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Kooky Korky 21,901 Views

Joined Feb 12, '10. Posts: 3,394 (53% Liked) Likes: 4,616

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  • Aug 15

    Quote from Atl-Murse
    Somehow you got stuck by a dirty needle in a urine cup ! How did a needle get in a urine cup? How did you get stuck ? Do you need some attention ? either you are a troll or you need a new line of work.
    This can happen if the urine collection container is the one that is made to draw up the vials to send to the lab for a u/a and c&s. It's a sharp in the lid to aide in filling the specimen tubes.

    This has happened to staff who aren't aware of the sharp in the lid.

  • Aug 12

    I see so many posts here about the unfairness of these programs. Some even go so far as to say the BON has ruined their lives. What I rarely see form the complainers is any personal accountability. We need to remember what got us here. In my own case I was a completely out of control alcoholic who overdosed on pills and booze and ended up in the ER of the hospital where I worked. Weather you were diverting to feed a habit or may the stupid 1 time decision to get behind the wheel of a car - it was that action that put you in a BON program.

    While I agree that these programs can be Draconian - we have to remember that we would not be here but for our own actions.

    In my own case - If I wanted to save my license and my life I had no choice but to humbly do what I was told. I embraced the program learned to walk the walk and talk the talk. I braided those 12 steps into a lifeline and hung on for dear life. I graduated from the CA Diversion program in 2007 and never looked back. For those of you who are struggling I will send you the Wisdom that only Country Music can convey "Don't give up, Hold on a little longer, What don't kill ya only makes you stronger" (Zach Brown) .

    This too shall pass. You will feel the sunshine on your face again.

    Peace and Namaste


  • Aug 12

    Quote from klone
    I am the manager of an OB department in Oregon. I'm wondering what effect this litigation will have on our practices. Are we going to require moms to get up out of bed and sit in a chair every time they need to feed their baby? Will a nurse have to sit in the room with the mom the entire time she's holding her baby unless another adult is there? What effect is this going to have on patient satisfaction? On breastfeeding, and mother-infant bonding?
    Your questions illustrates one of the risks I see with multi-million $$ law suits. If you change your guidelines because research show that new guidelines will benefit patients and ultimately improve patient safety, then I'm all for it. However if guidelines are changed primarily out of fear of future expensive law suits, I regard that as just another example of defensive medicine motivated by protection for the provider rather than patient safety.

    Quote from klone
    mom fell asleep because of narcotics and Ambien, and suffocated her baby.

    While we do not routinely give sleep aids to women postpartum, once in a while we have. And all postpartum women are ordered narcotic pain medications - we give that out every 4 hours round the clock.
    (partial quote)

    I don't work on obstetrics so I don't have your expertise in that field, but I do work with treatment of pain. I'm surprised that your facility's policy is to give all postpartum women opioids every four hours. For how many days postpartum do you normally treat that way? I practice in a different part of the world and we don't habitually prescribe opioids after vaginal deliveries. (It's done if needed but non-narcotic pain medication is generally tried first).

    I'm curious, is your treatment regimen evidence-based? (The studies I've found, and I admit that some of them are quite dated, show that ibuprofen is as effective in managing pain following childbirth as is the combination acetaminophen/codeine, but with fewer side effects. I haven't been able to find research that supports opioids as baseline standard treatment).

    Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomize... - PubMed - NCBI

    We also don't prescribe zolpidem (Ambien) to breastfeeding mothers other than in extremely rare instances. Opioids and "Z-drugs" both cause central nervous system depression. We generally avoid concomitant use of opioid pain medications and benzodiazepine-like sedatives in breastfeeding mothers since it increases the risk of CNS depression.

    Quote from klone
    Very small amounts and yes, it's perfectly safe.
    What kind of opioids do you prescribe to breastfeeding mothers? I think it's a stretch to call it perfectly safe, since there have been adverse events associated with mothers breastfeeding infants while taking opioids. I can agree to that it's mostly safe and definitely agree that treating postpartum pain is a priority, but that it's important to be aware of the risk and to be very alert to symptoms of CNS (central nervous system) depression in the breastfeeding infant (and of course also in the mother).

    Opioid Metabolism

    Opioid pharmacokinetics can be a tricky thing. I've browsed the web to try to figure out what is used to treat postpartum pain in the U.S. One of the treatment options I found was codeine. Is that correct?

