MunoRN 46,400 Views
Joined Nov 18, '10 - from '.'.
MunoRN is a Critical Care.
She has '10' year(s) of experience.
Posts: 8,221 (70% Liked)
I'm not sure how that would mean less for the physician. Without your proposed service, they would have to document the basis for covering an non-formulary medication and communicate that to the insurance company. With your proposed service they would still have to document the basis for covering a non-formulary medication and then communicate that to you, so it seems like the same process for the physician except with you as the middle man.
According to the coverage, the problem is that the nursing staff didn't have all the patient brought over to the hospital across the street, that wouldn't have been affected by lack of staff or working overtime. Personally if 8 people in your nursing home die simply because they lost air conditioning during pretty typical early September florida weather, then maybe it was well past their time to go.
There's not really any good reason why fentanyl has to be limited to use in the ICU. I know there are places where there is hesitation to use it on the floors, but I think it's just due to lack of familiarity. Fentanyl is actual an ideal opiate for those with renal issues or whose BP doesn't tolerate other opiates well. Where I work now, it's the only option for PCA's, which makes more sense than using something with a 3 hour half life.
Personally, I would have handled it by reporting the actions of your nursing director to the BON as they were pretty clearly negligent, but then again I'm a trouble maker.
According to the Navy these weren't nurses, "Capt. Brenda Malone, spokeswoman for the*U.S. Navy Bureau of Medicine and Surgery, which oversees several hospitals around the country, said the employees are corpsmen or medical officers for the Navy, not nurses. "
Disturbing images show Navy hospital staffers mishandling infant, calling babies ‘mini Satans’
I'm guessing by signing for the portable tank you are saying that it's being filled. If the patient switches to the portable tank during the day then it seems like it would make more sense to be filled at night so it's ready in the morning, that may be the issue.
If the patient is getting oxygen, at the ordered rate, and using the correct route then there is no med error, the source of the oxygen is a separate matter. To have both an oxygen concentrator and home oxygen tank fill system covered by insurers there needs to be physician's orders to establish the necessity for oxygen therapy using those systems, which is why an order exists specifying the oxygen sources the patient qualifies for.
I'm not really clear what your asking though, has the patient been using an empty oxygen bottle during the day?
If she preferred that the patient have a sitter, did she provide you with a sitter? Sometimes aggressive patients require both a sitter and restraints, I'm not sure what alternative plan she provided?
Patient hand-offs are well known as an opportunity to prevent or contribute to harm to a patient, they should not be interrupted for a non-emergent issue. I wouldn't have any problem reminding my manager that I'm handing over a patient and that the MD will be the very next thing on my list, if my manager has any problem with that, then I'd be happy to go over my job description with them, as well as hers, and remind her of my employers standards on communication and preventing patient harm as well as current best practices which would include a reading list of John Nance's Why Hospitals Should Fly, Atul Gwande's The Checklist Manifesto, AHRQ, NIH white papers, etc.
It's unfortunate that we don't view ourselves as being an integral part of patient safety and effective care, and therefore should freely alter our practice to fit the needs of others.
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