Best Incident Report Ever Written

[KalipsoRed21, BSN, RN]

So, my job is dumb...as all my nursing jobs have been. I'm 1 nurse trying to run a clinic that has 6-7 different surgical specialties and 10 physicians (yay, we just got one more). There are significant issues with this facility regarding policy and pathways of care. Basically they have 1 big facility that has been running for 100 years and things are fairly smooth there, but they have branched out and bought 3 other facilities in the last decade. The satellite facilities are crap shoots and they are having an enormous issue trying to translate their success at the main facility to the other facilities. Mainly, I think, the issue lies in the fact that the main facility is a teaching hospital (so they have a *** ton of slave labor...um residents to ensure things run smoothly.) The 3 satellite facilities  have far fewer to no residents on top of the fact that they are working with private physicians to fill in care gap needs. So where you can maybe demand tenured staff and residents run their departments one way when employed by the school, it is harder to do with private physicians who want to do patient care their way. So in general it is just a whole bunch of confusion, lack of knowing who to call, and very few to no protocol orders where you can think on your own and take a few actions. 

On top that they have no effective communication.

99% of the facilities/clinics/home health I've worked at you can call the main number to that floor/department/business and get directed to someone who can assist you with getting to the person you need. Here they are trying to use the EPIC in basket and TEAMs chats to communicate real time patient needs. And if you  need to get a hold of someone quickly and try to call that specific clinic, the number you call sends you to a call center where non-clinical, secretary like people attempt to reach the same clinic via TEAMs and EPIC in basket like you just did...with the same amount of success. Like back line directory for in house staff please?

Anyway, this is also how they attempt to contact us regarding urgent patient needs as well. Because these secretary like people are not allowed to say something like, "I am unable to reach the nurse at the clinic you requested. I will relay this message to that clinic right away, but if you feel you are experiencing an emergency please call 911.” The organization's excuse is that these phone operators have no medical background and thus cannot advise people to go to the emergency room. I think we all know the statement above does not advise the patient to go to the emergency room. It is just letting them know that if they feel they are having an emergency they should be calling 911. And I found out recently that apparently every other clinic has certain calls triaged by nurses that work in the call center...but not my clinic. Apparently since my clinic has surgery patients it was determined that the clinic needs to triage their own patients.? Um, okay? Yay, run clinic, do FMLA forms, answer emails, do preop teaching, schedule surgeries, request cardiac clearances, review urine cultures for up coming cysto scopes, assist with excisions and cystoscopes, teach self cathing, wound care, ostomy care, ensure supplies are ordered, answer MyChart patient messages, try to have some sort of follow up on all of the above, AND urgent calls. ?? My MA and LVN can room, assist with some procedures, and call patients back about normal test results. Sooooo yeah, great. 

I have, not surprisingly, sent in several RLDatix (EPICs incident reporting system) over the last year that I've worked there. 5 so far. The latest was my piece de resistance. 

There was a patient who called in requesting assistance. One of these non medical operators TEAMed me (like a computer chat) the following:

"Breast Oncology Patient surgery on (the day before) complains of nearly passing out when getting up and BP is 85/50 per home device. Please advise."

Two hours later when I finally sat down at my computer and saw it, I ,of course, immediately called the patient and told her to go to the ER. 

Then I wrote a lengthy RLDatix that included the following, "the communication in this organization ***. The policy is not to use one's cell phone at work, however, there is no direct way to communicate with anyone without finding out what their cell phone number is. One must attempt a lengthy battle 1-2 times with these inefficient communication pathways before finally just getting that person's cell number for future needs. This is just *** ridiculous.” I did not file this incident anonymously...as I do not on any of my reports. 

I got called into the office yesterday because the CNO told my manager that I needed to be told not to use inappropriate language in these reports as they are seen by many people across the organization and at the highest levels. And my response did not please my manager, because I told her that was good I wanted them all to see what I wrote and how I wrote it. She then tried to get me to see reason by telling me that inappropriate behavior was not tolerated. I informed her that if they needed to fire me that was okay. I'm not sorry for how I worded my report, and I'd have another job in 5 minutes. ??

Yeah, I probably have a target on my back now, but the whole thing just makes me laugh and very satisfied. I at least know I was heard, but like always, no one was listening. Aww well, one fun kick in 15 years was worth it.

