Content That TJ'sMOM Likes

Content That TJ'sMOM Likes

TJ'sMOM 1,889 Views

Joined Sep 17, '12. Posts: 8 (50% Liked) Likes: 13

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  • Oct 15 '12

    How about the doctor orders a standard dose Ie 2mg MSO4 or 2mg of dilaudid, etc. Problem solved! Instead we waste medicine the patient could use and is paying for and the patient doesn't get the full pain relief they deserve! I think that's what ridiculous about it all!

  • Oct 15 '12

    All of that would be wonderful and all well and good if people actually had time to do all of those things. I know that the facility I work in we do end up taking shortcuts but it's not because we are all sitting around socializing. The vast majority of us are working our tails off constantly. I am still pretty new to all of this but even the nurses and the med aides that have been at this for years struggle to get everything done. It's easy to sit in the position of a supervisor and say all of the things that should be done but not so easy to actually do them. My supervisor worked the floor on what is normally my shift the other night and by the time I got there I could tell she was getting her rear handed to her. I am not someone who is easily offended and I can generally see all points of view but honestly your article came off as a little condescending at times. In an ideal world I would love for our shifts to go like this and for us to be able to do things by the book but it just doesn't work like that.

  • Oct 15 '12

    Quote from VivaLasViejas
    Failing to actually read the order. You'd think it would be simple to transcribe an order like "Warfarin 2 mg tab, 1.5 tabs PO Q PM on Mon-Wed-Fri, alternate with 4 mg on all other days." But if you're not paying attention, you might see only the "2 mg tab" on M-W-F, and thus underdose your patient. It's a lot of fun to explain this to the anticoagulation clinic when they're on the phone demanding to know how the patient's INR could be 1.1 when he's supposedly getting 7.5 mg of warfarin 4 days a week with 10 mg on the other three....
    I could read this order five times and still get it wrong...

    2mg tablets of Warfarin. Give 1.5 tabs on M,W,F. That's 3 mg of Warfarin, is it not? Alternate with 4mg of Warfarin (that would be two 2mg tabs or one and a half 4mg tabs- 6mg total) on all other days. I can't for the life of me figure out how the patient is supposed to be getting 7.5mg 4 days per week and 10mg on the other three.

    There really should be two separate orders here. One that says Warfarin 7.5mg M-W-F. Another that says Warfarin 10mg T,Th,S,Su (using approved day abbreviations). Does it really matter that they are 2mg tablets? That just confuses things.

  • Oct 15 '12

    Certainly nurses can and do make all of the above errors BUT...maybe places should use actual nurses for med administration instead of med techs? I know, I know med techs are cheaper.

    Plus the more places something is supposed to be documented the more chances there are for discrepancies. My facility requires narcs to be documented in four different places. It's really annoying.

  • Oct 15 '12

    In my state, we do not use med techs. What is a med tech scope of practice, are they educated like nurses? Do they transcribe orders? Are they responsible for interactions?

  • Oct 15 '12

    Quote from VivaLasViejas
    Neglecting to document medications in all the right places. During our recent survey, we narrowly escaped a 'harm' tag for sloppy narcotics documentation on one particular resident who uses a lot of PRN pain meds. (Which should've triggered a pain assessment on my part, IF someone had notified me and/or IF I'd been auditing the MARs as often as I should.) The med would be signed out in the narcotics book and on the front of the MAR, but not on the back; or, it would be signed out in the narcotics book and documented on back of the MAR but not on the front; or, it would be signed out in the narcotics book and not accounted for on either the back OR the front of the MAR. Nine med techs almost had to go to OccMed and pee in a cup, while three managers holed up in the administrator's office for two solid days putting all the puzzle pieces together to prove that there was no narcotics diversion going on.
    Why is it required to document in THREE places? I can understand narc book and on the MAR, but why would it need to be documented TWICE on the MAR, that just seems to be asking for trouble.

  • Oct 12 '12

    Did you ever have a moment like this?

    Happy Halloween everyone!



    Click Like if you enjoyed it. Please share this with friends and post your comments below! Want more nursing cartoons?

