they will use the med sheet to avoid medication interactions when they write new orders.

  • That means, if you can’t remember your medication dose, and you guess at it, that guess becomes your dose. Maybe it’s right, maybe not.
  • That means that “I take a water pill, a blood pressure pill, a sugar pill and a stomach pill” will pretty much guarantee that your usual medications will not be ordered, at least in the beginning.
  • That means “my doctor has a list of all my meds” means nothing after office hours because (a) the office is closed and (b) your doctor is probably not on call and trust me, the on-call doc is not going to go to the office and look you up right then and there.

This means that in this day and age, you better have a list, it had better be accurate and it had better be up-to-date and in your wallet (not your wife’s purse or your husband’s papers) at all times.

*****

You would be stunned at the number of alert, oriented, intelligent adults who honestly have no clue about their medications or are so stressed on admission that they cannot remember clearly.

The vast majority of physicians will move hell and high water to find out what you are taking and order appropriately. Then again, some will take that med rec sheet so literally that all they will do is check the “order” box next to what is written: medication names that you provided and medication dosages that you stated

So, it is to your advantage to make it as easy as possible for your hospital health care providers to make sure you receive the appropriate medications.

The majority of this responsibility is now on you, the patient.

Not the doctor. Not your family. Not the paramedic who has to go through your medicine chest.

You.

Make a list of what you take, keep that list up-to-date and keep it with you at all times.

I know it sounds crazy, but under the medication reconciliation requirement, you are essentially writing your own prescriptions when you are initially hospitalized.

Make sure you know what they are.

You health, and your life, may depend on it.

******************************

Major hat tip to my (very) esteemed colleague who actually had the idea for this post and graciously let me use it!

August 15, 2008, 8:28 pm

The Waiting is the Hardest Part

Another offering to the god of constipation.

Okay, fess up.

How many of you snuck Ex-Lax pieces out of your Grandmother’s medicine cabinet because it was “chocolate”?

I did.

Guess what happened…

Nothing.

No diarrhea. No abdominal cramping.

Nada.

Well, something actually did happen.

I got caught!

And back in the early 60’s, pre-Dr. Spock days of child discipline, one did not sit one’s child in the corner for a “time out” or have a “discussion” with one’s preschooler.

If you get my drift.

Let’s just say that I never, ever did that again.

********************

I was on my way back from Employee Health, where I had received my annual TB test. I was pleasantly surprised to find out that they had titres on file for my childhood diseases.

It’s a wonder I lived past the age of eight. I have had rubella, rubeola, varicella-zoster and mumps!

But I digress…

I needed these lab values to send to Green Bay to be on-file when I began my community nursing practicum. But there was no mumps titre.

Hence my early morning trip to our hospital laboratory at 0750.

*****

The waiting room was packed. Solid.

I immediately started getting tense. I had to be home by 1030, and I had a 40 minute commute. I signed my name on a slip and placed it in the “to-be-called” box. I skrunched into a corner seat with a good view of The Today Show.

I was never going to get out in time.

I just knew it.

What the hell was the lab doing back there? Baking biscuits for breakfast?

****

One patient was called.

I noticed that Matt Lauer was growing some hair back.

And when the hell did Al Roker lose all that weight?

I don’t watch the Today show very often.

*****

Another patient was called.

Good Housekeeping had an article on spicing up your sex life.

(Yawn.) Yeah, okay.

People had an article on Britney.

(Yawn and gag.)

*****

Another patient was called.

Dammit! I have things to do today.

The local forecast calls for sun.

Of course it does.

This is July in the San Francisco Bay Area, you were expecting snow?

*****

“Kim?”

Ah…finally! This wait has been ludicrous.

Tourniquet goes on. Blood comes out.

The tech and I chat about the ever-impending Joint Commission visit.

Finally, I am free to head home.

The lab is so damn slow!

*****

It was 0820. I had taken a seat, been registered and had my blood drawn within only 30 minutes.

