Thrifty Facilities?

  1. Ever work in a facility where there are no TB syringes? I had to give
    morphine injections to a dying patient the other night and, was surprised to
    find that this place used 1cc insulin syringes for this and for heparin and PPDs as well, I would presume. I was told by the staff that it was a major issue to ask for any IM syringes.

    I can understand being thrifty, but most LTC facilities are privately owned, sometimes by a group of investors or in this case by a family, living far away in a sunbelt state. This is just one example of their cost saving measures.

    They also have the very cheapest, flimsiest gauze face masks that wouldn't protect you from a good sneeze or anything else.

    It is not unusual to postpone obtaining urine specs because there are no
    cath kits or the components to make a kit. It is becoming harder each year
    to work in these places. I pity the staff since I work thru an agency and
    don't have to deal with this on a daily basis.
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  2. 26 Comments

  3. by   traumaRUs
    Its not just nursing homes either. I work in a for-profit hemodialysis unit that allots two and just two 4X4's to cover the needle insertion sites!!!

    I found this out by accident when I was examining a pt and he started to bleed and I grabbed a few (maybe 3-4) 4x4's and was rudely told that I was "wasteful."

    Gee whiz....next time I'll have the patients bring their own!
  4. by   SuesquatchRN
    Heh.

    I needed surgical tape Monday. Was given ONE roll.

    I put it in my pocket or I'll never see it again.
  5. by   GardenDove
    Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.
  6. by   SuesquatchRN
    Quote from GardenDove
    Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.
    Wasteful of what? I should stint on the Betadine? Suction with a sterile trach kit less frequently? Reuse disposable gloves?

    Seriously. Where would you suggest we stint?
  7. by   GardenDove
    You don't think medicine is wasteful? I see appalling waste everyday. I don't blame it on individuals, but our system is incredibly wasteful of materials and resources, in my opinion.
  8. by   SuesquatchRN
    I don't see waste of material in my facility, no. Waste of resources - well, it is amazing to me that someone 87 and dying is getting daily tests, but do you want to explain to the non-paying family that maybe the money would be better spent on a younger person?
  9. by   indigo girl
    Quote from GardenDove
    Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.
    SOME, yes of course, but I really do not think that is a big issue in LTC today. I can not speak for hospitals as I no longer work in that area. What I do see, and pretty consistently, is that some facilities are so frequently short of supplies, that you have to wonder how they even manage to function daily.

    Just a few more examples, one place seldom has enough linen at night, in fact this is common in a number of facilities. If a GI bug hits, as it did a number of facilities recently, it was a hugh problem. Yet, should the state appear at the door, like magic, brand new linen (unstained) appears from the locked basement storage areas. Staff are forced to make difficult choices all the time about how to keep residents dry and clean with inadequate supplies.

    I have seen them have to use wall soap dispensers because there were no
    bottles or even bar soaps available to wash residents.

    Or picture a facility with 4 different units having to use one glucometer between them and down to their last bottle of test strips. What time do we all have to start doing our fasting blood sugars? It is not unusual to have one pulse oximeter or thermometer device being shared by 4 or 5 different units. You are always waiting or searching for these machines. And because in many places, the nurse must do the vital signs herself, she is the one spending valuable time searching for the equipment. So, whenever there is an outbreak of noro virus or flu (like every winter) with several patients sick, it becomes very difficult, stressful, and time consuming.

    I could go on and on, but I think most in LTC are seeing this. Are we wastful? How can we be? There is barely anything left to waste!
  10. by   withasmilelpn
    Quote from indigo girl
    SOME, yes of course, but I really do not think that is a big issue in LTC today. I can not speak for hospitals as I no longer work in that area. What I do see, and pretty consistently, is that some facilities are so frequently short of supplies, that you have to wonder how they even manage to function daily.

    Just a few more examples, one place seldom has enough linen at night, in fact this is common in a number of facilities. If a GI bug hits, as it did a number of facilities recently, it was a hugh problem. Yet, should the state appear at the door, like magic, brand new linen (unstained) appears from the locked basement storage areas. Staff are forced to make difficult choices all the time about how to keep residents dry and clean with inadequate supplies.

    I have seen them have to use wall soap dispensers because there were no
    bottles or even bar soaps available to wash residents.

    Or picture a facility with 4 different units having to use one glucometer between them and down to their last bottle of test strips. What time do we all have to start doing our fasting blood sugars? It is not unusual to have one pulse oximeter or thermometer device being shared by 4 or 5 different units. You are always waiting or searching for these machines. And because in many places, the nurse must do the vital signs herself, she is the one spending valuable time searching for the equipment. So, whenever there is an outbreak of noro virus or flu (like every winter) with several patients sick, it becomes very difficult, stressful, and time consuming.

    I could go on and on, but I think most in LTC are seeing this. Are we wastful? How can we be? There is barely anything left to waste!
    It sounds like you work at my facility! Even worse, in my opinion is the 11-7 nurse supervisor that shrugs and says, "I guess we won't do them then", when it looked like we were running out of test strips. Excuse me?!? Much as I love my patients I'm beginning to think I don't want to work in LTC or even nursing anymore. It just seems like nobody cares.
    I do get frustrated with waste though- like a patient gets d/c'd home and their meds get wasted. 1000's of dollars down the toilet. Or how about reams of redundant paper charting?
  11. by   stillpressingon
    Quote from withasmilelpn
    It sounds like you work at my facility! Even worse, in my opinion is the 11-7 nurse supervisor that shrugs and says, "I guess we won't do them then", when it looked like we were running out of test strips. Excuse me?!? Much as I love my patients I'm beginning to think I don't want to work in LTC or even nursing anymore. It just seems like nobody cares.
    I do get frustrated with waste though- like a patient gets d/c'd home and their meds get wasted. 1000's of dollars down the toilet. Or how about reams of redundant paper charting?
    Yeah, isn't it crazy how stuff that we should be scrimping on we "can't," and things we shouldn't, are "essential for the benefit of our pt's" Huh?? Oh, Brother!
  12. by   SuesquatchRN
    You said it, Indigo Girl.

    But we don't waste meds, except narcs. We keep 'em to use when we need to start someone on something STAT and can't wait for the out-of-facility pharmacy to deliver. Plus, we can only order one week before running out.
  13. by   BULLYDAWGRN
    suessquatch i'm tending to agree with you on the 87 yo thing. we get terminal ill full dnr pt's admitted to our icu every day. now these pt's could easily be managed on a less skilled or less exspensive floor/unit per say. but as far as being wasteful with supplies, yes i've been guilty of that. but you know when your being ran ragged like a dog, you tend not to think about only grabing 2 4x4's at a time.
  14. by   htrn
    I see alot of waste in my department. We have delivery packs with oodles of paper drapes that never get used and each instrument pack contains 13 instruments that need to be resterilized and packaged - we only use two or three hemostats and one or two pairs of scissors - maybe a needle driver - but that's it.

    Another thing that makes me crazy is that we do normals on glucometers every night, whether we have patients or not. That's 60 strips a month, not incuding what we have to do when we change bottles. Why can't we run normals at the time we run a bedside glucose if it hasn't been done in a few days.

    We go through so much IV tubing, especially if we have a labor patient go to c-section. Anesthesia will pitch all of our tubing and hang their own. They don't even bother to try to keep any of the tubing sterile so we can use it post-op. Very wasteful.

    But, they will tell us we can't have all the linen we need because it is too expensive.:trout:

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