Latest Comments by MunoRN

MunoRN 58,683 Views

Joined: Nov 18, '10; Posts: 8,862 (71% Liked) ; Likes: 23,767
Critical Care; from US
Specialty: 10 year(s) of experience

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  • 2
    Penelope_Pitstop and kbrn2002 like this.

    Quote from kbrn2002
    I guess LTC really is a different beast. It's not at all uncommon for us to send meds, even controlled meds home with a resident. We will send meds out with a resident during a therapeutic LOA if they are going "home" with family for a few days, there is even a separate category in our Pyxis type machine for dispensing LOA meds.

    On rare occasions we have discharged a resident with controlled meds. This is dependent on their payer source, for example if the meds are covered by insurance and recently filled their payer source may not cover another refill after discharge. In that case the meds are sent home with the discharging resident. If they are responsible for themselves they sign that they accepted the meds upon discharge, if they have a POA that person signs that they accepted the meds.
    The difference there is that meds given in an LTC have often already been dispensed for that specific patient by a pharmacy, the LTC is then giving the patient meds from the patient's stock of meds, not the facility's stock of meds, this is technically assisting with self administration rather than administering. There's no problem sending these meds home with a patient because they were dispensed for the patient from the beginning.

  • 10

    Giving a patient a medication for them to self-administer typically falls under "dispensing". You could either administer the medication before they leave, or have it properly dispensed by the hospital pharmacy if they are able to do that, which means properly labelling and packaging it for self-administration.

  • 3

    I would declare your experience on an application as what it actually is; progressive care. There's certainly nothing wrong with progressive care experience, but it is by definition a different level of care from critical care. As someone who as served on hiring committees, we would be more likely to consider progressive/intermediate/step-down experience when we're looking for critical care experience then we would be to continue considering someone who wasn't honest on their application.

  • 0

    Quote from Wuzzie
    We mask, clean the site and use sterile gloves. We have the patient as supine as possible. When I pull the line I do so slowly and coil it around my fingers to keep it from flapping around. We do this because there is a chance, albeit small, that a vessel spasm may cause the line to become, for lack of a better term, stuck. When that happens we re-dress the site with the coiled line under the dressing and wait for about 30 minutes to let the vessel relax. We only use sterile gloves and mask for the purpose of protecting from infection during the time the line is re-dressed. We have gone away from using antibiotic ointment in favor of a dab of plain sterile Vaseline covered by a Tegaderm. Our ID people do not want us using antibiotic ointment because there has been a huge bump in the number of allergic reactions to it. I tried to clarify with a previous poster who spoke of a patient dying from an air embolus from a line being pulled but have not received that clarification so far. There are numerous cases of air emboli related deaths happening with traditional CVCs, Sheaths and Apheresis catheters but to date there is no documented instance, that I could find after an exhaustive search, of it happening with a PICC. Despite this I will continue to proceed with due caution when removing PICCs because I do not want to BE the first documented case!
    I would avoid using petrolatum directly on or in the puncture site, this presents the potential for the petrolatum to enter the vessel, and there has been at least one documented case of death due to petrolatum emboli that entered through a CVC tract. What's safer, and more effective, is to use a gauze either pre-impregnated with petrolatum or to add the petrolatum to gauze and make sure you work it in.

    The benefit of using air embolism precautions when removing a PICC isn't established either through evidence or even just theory, once the line is removed it's no different than a peripheral site. I would say it doesn't hurt, so why not, but there is certainly an aspiration risk that is not really outweighed by any potential benefit.

  • 5
    tsm007, dudette10, RobbiRN, and 2 others like this.

    The Sepsis guidelines have never actually recommended initiating basing antibiotic treatment on the screening tools in use, the screening tools are only meant to trigger further assessment to determine if the patient actually requires antibiotics. The most recent guidelines (Sepsis-3) not only reinforce that basic screening tools shouldn't initiate treatment, but that they really shouldn't be used at all since they are too broad.

  • 8
    Fiona59, nursej22, NurseBlaq, and 5 others like this.

