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NRSKarenRN, BSN, RN Moderator 134,963 Views

Joined Oct 10, '00 - from 'RN Spirit from Philly Burb'. NRSKarenRN is a PI Compliance Specialist, prior Central Intake Mgr Home Care Agency. She has '35+' year(s) of experience and specializes in 'Home Care, VentsTelemetry, Home infusion'. Posts: 27,410 (22% Liked) Likes: 13,566

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  • 2:36 pm

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • 12:56 pm

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 19

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 19

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 19

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 19

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 19

    In many areas of US, syringe driver pumps are not used on patient care units due to them not being tamper proof. Instead, self contained CADD PCA pump most popular in Philadelphia PA area as allows patient to be ambulatory or move around in bed more freely.

    Examples of syringe driver pumps:


    s-l225-jpg


    ip-22a-syringe-


    -mg-2987-jpg

    Some articles of interest

    Syringe driver pump use and setup:

    Syringe Drivers: Setup, Patient Use, Problem solving


    Clinical protocol for the use of syringe drivers in Palliative Care

    Safe practice in syringe pump management

    Guidelines for Syringe Driver Management in Palliative Care


    Overcoming fear of administering last dose pain medication hastening death involves coming to terms with ones immortality, understanding disease process in end stage illness, nursing ethics, end of life care and effective medications for symptom management.

    The Double Effect of Pain Medication: Separating Myth from Reality

    Managing Pain in the Dying Patient

    Managing end-of-life symptoms - American Nurse Today

    ANA 2016: Nurses’ Roles and Responsibilities in Providing Care and Support at the End of Life


  • Aug 15

    Subject: Doctors have stories, too...

    A man comes into the ER and yells, "My wife is going to have her baby in the
    cab!" I grabbed my stuff, rushed out to the cab, lifted the lady's dress, and
    began to take off her underwear. Suddenly, I noticed that there are several
    cabs and I was in the wrong one.
    ------------------------------------------
    At the beginning of my shift, I placed a stethoscope on an elderly and
    slightly deaf female patient's anterior chest wall. "Big breaths," I
    instructed. "Yes, they used to be," the patient said sadly.
    -------------------------------------------
    One day I had to be the bearer of bad news when I told a wife that her
    husband had died of a massive myocardial infarction. Not more than five
    minutes later, I heard her reporting to the rest of the family that he had
    died of a "massive internal fart."
    -------------------------------------------
    I was performing a complete physical, including the visual acuity test. I
    placed the patient twenty feet from the chart and began, "Cover your right
    eye with your hand." He read the 20/20 line perfectly. "Now your left."
    Again, a flawless read. "Now both," I requested. There was silence. He
    couldn't even read the large E on the top line. I turned and discovered that
    he had done exactly what I had asked. He was standing there with both his
    eyes covered. I was laughing too hard to finish the exam.
    --------------------------------------------
    During a patient's two week follow-up appointment with his cardiologist, he
    informed his doctor that he was having trouble with one of his medications.
    "Which one?", asked the doctor. "The patch. The nurse told me to put on a new
    one every six hours and now I'm running out of places to put it!"
    The doctor had him quickly undress and discovered what he hoped he wouldn't
    see; the man had over fifty patches on his body. Now the instructions include
    removal of the old patch before applying a new one.
    And you always wondered why instructions always seemed to state the obvious!
    ---------------------------------------------
    While acquainting myself with a new elderly patient, I asked, "How long have
    you been bedridden?" After a look of complete confusion she answered, "Why,
    not for about twenty years, when my husband was alive."
    ----------------------------------------------
    I was caring for a woman from Kentucky and asked, "So how's your breakfast
    this morning?" "It's very good, except for the Kentucky Jelly. I can't seem
    to get used to the taste," the patient replied. I then asked to see the jelly
    and the woman produced a foil packet labeled "KY Jelly."
    ----------------------------------------------
    And of course, the best is saved for last a lady walked into a pharmacy and
    spoke to the pharmacist. She asked, "Do you have Viagra?" "Yes," he answered.
    She asked, "Does it work?" "Yes," he answered. "Can you get it over the
    counter?" she asked. "I can, if I take two," he answered.
    __________________________________________________ __

  • Aug 14

    Texas nurses who truly feel unsafe staffing can complete Safe Harbor Peer Review form
    documenting conditions that may lead to violation of TX nurse Practice Act.... such submission may incur further employer scrutiny... use with caution.