Oh, and I later found out the patient that called was bleeding internally and had to have emergency surgery. Her HCT had dropped from 33 day of surgery to 18. Soooooo, yeah....*** and *** (which I wrote that way, not the word) are super disturbing when compared to almost letting someone sit at home and bleed to death while waiting for a call back.

[JKL33]

KalipsoRed21 said:

CNO told my manager that I needed to be told not to use inappropriate language in these reports as they are seen by many people across the organization and at the highest levels.

So I get it, professionalism is preferred. But it truly suuuuuucks...the things they will do in order to have the appearance of everything being okay. They are more afraid of higher-ups finding out that things truly are a dumpster fire than they are the dumpster fire itself.

I have seen that insane behavior many times. Crappy care? No problem. People hearing that the care is crappy >> utter freak out.

You should keep a little log of time spent attempting to contact persons in the system to facilitate patient care. Total up the hours wasted in a week and attach to next very professionally-worded incident report.

We actually had a change (improvement) in computer log-in procedure at one place I worked because one of the most respected RNs in the unit documented an avg of 60 mins spent logging into computers during a typical 12 hr shift. ???‍♀️

 

[klone, MSN, RN]

Every time I read about your work environment, it gets me hot.

[CrunchRN, ADN, RN]

You are fabulous. Honestly. Keep us updated.

[toomuchbaloney]

Clearly the patient is not the center of the care model in your large organization. That is typical in the American health system that has falling outcomes and unsustainable costs. 

[KalipsoRed21, BSN, RN]

toomuchbaloney said:

Clearly the patient is not the center of the care model in your large organization. That is typical in the American health system that has falling outcomes and unsustainable costs. 

Ta-rue and it drives me nuts! I'm not even sure I can trust them to cone up with a good plan of care, a safe plan of care, but I'm sure they will charge the poop out of me for the crappy plan they have.

[Emergent, RN]

toomuchbaloney said:

Clearly the patient is not the center of the care model in your large organization. That is typical in the American health system that has falling outcomes and unsustainable costs. 

After reading how the hospital managers brushed Lucy Letby situation under the rug, I think that Healthcare managers everywhere are primarily trying to meet their bottom line and keep their lucrative salaries.

[KalipsoRed21, BSN, RN]

Emergent said:

After reading how the hospital managers brushed Lucy Letby situation under the rug, I think that Healthcare managers everywhere are primarily trying to meet their bottom line and keep their lucrative salaries.

Touché, a good point. Still statistics are that the US system is more likely to kill you...or let you die...than the UK, Finland, Canada, et all.

[brandy1017, ASN, RN]

This can't be the normal way a surgical clinic runs!  They have the highest risk but no dedicated triage nurse, one nurse for 10 doctors.  It isn't safe and that patient could have died.  It is insane!  Not to mention there is no excuse for this and they make good money, unlike primary care so why aren't there more nurses?  Also common sense should be able to call your cell phone especially if you are not sitting at a desk as a triage nurse would be.

Where is the risk manager in this organization?  They need to make changes so someone doesn't die the next time there is an emergency!  It would be a sentinel event that could risk their medicare funding!  Not to mention a lawsuit and all the bad publicity so hopefully you have helped wake them up.

[toomuchbaloney]

There are not more nurses because nurses cost more money without the ability to bill for time and service.  The fact that it benefits patients to have increased interaction with RNs in healthcare settings reveals that patient benefit is not the priority.  

[brandy1017, ASN, RN]

toomuchbaloney said:

There are not more nurses because nurses cost more money without the ability to bill for time and service.  The fact that it benefits patients to have increased interaction with RNs in healthcare settings reveals that patient benefit is not the priority.  

That's just an excuse they use.  The medicare reprisals for adverse events cost the hospital and clinics money and that should be an incentive enough.  And if they were concerned they would use their lobbyists to advocate for a change in payment structure, but they don't bother which tells you what they really think!  In fact, they are too busy lobbying against safe staffing and patient ratio's.  It is a very perverse situation where they need nurses and we are literally the backbone holding the place together, yet they prefer to have an adversarial relationship with us!  Totally stupid and short sighted which has resulted in an exodus of nurses from the field, truer words  haven't been spoken as I saw on a union banner.