    Codeine is metabolized into morphine by the enzyme cytochrome P450 2D6/CYP 2D6. Most individuals have two functionals copies of the CYP2D6 gene and they will get pain relief and "normal" blood concentrations of morphine from codeine, but among for example Europeans approximately 1 in 12 don't have any active gene copy (thus unable to convert codeine into morphine) and won't experience any analgesic effect. On "the other end of the spectrum", we have individuals with functional duplications of the genes and these individuals are known as ultrarapid metabolizers. This rapid metabolism will lead to (sometimes much) higher concentrations of morphine in the mother's blood and breastmilk. The percentage of the population who are thought to be CYPD26 ultrarapid metabolizers varies by race/ethnic background. In some populations it's as high as ~30%.

    This is a case study about an infant death associated with maternal codeine use:

    Safety of codeine during breastfeeding


    Regarding the high cost of healthcare in the U.S. I believe there is definitely more than one factor that affects it and that the factors are entwined and synergistic. I don't necessarily think that law suits is the main one, but I'm a bit surprised that many seem to think that multi-million dollar law suits aren't a factor. Where do people suppose the total amount of billions of dollars actually come from? Out of whose pocket ultimately?

    Quote from RobbiRN
    What country are you from macawake? Are you accepting immigrants?
    I live and work in Sweden and Norway We are.

    Quote from RobbiRN
    The lawyers here plead before the jury how morally imperative it is for the wronged individual to be properly compensated for all his or her suffering before the law firm walks off with nearly half the loot. Lawyers routinely seek litigation, advertising that "there is no cost unless we recover for you."
    Quote from RobbiRN
    Litigation is the main driver behind costly and often misdirected "defensive medicine."
    I agree with you. The entire purpose of "defensive" is to protect against something and I don't see many other plausible and sufficiently powerful threat candidates in the healthcare arena.

    Quote from Anonymous865
    Research shows that the top 3 reasons people file a medical malpractice lawsuit is to get the truth, to prevent this from happening to someone else, and to get someone to say I'm sorry and/or acknowledge their injury.

    Money does make it on the list of reasons people sue, but only for actual losses and to pay future care costs.
    From your response, I get the feeling that I wasn't able to make my point very clearly? I have no doubt that the motivation/priority for most people is to hear someone accept responsibility and to actually get an apology if they've been mistreated. That's pretty much universally applicable, it doesn't really matter if it's a friend or family member who said something hurtful to you or if it's a nurse or physician who has been negligent. People need to be seen/acknowledged and if someone has done wrong by them, it helps if you hear the person accept accountability and offer a sincere apology.

    Quote from Anonymous865
    If someone has been harmed by another's negligence they should be able to get their case heard in court.
    I guess you are an American? We're likely conditioned to think differently. If I get injured I couldn't care less about my day in court, unless I was the victim of a criminal attack. If I suffer injury from a mistake made by healthcare professionals either due to negligence or unreasonable work conditions (overworked and understaffed), I want an acknowledgment of my suffering and an apology. Money wouldn't make me any happier or heal injuries or any potential psychological scars.

    If the physician or nurse's mistake was serious enough that it can't be corrected by additional training and wasn't caused by variables outside of their control, then it's in my opinion appropriate with disciplinary action against their license, up to including revocation when warranted.

    I suspect that people in my neck of the woods are generally more trusting and likely happier for it. It might surprise you to hear that we don't have anything like a consent form that the patient needs to sign.

    I've had several surgeries myself and I have always been treated with respect and have only one minor complaint which I verbalized when it happened and received a genuine "I'm sorry". That was enough for me.

    I work with surgical patients all day long, (well all night long actually). I provide sedation, analgesia, amnesia and muscle paralysis when needed and generally just do my darndest to keep them alive. Before surgery I simply ask them if they want me to provide them with treatment that is medically most sound and do what I have to to keep them safe? Almost everyone simply say yes, and the few who are interested in the details or have special requests will voice them and I will take note. It doesn't have to be any more complicated than that. Not a single piece of paper is signed and I have not had a single complaint filed against me in ten years of nursing. I have however received a ton of boxes of chocolates, thank-you cards/notes, little glass figurines of angels, home-baked cakes, christmas tree ornaments, hand-knit warm socks for winters etc.