30 minutes.

In the time it takes Dominos to deliver, the lab had drawn four patients including myself.

They were hauling butt back there.

But it didn’t feel like that in the waiting room.

*****

I felt like an idiot for being so tense and inwardly impatient.

But now I understand why someone will be upset that it took an hour-and-a-half for their abdominal evaluation in the ER. There are two reasons.

One, they don’t understand how the department works. We see the overview. They see themselves.

And two, time really does distort when you are waiting.

Now I get it.

******************************

An original post from www.emergiblog.com.

August 11, 2008, 2:30 pm

Termination in Five…Four…Three…

Here we see registered nurses working in the laundry room.

Whatever they are doing, it’s out of the same material “of which Kotex is made”!

So… Kotex is made from hospital towels?

Doesn’t this make you wonder what the other 15% of hospitals use?

How many “absorbents” are on the market anyway?

Reminds me of when I shadowed a nurse who was the head of Central Supply as part of our rotation in nursing school.

Not one iota of patient care! She didn’t even put together trays, let alone wrap them.

I’m sure it was a big responsibility, keeping a large medical center in sterile instruments, but it hardly took an RN to do it.

I remember thinking, “What a cu-shy job!”

********************

I am a manager’s worst nightmare.

I procrastinate. I admit it.

I turn in certifications on the last day. If my license if due to expire on the 30th, I have it in on the 29th. Apparently this causes emotional stress in administration as they face the ever-impending Joint Commission search of all files related to employees.

But I have a feeling I may not be the only one.

*****

Superior Medical Center has now started “the countdown”.

For example, I might find this in my mailbox.

Dear Staff Member,

This is to inform you that your ACLS/BCLS/PALS/TNCC/ENPC/ATLS/CEN/Nursing license is due to expire in two years.

Please provide a copy of your new card.

Failure to do so can result in termination of your employment.

Sincerely,

Management

This is followed up with exponential frequency, and ever more ominous threats of dismissal if said card is not provided.

So, you provide said cards, despite the fact that not having to come to work would be a wonderful reason for not providing it.

*****

Then you find this in your mailbox:

Hey Staff Person,

Your ACLS/BCLS/PALS/TNCC/ENPC/ATLS/CEN/Nursing license expired two months ago.

If you don’t get your butt in gear, like, tomorrow, you’ll be like, homeless in a month because you won’t be getting a paycheck anymore, and if we have to send another message, it will be with Tony Soprano, capiche?

Sincerely,

Management

Now you know you sent that damn card in. So you call Human Resources, the source of the threat letters.

*****

“Human Resources”

“Hi, this is Kim from the Emergency Department. I just got a rather threatening letter regarding an ACLS/BCLS/PALS/TNCC/ENPC/ATLS/CEN/Nursing license that I submitted two months ago.”

“We never received it.”

“Well, I sent it.”

“Where did you send it?”

(Sigh) “I gave a copy to my manager and sent one to the nursing office like I’m supposed to, dork.

“Oh, that’s the problem! The nursing office doesn’t handle nursing certifications anymore. HR does it now.”

“Excuse me? When did the nursing office, the one-stop-shop for all our nursing needs, stop keeping track of the nurses?”

Yadda, yadda, yadda.

*****

Now wait just a minute here.

My facility is not a huge, faceless World-Renown- Hospital-With-Attached-Medical-School. If my wayward in-house mail was opened in the Nursing Office, why would the person in question not put it back in the manila envelope, mark it for HR and send it on its merry way?

And where did my copy go, if not to HR?

Something tells me that the manager of engineering now knows I passed ACLS.

*****

The moral of the story?

I turn my cards in on time.

And I make three copies of the card in question and hand them personally to the HR department.

God forbid they send Tony Soprano to my house.

Then again, he likes Journey so he can’t be all bad.

******************************

An original post from www.emergiblog.com.

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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