    Quote from DesiDani
    The moderators should correct abuse too
    By the way, I didn't think you were a nurse."

    That repeated remark on this thread IS a put down. Yet you're right I do need to report it and not add to the problem.

    Any how, why do some here get so upset when a thread is calling nurses mother Theresa. Some are bad big deal
    You're making broad, unsubstantiated accusations of abuse, it shouldn't be too surprising if that isn't well received.

    If you want to discuss whether specific scenarios might be appropriate or not that,s one thing, but not broad unsupported claims.

  • 5
    BCgradnurse, pixierose, psu_213, and 2 others like this.

    Quote from DesiDani
    Nurse abuse is not an excuse to justify patient abuse. Even if the nurse feels threatened and she rightly calls the guards, that nurse shouldnt stand by if the guard gets too violent. Just saying he was protecting me because the patient didn't let me put in an iv is not an excuse.

    It is a matter of perspective. A family member isn't going to care about you getting, only that their loved ones got hurt under your care.

    At my job we have to take semi annual desculation training. They say you always have to be aware of your actions, because it may be perceived as abusive.
    The evidence is pretty clear that nurses are far too often on the receiving end of physical violence, incidents of truly unjustified physical intervention are relatively rare.

    There is unfortunately a view that violence against nurses is somewhat justified because of a perception that nurses are often violent towards patients, which you seem to be perpetuating, and that's not really acceptable

  • 12

    Quote from NurseCard
    Are you talking about CPR? Or what?
    I'm referring to pretty typical ICU care that I provide in patients where the family doesn't see any downside to what we're subjecting them to. (I'm not agreeing we guilty of "brutality", but it is refreshing to see someone complain that maybe we need to provide less interventions sometimes).

  • 13
    brandy1017, KelRN215, KatieMI, and 10 others like this.

    I wish the public were more willing to see what we commonly do as brutality, but unfortunately the public and family members tend to be more likely to disagree with us when we say that what they are asking us to do is essentially brutality.

  • 5

    Quote from cmefford
    The NRA Foundation's 990 form filed with the IRS for 2010 shows it raised nearly 23.4 million in total revenue and provided more that 2,200 in grants for community programs for hunters, competitive shooters, gun collectors, law enforcement, women and youth groups, including boy scouts and 4-H clubs. In all 21.2 million went for grants.

    The NRA foundation has NO STAFF and PAYS NO SALARIES.

    The NRA has a fundraising program that allows gun customers to "round up" the purchase price to the nearest dollar as a contribution, in the same way other stores ask for small donations for cancer or hunger.

    This helps provide grants for gun-related training and education programs. The money goes to support firearms safety education, wildlife conservation and other firearm related public service programs.

    Do Assault Weapons Sales Pay NRA Salaries? -

    The NRA has a program called National School Shield, it is used to promote awareness, education, advocacy, and GRANT funding for schools to increase the protection of the kids.

    National School Shield | About

    Yeah, they are a horrible foundation, how dare they offer educational information, firearms training, grant money for shooting sports, grant money to help offset the cost of protecting our children from criminals, because last I checked NOT one criminal followed the LAW, and when firearms are not available, they will use any means necessary to harm people. There are many instances through out recent history where criminals have used knives, bombs, cars, etc to harm people.

    So, you can continue to bury your head in the sand and blame the NRA and law abiding citizens, or open your eyes and realize guns are not the issue and criminals, mental illness, etc are.
    As an NRA member and proponent of responsible firearm regulations that ensures gun rights remain as they were intended, to be benefit to society rather than a scourge, I have to clarify that these remarks do not represent the majority of even NRA members.

    There is most definitely a problem with the current ease with which criminals and the criminally insane can obtain firearms, it's not simply a problem that has no actual relationship to firearms. And no, we don't believe that a deranged person with bad intentions coming through the door of a classroom is just as dangerous if they have a knife as if they have a large magazine capacity semi-auto rifle. And no, we don't believe that we should abolish every single law in existence because by definition criminals don't follow them.