    Quote from Emergent
    I'm surprised at all the negative comments regarding the mother suing. It does sound like negligence. We don't allow people on these drugs to drive home, why would it be considered safe in any place to hand the newborn baby to a mother on drugs in a bed?
    I'm not sure if you include me in those you think are negative towards the mother? I deliberately haven't voiced whether I think that her case has merit and whether I think of the specific details surrounding her situation amounts to best practice or is even acceptable.

    My gripe is with the phenomenon of multi-million dollar law suits.

  • Aug 12

    Quote from Zyprexa
    That was my first thought as well. Mom kills baby, later blames nurse and sues because she needs cash. People are terrible like that.

    Also, why are postpartum moms getting narcotics around the clock??? I get that labor is painful, but can people not tolerate pain anymore or something? Give mom some tylenol and a heating pad.
    Off topic, but I have been sent HOME with oxy after babies #2-5. I had more pain postpartum than during stage 1 labor, to the point where I was nauseated and near tears -- especially when baby fed. CNM for baby #2 said my uterus was involuting (is that a word?) faster than usual, and subsequent babies hurt more anyway. I do have a reasonable pain tolerance; in fact I was unmedicated during labor with all except #4 -- including #1 whose labor was induced.

    So yeah speaking for myself, I really couldn't tolerate the pain. In my defense, I clock-watched for my prn ibuprofen too.

  • Aug 12

    I am the manager of an OB department in Oregon. I'm wondering what effect this litigation will have on our practices. Are we going to require moms to get up out of bed and sit in a chair every time they need to feed their baby? Will a nurse have to sit in the room with the mom the entire time she's holding her baby unless another adult is there? What effect is this going to have on patient satisfaction? On breastfeeding, and mother-infant bonding?

  • Aug 10

    They didn't correct her on your previous complaints, or if they did, it didn't work. I think that firing was coming for a long time, and you did a good thing.

  • Aug 6

    Call your ombudsman, yesterday. You are a mandated reporter, so that should eliminate any dilemma about what to do.

    It's uncomfortable dealing with dementia pts who grope staff, and NO you don't have to allow it -- BUT we are more able to defend ourselves. A self defense class could teach you effective ways to escape various grips without hurting the offender. If he calls you mean, let it roll. That statement has nothing to do with you.

    Female residents on the other hand -- vulnerable people -- are not being protected from sexual assault/battery. Sexual assault/battery is not "cute" -- they are CRIMES. Those ladies/their families need to have an expectation of safety and security. Your facility is aware that they are neither safe nor secure, and are allowing it, and even encouraging it by calling it "cute."

    Years ago I worked as a CNA in LTC. One of our male residents thought one of the female residents was his wife. Now he was physically incapable of hurting her, but she was truly terrified that he would come into her room and try to have sex with her. She would say, "he thinks I'm his wife. What is he going to do if he sees me in bed in my nightgown?"

    That is what this guy is doing to your female residents. The differences are 1) they may not be able to articulate it, and 2) this guy is actually capable of battery.

    Someone needs to protect those women.

  • Aug 6

    Quote from Kooky Korky

    Do you have a buzzer of some kind? Some little hand-held thing that he could touch and feel a buzz? Nothing that
    would hurt him, just something that would distract him? Or a flashing light? Some flashlights actually flash on and off.
    Again, a distraction. Does he have a music box? A little ballerina dancing around in a jewelry box when you open the
    box? Or a twirler of some kind? You blow on it and it twirls. How about a harmonica? Cheap, small, musical, keeps
    him occupied for a while?

    is there an alarm on his chair and bed that would warn you that he is up and likely going prowling?
    These/similar are good ideas. I did a quick search before replying earlier - - one of the studies mentioned that a particular patient's behavior had been seriously decreased after they gave him a stuffed Pink Panther!! He was preoccupied with it and carried it around.

  • Aug 5

    This was so incredibly informative! I am a nursing student interested in working in the BICU at NYP/Weill Cornell. Hoping I can get my Capstone there this fall, and this was such a great post to prepare myself if that happens. I looked up some of the books you recommended and everything lol

    @bent1993 Did you start yet? How is it going?

