Thursday, February 19, 2015

Anybody? Anybody?

No ranting or political anything in this post.

Actually, it's just an adorable story that was related to me by a new, very cool acquaintance.  And, it's a good reminder to me that those of us in ER should consider the perceptions of other members of the healthcare team.

At a recent party, I met a really smart little Hipster Gal who works in marketing at a hospital where a fellow travel nurse is currently working.  This drew my interest right away because one of my bestest friends, Legs, also works in marketing for a medical group.

Hipster Gal began talking about her younger sister, in her early 20s, who only recently completed her training to be a phlebotomist --y'know, the person who draws your blood.  So, this very young 20-something has very, very limited experience, but was stationed in her hospital's ER  on her first shift.  She ended up in a room with a full on CPR code.  The team had been unable to gain peripheral IV access so they inserted an IO (intraosseous) needle.  This means a very large needle that is forced into the bone (most often in the shin, but more and more in the shoulder) to use the bone marrow as the venue for intravenous medications and fluids.

Now, there are plenty of emergency crew members who don't encounter an IO for quite a while into their first year or even longer.  So, for a kid with no actual medical experience to be thrown into that scene on her first day had to be a bit overwhelming.  Just watching an IO be inserted can be hard.  It's kind of brutal -- but always completely necessary when performed.  It's a last ditch option for administering life saving medications.

Now, while this is all going on, CPR is in progress.  Apparently, as often is the case, after exhausting all treatments, the doctor was ready to call the code, but asked what is almost always asked, in various verbiage,  before declaring death, "Anybody got any objections to calling it?"

This poor kid, seeing this person laying there, exposed, with needles and wires and tubes coming and going, thinks this is a vote.  And, all she can figure is, "If I don't say something, they're going to say this person is dead!"

She was unaware that the person WAS dead.  We don't code living people.  If we are doing CPR, we are attempting to reverse the current state of not alive.

I feel sorry for her that she was thrown so far into the deep end on her first day.  But, it seems she sort of rolled with it and, hey, it can only get easier for her from here.

Friday, February 13, 2015

Continuous Improvement AND Respect for People

I love this blog post.

It explains, perfectly, why I so resent the new rule we have been handed down in my workplace.

Just as this article postulates, as is the case with most folks, if you give me a good reason why I must do things a certain way (ie, urinary catheter prevention, ventilator assisted pneumonia prevention, bedsore prevention, etc) and I am on board.

Give our team input on making things better and the productivity of our department skyrockets (our ER has amazing, trend-setting throughput models that the staff helped to organize).

It demeans educated, skilled people to simply hand down a ridiculous rule with no context, no explanation and no apparently valid reason.

Some background: most all emergency departments use computers on wheels to be mobile, move from room to room and still document in real time.  We use them to scan medications for administration and for collection of all samples as well as documenting care/vital signs/assessments, etc.  Small sidetrack -- we used to call them COWs (computers on wheels). We now call them WOWs (workstations on wheels) swear to Tebow, because someone somewhere thought it could be perceived as insulting to hear them called cows.

Of course, there are not always enough of these to go around, but we need them literally all day, all the time.  So, we tend to pick one, clean it off with antiseptic wipes, log in (we have a quick couple of keys to tap and lock it so that we are HIPAA compliant) and label it by putting our names on a little piece of paper and taping it to the WOW.  This way, it's always available and no one makes off with it without at least saying, "hey, can I borrow your WOW?"

The rule?

We can't put our names on the WOWs.  Why?  It's in violation.  Of what?  A rule.  What rule?  Well, it's a rule.  Whose rule?  Well, maybe Joint Commission.  Really?  Why would Joint Commission care?  What's the reason?  We don't know.  Just don't do it.

Tell me I must do something or not do something "because it's the rule"? can pretty much figure that I'm going to ignore that rule or find a way around it.  And so will most people.