JCAHO: "Behaviors That Undermine A Culture of Safety"

That's one article that was way overdue. But better late than never.

This is excellent. I just quit a facility due to immature behaviors after working there for 2 years due to a contract. I am not a whistle-blower, but JCAHO should be looking into the facility I quit because bullying was out of control there. My new facility is like night and day. It is way at the opposite end of the spectrum and recently had a 100% pt satisfaction score for the unit I just started.

I would say this is unbelievable, but it is JOKO. I agree that what they are saying is accurate, but how much more do they plan on dancing around the real root of the problem with patient safety? I guess now they should release a statement that unsupportive mgmt. is a detriment to pt. safety, egotistical MDs can be a detriment, semi-private rooms, nasty cafeteria food, etc. etc.

But whatever they do, don't address SAFE STAFFING!!!!! O NOOOOOOOOO!!!! they certainly don't want to take the direct approach cause then their existence would no longer be required and they couldn't milk their power for every ounce; hence they would no longer need to come up with this extraneous stuff to justify their existence. JOKO=

WOW, it's about time somebody said it. No.....actually that's not right. There have been a few nurse studies which have basically stated the same thing. But I am glad to see this is being addressed once again. The report claims that it's only 4-6% of people who are bad players, that was surprising. Anecdotally I would have guessed the number to be much higher than that, maybe 20-30% of both physicians and other members of the healthcare team. Will JCAHO require hospitals to show that they are addressing this issue in order to retain accreditation? I hope so.

Safety goals... politics...team members not taking accountability... blaming...intimidation tactics...It's very unsettling...

I work in a CVICU. Just yesterday I had a CT surgeon deny giving a verbal order to d/c a consulting physician's order... the surgeon denied d/c'ing the order to the consulting physician after the consulting physician demanded I put the surgeon on the phone to explain why it was d/c'd...he threatened to sign off the case if the nonsense and non-communication continues...I don't blame him... but the nurses are caught in the middle of this type of ******* contest... and everyone's **** is the same color and the nurses are getting splashed from all sides... But when a CT surgeon denies a verbal to save political face and leaves the person who wrote the verbal out to dry... that is heinous... and unethical... I'm actually thinking of leaving my unit over this so I don't have to deal with this particular team member... It is not an isolated case of this sort with this surgeon...

What to you guys do when physicians or surgeons deny their verbal orders? Anyone have any comments?

I hate to be so jaded but this will not change a thing!

Nurses on a surg floor entered more than one incident report regarding a surgeon who denied verbal or phone orders which more than one nurse said he made on seperate occasions. In the end, he was notified that at least two nurses would need to be present when he gave verbal or phone orders. It worked....he left.

Thanks for your experience and how this was handled... we have two physicians that nursing staff will not take verbal orders from... I've told one myself that he would have to come to the unit and write the order in the chart himself because he lied about an order I took from him myself weeks prior... I made sure nursing staff was informed of the situation...I explained verbal orders were a privilege given to physicians granted by nursing... JCAHO safety goals state whenever possible the prescribing authority is to write the order him/herself...I'm, quite frankly, tired of taking non-emergent verbal orders from prescribers (whether physician, PA, NP or otherwise) who are standing right on the unit. To get around that I'll say "I need to read back and verify... in order to do that safely, first I'll actually have to write it in the chart and then after it is actually written read it back... please wait here for a moment so you can verify the read back..." Then I'll go through the whole thing and then say "While you're here... why don't you just give this a little John Hancock for me... thanks!" ... then they catch on that they are better off doing it themselves... and my patient is safer...as am I...

As far as the witness approach... we do that as well...except sometimes the witnessing nurse might be busy and the physician will unfortunately have to wait on hold for five minutes or so for the the witnessing nurse...

So they catch on fairly quickly that is a good idea to actually collaborate with the nurses... some of them anyway...

I have another winner last week who wrote for FFP and never bothered to get a consent... then when I informed him, after he answered my CVICU page an HOUR later (!!!!), he said, "You told me he already got blood products..." LIE LIE LIE LIE LIE... "No, I most certainly did not... in fact you never bothered to speak with the critical care nurse in charge of this patient, moi, when you were on the unit... so I most certainly did not"

The patient had an INR of 3.6 and needed to be tapped by IR...and get a PEG...So his INR needed to be below 1.6 for the procedures... of course I was also giving Zosyn Q6 hours... which was going to defeat all the work of the FFP anyway... So when he was informed of the no consent issue he asked me who was doing the procedures... and then told me to get consent from them...

To this I said...."Okay Dr. Soandso... Since I am writing this telephone order in the chart I'd like to read back and verify... Please find another physician to get consent for the prescribed FFP I ordered... Is that correct? I thought he'd realize how ridiculous this was... He said "Yes, thank you!" and hung up the phone!

I had to report the incident...like I had time to write it up... and like writing it up was going to make any difference...except encourage retaliation on me...

As far as the surgeon I initially referred to, I am going to be needing to take STAT verbals on crashing fresh hearts from a bedside cellphone... and I am now, quite honestly, really having trouble with it... because in a bad outcome situation that might be caused by a risky order... I'll be hanged with a statement that the surgeon never gave the order... and I cannot very well refuse to work on this surgeon's cases and stay on my unit... so I'm in a bit of a dilemma...

There is another critical care unit with a day shift opening (I work days) in a month or so... and I am seriously considering switching over

I love being on the CTICU... but I'll probably love MICU as well...will enjoy a whole new learning curve and expand my skill set...

Just another example of how patients are compromised by JCAHO recommendations being ignored, which is a theme of this thread... since my unit is already short staffed and I work about 120 hours per two week pay period... my absence will be a hit on my unit... but what am I supposed to do? Risk my license to a surgeon's nonsense?

I have great seniority on my unit...and will give that up in the transfer... and can pick up all the overtime I want, which I cannot on the unit I'd transfer to... but I can pick up overtime on my current unit after I switch, if I switch...so that's really a moot point...

Arrrrgggggghhhhh... really disgruntled... but the Patient Safety Goals heading really caught my eye after this issue yesterday... thanks for the forum to vent on it...

how long have we been griping about toxic workplaces???
and now it's news?

*sigh*
ok...i'll take it.
and it better be enforced.

leslie