  • Aug 5

    Quote from Guy in Babyland
    You need a dedicated Nursery nurse for days when this happens or transferred officially to Peds floor and have Peds nurse care for the baby. In the first example, what is the difference between leaving the baby on the Peds floor with no Peds nurse responsible for it and leaving it in your nursery without anyone in the nursery with it? Who is responsible when something happens to the baby in between your 2 hr check-ins on the Peds floor? You or the Peds nurses?

    In both examples, you are liable for a patient that is out of your unit and you only check-in on them every 2 hrs.
    Agree with Guy. I've only ever seen it the way he described: kids staying for photo or NAS get officially transferred to peds (with a peds nurse) where parents can room in and do most cares, well kids with sick moms get admitted to the nursery. A designated 'nursery nurse' has to be present for kids staying in the nursery.

    Having patients on a separate floor is absolutely a terrible idea.

  • Aug 5

    This was very informative article. I was unaware of PICS until now. I have a home health patient/family, that I'm not sure exactly fits description of the syndrome, but it has made me think introspectively after reading the article.

    The patient has a congenital defect and was recently place in a medically induced coma due for several weeks, for what the parents perceive, as a medical error on the part of the physician. As a result of the treatment and long term hospitalization, the child can no longer walk, has an intolerance to activities and a diminished cognitive capacity, by way of comparison, to prior bench marks.

    To some degree, the mother has now abandoned physicians’ orders and is seeking out holistic and complimentary alternative medicines. While I support different approaches, some of her interventions are completely devoid of the scientific process and often run contrary to the basic nutrition, circadian rhythms, and other evidence based interventions.

    While I understand her over compensation and hyper-vigilance is to some extent a result of the trauma, I believe it is quickly developing into an ineffective coping strategy which is adversely effecting the sound medical treatment of her child. Any type of scientific reasoning is most often met with emotional resistance. My focus has since shifted to comfort and care measures for the patient because any other long positive outcomes are being over shadowed by her efforts.

    It has created a difficult and complex situation for which I can foresee no immediate solution.

  • Aug 5

    Quote from JKL33
    Well, I know nothing about this Rosemary Kennedy situation except what I just briefly read here on the interwebs, but does anyone else think it's possible that the lobotomy caused her ultimate problem?? The one they wanted her to have because she wasn't doing too good of a job conforming to the family standard for "appearances"?

    That story doesn't add up. You don't supposedly get deprived of oxygen for two hours and be a mostly normal child....or live at all.
    The lobotomy did cause her ultimate problem. As a child she was cognitively delayed and uncoordinated; as she grew she reportedly became quite uninhibited around men (and really pretty besides!), plus had a rage problem. Anyway, there is speculation that she may have had some ischemic brain damage from her traumatic birth, and possibly a coexisting mental illness that today would be treated, or possibly Asberger's.

    Concerned about the family's reputation, Daddy Dearest decided on the lobotomy. The resulting TBI left her completely devastated.

  • Aug 5

    I'm not suprised that Rosemary Kennedy's lobotomy went bad. One of the drs involved was Walter Freeman. He eventually came up with the transorbital lobotomy, he also stopped partway through a procedure to pose for a picture. That ill-timed photo op killed the pt.

  • Aug 5

    Lol absolutely not. I have caught a few babies, or walked in the room to find a baby in the bed, when the doctor was not available (in another delivery, in the OR, seeing a patient on another floor). I'd imagine it's hard to keep a baby inside that is trying to come out. It's almost impossible to convince a mom not to push when she is that far, and even if she can somehow breathe through it, her body is going to push for her anyway. It's much safer to just call for help and throw on some gloves and catch the baby. It's generally not a big deal. Precipitous babies usually come out pink and screaming anyway. The first baby I caught by myself was En Caul, which was really neat to see! Too bad there were no witnesses except me and the mom!

  • Aug 5

    With my second child I went from 6 to 10 in <30 mins. As I was un-medicated, I was VERY aware that I needed to bear down and there was no way he was staying in much longer. The nurses didn't skip a beat, they knew trying to convince me to hold on was futile lol. They broke down the bed, encouraged me as I was pushing, and two pushes later caught him with no doc in sight (she came rushing in the room 2 minutes later, poor woman had sprinted across the parking lot!). From the way they handled it, I got the feeling that it was FAR from their first rodeo. If I could, I would go back and shake the hand of the nurse who caught him, she handled the situation like a CHAMP!