OG tubes......

Goose Xx, MSN, RN, EMT-P, CRNA · Sep 3, 2013

I work with students in a lousy program. They drop OG in all intubated patients. They drop temp probes in everyone even though there is nothing more they can do to warm the patient and the case is so short a temp. is not significant. In short, it's the cook book approach which I see at work in all recent grads, MD or CRNA. We've dropped our standards to let people in CRNA programs who will never have the aptitude or intelligence to rise above high mediocrity. And unless they've recently left the table from a big steak dinner, that little old NG is going to miss a lot. You're fooling yourself if you think you're doing anything of benefit to the patients (except in those cases where it's indicated....but that would require THINKING).[/quote']
So you vote no for OG's. Just kidding. I agree.

allnurses Guide · Sep 3, 2013

I do see new MDAs and CRNAs most often following "cook book" anesthesia or basically just like they were taught in school New anesthesia providers are also the ones most likely to change their practices and follow EBP, whereas I see more experienced anesthesia providers very reluctant to follow new EBP unless forced to do so. There are pros and cons to everything....

Go-GetterRN · Aug 31, 2014

I know this is a pretty old topic, but i was just reading and some questions came up in my head. I am currently a RN, I plan on applying to crna school in a year. A trend I have noticed firsthand in a lot of ICUs is the guidance of medical/nursing care by insurance companies (mainly Medicare/medicaid.) Things like quality measures, core measures, etc that say we HAVE to do x, y, and z interventions and treatments on all of our patients or we (the hospital) won't get reimbursed. I'll use the common example of SCDs/lovenox. Back in the day, nurses made the assessment that their patient was bed-bound and thought to themselves, 'hmm my pt is at risk for blood clots due to venous stasis so maybe i should call a doc for a lovenox order or SCDs'. They then called the doc and got orders and all was well. But this day in nursing, ALL patients in the icu get SCDs and/or lovenox whether they are bedbound or not (thats my hospital's policy.) This is just one of MANY similar policies. BTW, I'm not saying these are bad things because I'm willing to do whatever has been proven to increase patient outcomes, I'm just saying all these small things get tedious and make me feel like I'm not allowed to make any decisions regarding patient care.

So my question to crnas and srnas is, do you see similar things happening in anesthesia that may take some of the critical thinking out? Similar to scd/lovenox being mandatory for all icu patients, do you think og/ng tubes will be mandatory for all surgical pts requiring an ETT in the future?

allnurses Guide · Aug 31, 2014

I know this is a pretty old topic, but i was just reading and some questions came up in my head. I am currently a RN, I plan on applying to crna school in a year. A trend I have noticed firsthand in a lot of ICUs is the guidance of medical/nursing care by insurance companies (mainly Medicare/medicaid.) Things like quality measures, core measures, etc that say we HAVE to do x, y, and z interventions and treatments on all of our patients or we (the hospital) won't get reimbursed. I'll use the common example of SCDs/lovenox. Back in the day, nurses made the assessment that their patient was bed-bound and thought to themselves, 'hmm my pt is at risk for blood clots due to venous stasis so maybe i should call a doc for a lovenox order or SCDs'. They then called the doc and got orders and all was well. But this day in nursing, ALL patients in the icu get SCDs and/or lovenox whether they are bedbound or not (thats my hospital's policy.) This is just one of MANY similar policies. BTW, I'm not saying these are bad things because I'm willing to do whatever has been proven to increase patient outcomes, I'm just saying all these small things get tedious and make me feel like I'm not allowed to make any decisions regarding patient care.
So my question to crnas and srnas is, do you see similar things happening in anesthesia that may take some of the critical thinking out? Similar to scd/lovenox being mandatory for all icu patients, do you think og/ng tubes will be mandatory for all surgical pts requiring an ETT in the future?

Anesthesia care is still quite individualized. All of medicine/nursing had quality of care indicators anymore but thankfully a lot of receipe type care has been avoided in anesthesia so far.

Go-GetterRN · Sep 1, 2014

Ok thats good to hear. I'm guessing there would be a lot of complications with enforcing those type of things on anesthesia providers because a lot of the time they arent hospital employees. But it wouldnt surprise me if medicare and friends started threatening to cut anesthesia reimbursment if the most current EBP isnt being practiced. But even still, I've been told theres many ways to get the job done in anesthesia, so theres probably not strict guidelines they could enforce for every case. Thats one of the things thats so fascinating about the profession

subee, MSN, CRNA · Sep 2, 2014

I disagree somewhat. I just retired after 35 years and remember frequently complaining how cookbook it was becoming. It struck me that we were constantly compromising ourselves to accommodate the lazy or incompetent people. It really annoyed me to have to put an X in the box that antibiotic was given on time and pt. had been beta blocked (talk about cookbook!). When the day came that I had to turn my back on the patient to put little X's in the boxes on the computer, I quit. But by that time I was already old and cranky and was losing the power in my hands.

etherscreen · Sep 9, 2014

Surgeons do things the same way every case, those of us in anesthesia should be making decisions based on a particular patient for a particular case at a particular point in time.

"Always" and "never" are dangerous words in our profession.

And no, I do not place OGTs without a specific indication.