  • Oct 12 '12

    Ask your NM if you need an order to change diapers, bath a patient, apply skin lotion, brush their teeth and provide perineal care. Just to be on the safe side. And while you're at it, ask the DON to look into her profile.

  • Oct 12 '12

    I agree that you acted with the intent of providing comfort for the patient who was in the process of actively dying.

    There was no way this poor individual was going to swallow the food pocketed in her mouth. At best it was going to sit there, rot, and smell bad. At worst it was going to actively choke her and cause an uncomfortable death.

    If you had an active medical order on the chart, which had not been discontinued by hospice, to suction as needed I believe you are covered.

    It sounds as if, perhaps, hospice had a conversation with your manager about how much the family appreciated your efforts. You acted like a nurse who could provide good compassionate care for a dying patient again.

  • Oct 12 '12

    I mean, you could have just as soon reached in and scooped it out with a swab or toothbrush. You don't need a doctor's order to perform oral care do you? But how gross and undignified is that? And what if something had droped back into her throat as you did that? THAT would've killed her. So, I'm sure the suction was quick, clean, and safer. The removal of the pocketed food was appropriate, regardless of what tool you used. I think you demonstrated a decent amount of critical thinking and problem-solving. Especially since it would have just rotted in her mouth (also undignified) and the family would have to be in there sitting with the stench (also undignified and obstructive to their grieving process). Don't let her do this to you.

  • Oct 12 '12

    Dumbfounded, I am.

    I can understand if you did deep suctioning (endotracheal); facilities and RTs can be weird about who is allowed, etc etc. But a YANKOWER?!

    In NO WAY could clearing crap out of a dying patient's mouth be considered anything but compassionate, BASIC care. It wasn't going to prolong her life (unless, of course the plan was to MAKE her choke on old food??).

    Ridiculous, and I'd fight it tooth and nail. Your manager is a nincompoop, period.

  • Oct 12 '12

    I spoke to my DON and she advised me to attach my own written statement to the write up. She said signing the write up only indicates that it was read to me, not that it was an admission of guilt. She agreed that I was providing comfort care and said she would look into the matter. She also said she would do an inservice for the unit managers to help prevent intimidation and other inappropriate behavior in the future.

  • Oct 12 '12

    Agreed...WTH?? I would not want to work in that enviornment. I am a bad nurse for making my patient clean, comfortable, and safe while they're dying? Okay.

    I can understand not wanting to deep suction someone who was hospice...very uncomfortable procedure, but just passing a yankeur around in someone's mouth? Please!

  • Oct 12 '12

    I am gob smacked.

    DNR doesn't mean NO care or let's do our best to kill them quickest. I am also confused why any order was even needed to suction. It would be a serious breach of practice NOT to suction a pt whose airway is compromised.

    I am a huge advocate for a pt right to die, however to not suction a pt is pretty close to actively smothering a pt.

    I am not familiar with hospice orders but honestly I am a bit horrified

  • Oct 12 '12

    We have SO many fake seizures it's ridiculous! There are 2 inmates who always manage to have "seizures" within 10 minutes of one another, even though they are in different units. We still have not figured that one out.

    I laughed at y'all's comments about the smelling salts because I have started to use those and they truly are "miracle workers" lol. Personally, I wish we could inform the inmates that "new research" indicates that large-volume enemas are the cure for seizures. But then again, some of them may like that.

    What's crazy is that we have a couple of inmates who are so predictable that the COs will call us in medical saying, "I/M ____ is going to have a seizure in 5 minutes...just a heads-up." Sure, enough, it happens. And they are such BAD actors! They come out of the "seizure" and they'll be like, "Wh- wh- where am I?" Nauseating, but funny as heck!

    This is how we outed this one malingerer: the Dr. came to the unit when the emergency was called, and he observed as we stated things like, "I don't know...if it was a real seizure, his jaw would be jutting out more," and the I/M jutted his jaw out. Then we said, "Yeah, his right leg would be at more of an angle" and other ridiculous, fake "symptoms." Every symptom we mentioned, the I/M would start doing. The Dr. finally ordered that next time he has a "seizure," he is to be put into the turtle suit (the green suicide getup) and put into the observation room for 4 hours. That room is FREEZING so it took only 1 time in there for him to be "cured."


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