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MunoRN 33,381 Views

Joined Nov 18, '10. Posts: 7,641 (69% Liked) Likes: 18,650

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  • Nov 15

    Many national and state hospital associations have model guides or policies on this issue. For example, here is Washington's: http://www.wsha.org/wp-content/uploa...Acceptions.pdf and here are the guidelines from the AHA: http://www.aha.org/content/00-10/gui...easinginfo.pdf

    Most of these guidelines follow the HIPAA requirements, which are protective of PHI. Generally speaking, I would only allow nursing staff to notify law enforcement of a fugitive if the nurse has a reasonable belief that doing so will prevent or minimize an imminent danger to the patient or any other individual. I would want to see that reasonable belief articulated in the chart and to have the nurse check with me, Compliance, Privacy or nursing leadership first.

    As for the OP, most hospitals do already have a policy on this: it is typically written and administered by Medical Records, Compliance, Privacy or Risk.

  • Sep 17

    This has been done in LTC facilities all over the country. Many states have alarm elimination initiatives for LTC.

    The evidence shows that falls did not increase when facilities eliminated alarms. In fact many facilities reported that falls decreased when they eliminated position-change alarms. (The evidence on whether it decreases falls is weak. The evidence that falls do not increase is strong.)

    To quote one study "We took a tiered approach to removing positio-change alarms from our facility, monitoring the fall incidence rate for a period before, during, and after the elimination of these alarms. After discontinuing their use, we found a decrease in the rate of falls, and a decrease in the percentage of our residents who fell. Staff has easily adapted and reports a calmer, more pleasant environment."

    Another study says "Using real-time information provided by falls incident reports the ADON tracked and trended data on a monthly, quarterly, and annual basis. During the final quarter of 2005, that encompassed the months of alarm reduction and increased resident monitoring on the target unit, there was a 32% reduction in the quarterly average of falls for this unit, when compared to the average number of falls for the first three quarters of 2005.

    Incidentally, this unit also experienced a reduction in the number of pressure ulcers identified for the final quarter 2005, as compared with the first three quarters of 2005. This could be the result of residents' toileting in advance of need, and more frequent ambulation and positioning, which were a part of the residents's individualized fall prevention plans.

    In addition, there was a 21% decrease in the CMS 'Prevalence of Falls' quality measure when comparing July 2005-December 2005 to October 2005 through March 2006. Both six-month periods shared the two-month intervention interval and subsequent evaluation. Additionally, the Director of Nursing has reported that the increase in activities on the unit has had an impact on the 'depression quality measure.'"

    From MASSPRO a Massachusetts Quality Improvement Organization, "The noise produced by alarms agitated residents so much that residents fitted with alarms did not move at all to avoid activating the alarm. This put them at greater risk for decline. Residents with dementia experienced an increase in agitation when fitted with alarms."

    Quality improvement in nursing homes: testing of an alarm elimination program. - PubMed - NCBI

    Elimination of position-change alarms in an Alzheimer's and dementia long-term care facility. - PubMed - NCBI

    Interventions designed to prevent healthcare bed-related injuries in patients. - PubMed - NCBI

    Nursing Facilities

    Nursing homes find bed, chair alarms do more harm than good - The Boston Globe

    http://c-hit.org/2013/03/20/state-nu...ive-carefully/

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3549269/

    http://m.ageing.oxfordjournals.org/c...ng.aft155.full

    The problem isn't that the facility is eliminating alarms. It is that they did not take a planned, systematic approach.

  • Aug 5

    I'm with the posters who've said talking about salary shouldn't be off the table. I don't walk around talking about it, but if conversations about equity and pay come up I'll disclose it. My point when I talk to people about it is always the same - knowledge is empowering. By knowing what people are making we're all empowered to negotiate better.

    When I was a student I asked my preceptors to talk about salary with me so I could get a sense of the market rather than depending on my employer to tell me what I'm worth. The phrase, "my market research has shown me that nurses are making X," is a surprisingly effective bargaining tool. One didn't want to discuss it, and I left it at that. The other agreed with me and asked me to keep in touch. Her information helped me negotiate for better salary, and in turn letting her know the outcome of my negotiations helped her in her next renegotiation. We both benefited. My cohort also shared information on our Facebook group so that we all had access to real-time info about what people were getting offered.

    I don't care if other people don't want to tell me their salary, and it's not something I drop into conversations, but in the context of helping each other out I'll tell anyone.

  • May 31

    Does anyone actually know HIPAA? It is not against the federal policy to disclose patient location, including if they are moved to another facility or unit. You can also give a general condition of the patient. We have been puppets of hospital administration too long- follow the law, and the code of nursing ethics.

    Here are some topics for professionals:

    Disclosures to Family and Friends | HHS.gov

    Here is the law:

    https://www.gpo.gov/fdsys/pkg/CFR-20...sec164-510.pdf

  • May 30

    OP, you mocked a mentally ill patient. You also do not know how the mother has handled him in the past. If you spoke that way to my child, my silence would be from surprise (in a terrible way), and requesting someone else would be reasonable and justified.

    And before anyone here jumps me saying I must be a parent who coddles poor behavior, my children are disciplined when they are blatantly rude. If I don't feel the need to do that in front of others, you wont see it, nor should you have to. They would apologize appropriately the next time you come in the room.