    What is Safe Harbor Peer Review?
    Safe Harbor is a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules

    The BON has no authority over employment issues, but a nurse does have civil recourse in matters where the nurse’s decision to invoke Safe Harbor was made in good faith, but negative employment action occurred as a result of the nurse's request. A nurse also has whistleblower protections when the nurse reports a facility, physician, or other entity for violations of laws relating to patient care and or illegal acts, such as fraud, see Nursing Practice Act, Section 301.4025 and Section 303.005 and Texas Administrative Code, Rule §217.20 Safe Harbor Peer Review for Nurses and Whistleblower Protections. You may wish to also seek your own legal counsel for advice. The BON cannot provide legal advice, and has no authority in civil matters.



    The Quick Request for Safe Harbor is an abbreviated form to allow a nurse to quickly jot down the key information necessary to invoke Safe Harbor in writing as required by Rule 217.20 at the time the nurse is asked to accept what he/she believes to be an unsafe assignment. Use of the form is not required, but is provided to make safe harbor an easier process for the nurse.


    The Comprehensive Request for Safe Harbor Form is a sample form that may be used to document the more in-depth information that the nurse must commit to writing before leaving the work setting at the end of the work period. The nurse may still supply supporting documents at a later time, however the details of the events surrounding the request must be recorded prior to the nurse leaving the premises. The comprehensive form also includes a fill-in-the-blank format that the peer review committee and CNO or nurse administrator can utilize to document the safe harbor peer review process. Again, this form is not mandatory, but is offered a guide to the process. An entity required to have a peer review plan must have policies and procedures that encompass other aspects both within and beyond the statutes and rules of peer review. In other words, it is not sufficient to use the BON Safe Harbor forms in place of official policies and procedures on nursing peer review.

  • Aug 7

    Texas nurses who truly feel unsafe staffing can complete Safe Harbor Peer Review form
    documenting conditions that may lead to violation of TX nurse Practice Act.... such submission may incur further employer scrutiny... use with caution.

    What is Safe Harbor Peer Review?
    Safe Harbor is a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules

    The BON has no authority over employment issues, but a nurse does have civil recourse in matters where the nurse’s decision to invoke Safe Harbor was made in good faith, but negative employment action occurred as a result of the nurse's request. A nurse also has whistleblower protections when the nurse reports a facility, physician, or other entity for violations of laws relating to patient care and or illegal acts, such as fraud, see Nursing Practice Act, Section 301.4025 and Section 303.005 and Texas Administrative Code, Rule §217.20 Safe Harbor Peer Review for Nurses and Whistleblower Protections. You may wish to also seek your own legal counsel for advice. The BON cannot provide legal advice, and has no authority in civil matters.



    The Quick Request for Safe Harbor is an abbreviated form to allow a nurse to quickly jot down the key information necessary to invoke Safe Harbor in writing as required by Rule 217.20 at the time the nurse is asked to accept what he/she believes to be an unsafe assignment. Use of the form is not required, but is provided to make safe harbor an easier process for the nurse.


    The Comprehensive Request for Safe Harbor Form is a sample form that may be used to document the more in-depth information that the nurse must commit to writing before leaving the work setting at the end of the work period. The nurse may still supply supporting documents at a later time, however the details of the events surrounding the request must be recorded prior to the nurse leaving the premises. The comprehensive form also includes a fill-in-the-blank format that the peer review committee and CNO or nurse administrator can utilize to document the safe harbor peer review process. Again, this form is not mandatory, but is offered a guide to the process. An entity required to have a peer review plan must have policies and procedures that encompass other aspects both within and beyond the statutes and rules of peer review. In other words, it is not sufficient to use the BON Safe Harbor forms in place of official policies and procedures on nursing peer review.