  • 3
    Horseshoe, scout mom, and JKL33 like this.

    Quote from dudette10
    I think we are getting stuck on the definition of the word "interpret" so let's skip that part and go directly to a role discussion.

    It seems that what you're saying is that, as a matter of course, nurses are fully able to bypass in-patient pharmacy all together and administer any medications a provider orders that he/she also agrees is clinically appropriate.

    It leads to the question, then, why have in-patient pharmacists at all?

    Do you believe they have no important role in the patient medication process, and that a nurse's education and clinical expertise suffices to ensure patient safety?
    Pharmacists certainly play an important role in the medication review process and they should be utilized whenever the clinical situation allows, but they aren't a required part of the process between a physician writing an order and the nurse interpreting the order and giving the med.

  • 2
    AJJKRN and brownbook like this.

    Quote from dudette10
    The sky will fall with the first error. You're right about one thing though, it's not the ideal way to do it.

    Then why do it that way at all?

    Anyway, the "other processes" also have their safety checks.
    If there's no reason to do it this way then you're right, it shouldn't be done that way given the additional potential for error.

    Quote from dudette10
    Can you provide a link to where you got this information? The way you have described the word "dispense" hinges on who (RN or patient) will actually be administering the medication, licensed or not and not all the checks that pharmacists do.

    I'm not a pharmacist, so I'm not sure if it would be appropriate for me to interpret a physician's order. I have not been trained in med interactions or all the lab values that need to be reviewed or all the indications for a med before being ok with a medication order.
    You're not sure if registered nurses can interpret a physican's order and administer a medication? I feel like I must not be understanding you correctly.

    It's certainly a bonus and ideally should be part of the process to have a pharmacist review the order, but a pharmacist is not required for a registered nurse to interpret an order and administer a medication.

    An example of a regulatory definition of "dispense":
    The act of dispensing includes the selection and labeling of prepackaged medications ordered by the physician or advanced practice nurse to be self-administered by the client. Medications may only be dispensed by a physician, pharmacist, or registered nurse.
    Public Health Nursing Manual | Local Public Health Agencies | Health & Senior Services

  • 5
    AJJKRN, LibraSunCNM, wondern, and 2 others like this.

    Quote from canoehead
    When pharmacy prepares the med, they are dispensing, and I know RNs are NOT able to dispense meds. I'd have to email the Board on this situation to see if it was legal.

    I know that pharmacy has two people to check their work, and education and environment to maximize safety. OP, your situation makes me very uncomfortable. If the RN draws up the med, and you give it, who signs it off? Who takes responsibility for the administration? Does your facility have a policy for med administration that includes one or two people? If you hunt, you might find the policy expressly forbids giving a med you didn't prepare.

    Check your policies, and email your professional group. They may have some clear answers for you. In the meantime, email your concerns to your supervisor, so they have been notified in writing that you are uncomfortable, and doing some research. If you have that proof, you'll be in a better position if something goes badly in the meantime.
    "Dispensing" as a regulatory term is actually different from what the pharmacy does when they prepare a med for use by an RN. "Dispensing" refers to receiving and interpreting a prescription and preparing and labelling it for use by someone not licensed to "administer" a medication. As nurses, we are licensed to administer medications, which means we can legally skip the "dispense" step and instead directly interpret the physicians order and administer the medication without it being "dispensed".

  • 14

    There is good evidence to support a bedside "Safety check" as part of report, however the evidence on handoff communication does not support a full report at the bedside. There is extensive research on handoff communication, and one the well established risk factors for an ineffective report or errors are distractions during the information sharing portion of report.

  • 9

    I would agree that having another nurse draw up the med for you to give is adding an unnecessary extra step that is presents an opportunity for error, but I think some are also maybe being a bit irrational in what that risk is compared to other processes that occur prior to administering a med. We're also trusting that the pharmacy tech calculated, measured, and labelled the med correctly. As for charting who drew up the med, every MAR I've ever seen has some way for you to chart who drew up the med. It's certainly not an ideal way to do it, but the sky isn't falling either.