  • May 21

    Quote from Anna Flaxis
    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."



    After an hour the pain relief kicked in?? I think better post-op pain control for your PACU patients would reduce the swearing you find so unpleasant.

    It isn't really okay to ask him, no, not for the sole purposes of addressing your own comfort levels as you've reported. He wasn't swearing at you. Unless it was offending another patient or there was a child nearby, it's a small sacrifice to make. And interestingly, it seems it might help cope with pain as PP's have said.

    Also, bear in mind the meds given peri-op can lower inhibitions, decrease ability to make decisions, temporarily change personalities and also cause loss of memory. As a PACU nurse you must have experienced patients telling you intimate details of their lives that perhaps they wouldn't usually? Similar sort of thing.

  • May 17

    I agree that you might want to talk with a financial profession about your questions ... but here is my $.02.

    Some nurses don't understand the way the US tax system works. As a result, they misunderstand what happens when someone suddenly gets a paycheck that is larger than normal.

    1. The "system" doesn't realize that the big paycheck is unusual for you and that you don't make that much every pay period. So it taxes that paycheck at the rate appropriate for someone who makes that much money on a regular basis. When you eventually file your tax returns, that takes care of itself as your final tax bill is calculated based on your total earnings for the year, not how much you made on your highest-grossing pay period. So it looks like "all of it went to taxes," when in fact, you'll be getting most of that extra taxes back.

    2. Some people don't understand how the tax brackets work. They mistakenly believe that when you are "pushed into a higher tax bracket," that higher tax rate applies to all of your income. It doesn't. That higher rate only applies to the portion of your income that falls into the higher tax bracket. So yes, if the extra income you earn working overtime pushes you into a higher tax bracket ... that money will be taxed at the higher level. But it won't increase the taxes on the money that is in the lower tax range.

    So you will never lose money by working overtime and getting paid extra. It's just that the extra money you are earning might be taxed at a higher rate.

  • Apr 15

    "Nurses in white dresses with yellow satin sashes
    These aren't a few of my favorite things..."

  • Apr 10
  • Apr 8

    Ok,
    CL, can you please send a link to the data that proves shedding happens after vaccinations?

  • Apr 7

    Range orders are allowed and encouraged by the american society of pain management nurses. They are NOT practicing medicine. some JC auditors mistakenly cite range orders as red flags, when JC itself allows for them. Please see http://www.aspmn.org/documents/Range...lished2014.pdf

  • Apr 6

    Quote from MunoRN

    If this seems like a sore spot for me, here's why; I work in an ICU that is a regional adult ECMO center, this means that every year at this time we have a whole section devoted to VV ECMO that's unofficially referred to as "flu-ville". Unlike other forms of ECMO, VV ECMO for the flu has decent outcomes in terms of survivability, although that still involves a horrific few weeks in the hospital and often a SNF stay. Our most common patients are 35-50 and otherwise healthy and I frequently hear "I don't get it, they never get sick" and "she's never needed a flu vaccine before", or just the general sentiment that someone avoiding a vaccine "to be safer".

    Even this very aggressive treatment isn't foolproof, and there are few each year that transition to comfort care, typically patients around my age and with kids my age. Transitioning a 35 year old to comfort care and having their 3 and 6 year little girls come to hold mom's hand while she dies makes it much harder to just say "oh well, everyone's entitled to their own opinions", some opinions are harmful.
    Well said.

    I am "next in line" caring for such patients in long-term acute, and can sign under every word above. Most of these patients who made it out of ICU survive and eventually start to breath, eat, speak and walk again, but the price paid for that is nothing but horrific, in all terms. Suspiciously many of them do not come "to their own old self", according to the families. Some end up on permanent vent and other means of chronic life support. We are speaking about people in the prime of their lives, 35 to 55, and most of them thought that flu vaccine is either not important at all, or only worths the trouble for seniors.

    Add to that people literally driven crazy by chronic pain of herpes zoster, and women of my age who had to go through horrendous procedure of pelvic evisceration to treat the complications of successful treatment of their advanced cervical cancer. It is heart-breaking to see kids visiting around Christmas when they answered on usual "what would you like from Santa?" something like "I want mom to come back home".

  • Apr 6

    Thanks Katie (and again Muno) for giving us real-life examples of the risk of not getting immunized.

    Regarding the film, the negative reviews are everywhere and the turnout for the film is negligible. I'm not paying money to see it and I would hesitate to watch it free just because of the frustration regarding the lies told.

    "Wakefield is one of the most scorned men in the medical world" which is why this film is so frustrating.

  • Apr 3

    Quote from banterings

    Other studies have looked at thimerosal and its connection to autism. These studies are flawed as well because they only looked at children receiving different amounts of thimerosal, rather than comparing children who have received thimerosal to those who have not.
    Just so everyone is clear, thimerosal was removed from all childhood vaccines in the US in 2001. Autism rates haven't dropped since then have they?

  • Apr 2

    Quote from MunoRN
    I don't think I caught most of the stream-of-consciousness part of the story, but why the handcuffs?
    And the cath?

    This is what I mean by restraints of any kind.


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