  • Aug 7

    Texas nurses who truly feel unsafe staffing can complete Safe Harbor Peer Review form
    documenting conditions that may lead to violation of TX nurse Practice Act.... such submission may incur further employer scrutiny... use with caution.

    What is Safe Harbor Peer Review?
    Safe Harbor is a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules

    The BON has no authority over employment issues, but a nurse does have civil recourse in matters where the nurse’s decision to invoke Safe Harbor was made in good faith, but negative employment action occurred as a result of the nurse's request. A nurse also has whistleblower protections when the nurse reports a facility, physician, or other entity for violations of laws relating to patient care and or illegal acts, such as fraud, see Nursing Practice Act, Section 301.4025 and Section 303.005 and Texas Administrative Code, Rule §217.20 Safe Harbor Peer Review for Nurses and Whistleblower Protections. You may wish to also seek your own legal counsel for advice. The BON cannot provide legal advice, and has no authority in civil matters.



    The Quick Request for Safe Harbor is an abbreviated form to allow a nurse to quickly jot down the key information necessary to invoke Safe Harbor in writing as required by Rule 217.20 at the time the nurse is asked to accept what he/she believes to be an unsafe assignment. Use of the form is not required, but is provided to make safe harbor an easier process for the nurse.


    The Comprehensive Request for Safe Harbor Form is a sample form that may be used to document the more in-depth information that the nurse must commit to writing before leaving the work setting at the end of the work period. The nurse may still supply supporting documents at a later time, however the details of the events surrounding the request must be recorded prior to the nurse leaving the premises. The comprehensive form also includes a fill-in-the-blank format that the peer review committee and CNO or nurse administrator can utilize to document the safe harbor peer review process. Again, this form is not mandatory, but is offered a guide to the process. An entity required to have a peer review plan must have policies and procedures that encompass other aspects both within and beyond the statutes and rules of peer review. In other words, it is not sufficient to use the BON Safe Harbor forms in place of official policies and procedures on nursing peer review.

  • Aug 2

    Texas nurses who truly feel unsafe staffing can complete Safe Harbor Peer Review form
    documenting conditions that may lead to violation of TX nurse Practice Act.... such submission may incur further employer scrutiny... use with caution.

    What is Safe Harbor Peer Review?
    Safe Harbor is a process that protects a nurse from employer retaliation, suspension, termination, discipline, discrimination, and licensure sanction when a nurse makes a good faith request for peer review of an assignment or conduct the nurse is requested to perform and that the nurse believes could result in a violation of the NPA or Board rules

    The BON has no authority over employment issues, but a nurse does have civil recourse in matters where the nurse’s decision to invoke Safe Harbor was made in good faith, but negative employment action occurred as a result of the nurse's request. A nurse also has whistleblower protections when the nurse reports a facility, physician, or other entity for violations of laws relating to patient care and or illegal acts, such as fraud, see Nursing Practice Act, Section 301.4025 and Section 303.005 and Texas Administrative Code, Rule §217.20 Safe Harbor Peer Review for Nurses and Whistleblower Protections. You may wish to also seek your own legal counsel for advice. The BON cannot provide legal advice, and has no authority in civil matters.



    The Quick Request for Safe Harbor is an abbreviated form to allow a nurse to quickly jot down the key information necessary to invoke Safe Harbor in writing as required by Rule 217.20 at the time the nurse is asked to accept what he/she believes to be an unsafe assignment. Use of the form is not required, but is provided to make safe harbor an easier process for the nurse.


    The Comprehensive Request for Safe Harbor Form is a sample form that may be used to document the more in-depth information that the nurse must commit to writing before leaving the work setting at the end of the work period. The nurse may still supply supporting documents at a later time, however the details of the events surrounding the request must be recorded prior to the nurse leaving the premises. The comprehensive form also includes a fill-in-the-blank format that the peer review committee and CNO or nurse administrator can utilize to document the safe harbor peer review process. Again, this form is not mandatory, but is offered a guide to the process. An entity required to have a peer review plan must have policies and procedures that encompass other aspects both within and beyond the statutes and rules of peer review. In other words, it is not sufficient to use the BON Safe Harbor forms in place of official policies and procedures on nursing peer review.

  • Jul 30

    from the pharmacy experts @ institute for safe medication practices:

    action needed to prevent serious tissue injury with iv promethazine


    problem: promethazine (phenergan) injection is a commonly used product that possesses antihistamine, sedative, anti-motion sickness, and antiemetic effects. the drug is also a known vesicant which is highly caustic to the intima of blood vessels and surrounding tissue. formulated with phenol, promethazine has a ph between 4 and 5.5. although deep intramuscular injection into a large muscle is the preferred par-enteral route of administration, product labeling states that the drug may be given by slow iv push, which is how it is typically given in most hospitals. however, due to the frequency of severe, tragic, local injuries after infiltration or inadvertent intra-arterial injection, ismp recommends that the fda reexamine the product labeling and consider eliminating the iv route of administration.

    severe tissue damage can occur regardless of the route of parenteral administration, although intravenous and inadvertent intra-arterial or subcutaneous administration results in more significant complications, including: burning, erythema, pain, swelling, severe spasm of vessels, thrombophlebitis, venous thrombosis, phlebitis, nerve damage, paralysis, abscess, tissue necrosis, and gangrene. sometimes surgical intervention has been required, including fasciotomy, skin graft, and even amputation....

    ...safe practice recommendations: along with the manufacturer recommendations, the following strategies should be considered to prevent or minimize tissue damage when giving iv promethazine.

    limit concentration. since 25 mg/ml is the highest concentration of promethazine that can be given iv, stock only this concentration (not the 50 mg/ml concentration).

    limit the dose. consider 6.25 to 12.5 mg of promethazine as the starting iv dose, especially for elderly patients. hospitals have reported that these smaller doses have proven quite effective.

    dilute the drug. require further dilution of the 25 mg/ml strength to reduce vesicant effects and enable slow administration. for example, dilute the drug in 10 to 20 ml of normal saline if it will be administered via a running iv, or prepare the medication in minibags containing normal saline if there is time for pharmacy to dispense them as needed for individual patients. (trissel confirms that promethazine is physically compatible when diluted in normal saline, with little or no drug loss in 24 hours at 21 degrees c in the dark, when prepared in glass, pvc, and polyethylene-lined laminated containers [handbook on injectable drugs, 13th edition. ashp, bethesda, md; 2005:1266].) extravasation can also be recognized more quickly when promethazine is diluted than if the drug is given in a smaller volume.

    use large patent veins. give the medication only through a large-bore vein (preferably via a central venous access site, but absolutely no hand or wrist veins). check patency of the access site before administration. note: according to the package insert, aspiration of dark blood does not preclude intra-arterial placement of the needle because blood can become discolored upon contact with promethazine. use of syringes with rigid plungers or small bore needles might obscure typical arterial backflow if this is relied upon alone.

    inject into the furthest port. administer iv promethazine through a running iv line at the port furthest from the patient’s vein.

    administer slowly. consider administering iv promethazine over 10-15 minutes. ...

  • Jul 29

    Multiple report comments we received echo our Admin concerns:


    This thread seems to be mocking the " I love being a christian nurse" thread. I find it very rude and condescending.
    I find this post to be VERY disrespectful. They are making a mockery out of a sincere post that another person put up regarding loving being a "christian nurse" I understand it is the "spirituality" forum but to make fun of other people like that is simply rude and immature

    It is one thing to disagree --but to mock and make fun of another persons religious viewpoints and deliberately post a thread to cause divisiveness and animosity violates our Terms Of Service.

    This thread will remain closed.

  • Jul 15

    Check out Aaron's Tracheostomy Page for up to date info on trach care along with the resources section: Surgical Procedures
    Critical pointers: Tracheostomies

    AN's Pulmonary Nursing sectionhas many resources too.


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