Trauma Room MEds

[canoehead, BSN, RN]

I work at a level 3 ER, striving to be a level 2 someday. At one point we had emergency meds on shelves in the trauma room, so we could just grab and treat as the doctor gave orders. A few months ago the pharmacy said we couldn't have any meds stored outside the Pyxis, and now we have just a crash cart with code drugs, nothing else.

When we get a patient in now the nurse has to run back and forth to the med room, and misses the thread of action on her patient. The doc even adds to what he needs or changes his mind, and she's in the med room, not even in sight, she comes back, and has to run out all over again. It's impossible to chart, give care and be a runner, and when you give report you realize how much information you missed out on.

What does everyone else do? Are your meds in the trauma rooms? Do you have an extra nurse assigned as a runner? Does anyone know of standards that say meds need to be within a certain distance relative to the trauma bay? How do you manage to get meds given, and maintain continuity? I'd like to get back to my boss with some suggestions.

[WKShadowNP, DNP, APRN]

We're not a trauma center but we do get some that need immediate stabilizing or our medical codes. There is a pyxis between our two trauma rooms that is easily accessible for some things, our airway cart meds (except for sux which is refrigerated) but in those situations we have someone to run and get meds.

[Nalon1 RN/EMT-P, BSN, RN]

Only meds are in the crash cart. Everything else you have to go get.

I believe that it is a JCAHO (or state) item that all meds must be secured in a locked area. Somehow crash carts get around that (ours do have the inventory tag on them, but no physical lock).

I know some facilities have a "Stemi" crash cart with basic meds for that (ASA, NTG, Plavix, Heparin, etc).

What type of meds are you needing in a trauma room? So long as they are not narcs, see if you can get some type of "trauma cart" for your facility.

[necc2008]

We have a pyxis in trauma room with pain meds, aspirin, nitro, Zofran and rsi kit. Any kind of drip someone has to go to other pyxis. Most times there is another nurse to run and grab those meds. It would be nice to have pressors and other drips in the trauma room pyxis. It would save a lot of time running back and forth.

[elijahvegas, ASN, RN, EMT-P]

Level 1 trauma center here.

If you don't have a dedicated trauma team per shift, that soubds like a real dangerous place to work.

There should always be at least 2-3 nurses, and another 2-3 medics all trauma/tncc certified

If its your patient your only job is to scribe. You stand in the room at all times and record every assessment finding and every med ordered. You dont leave to do anything else. The doc calls out orders and other members of the team follow them, and calls to you when its completed should you beed to ascribe a time to wheb certain actions took place

At least thats how ive seen them run

[Nalon1 RN/EMT-P, BSN, RN]

Level 1 trauma center here.

If you don't have a dedicated trauma team per shift, that soubds like a real dangerous place to work.

There should always be at least 2-3 nurses, and another 2-3 medics all trauma/tncc certified

If its your patient your only job is to scribe. You stand in the room at all times and record every assessment finding and every med ordered. You dont leave to do anything else. The doc calls out orders and other members of the team follow them, and calls to you when its completed should you beed to ascribe a time to wheb certain actions took place

At least thats how ive seen them run

Of course that is how it is supposed to be. Level I has the resources to do that. Level III/VI may not. Many times it is you, a tech, physician and hopefully another nurse.

[offlabel]

Level 1 trauma center here.

If you don't have a dedicated trauma team per shift, that soubds like a real dangerous place to work.

Dangerous, how?

[chare]

[...]

There should always be at least 2-3 nurses, and another 2-3 medics all trauma/tncc certified

[...]

If you are referring to four to six persons at the bedside, that's somewhat excessive for most situations. Three nurses, one per side and the primary nurse recording, is likely sufficient for the majority of trauma patients, with additional staff available and called to the bedside when needed.

[NotYourMamasRN]

I worked Level 2 ER and we had the same, but our ER was huge and we had a Pyxis right outside the two trauma bays. However, many times a medication that was needed was in another Pyxis, across the ER.

[canoehead, BSN, RN]

Is there a JCAHO standard, or ENA standard about the nurse not leaving the bedside, or the meds being within sightline? We need to go about 50 feet and out of sight/hearing of the trauma room to get meds. Often, the orders have changed by the time you get back. If the primary nurse has to do the running, they miss most of the plan of care, and treatments are delayed.

[elijahvegas, ASN, RN, EMT-P]

Dangerous, how?

Because that means youre either understaffed, or staffed with people unqualified and untrained . And im sure i don't need to go into detail about how thats bad for everyone involved

[elijahvegas, ASN, RN, EMT-P]

If you are referring to four to six persons at the bedside, that's somewhat excessive for most situations. Three nurses, one per side and the primary nurse recording, is likely sufficient for the majority of trauma patients, with additional staff available and called to the bedside when needed.

I suppose youre right. But this trauma center is all i know. We see and receive the worst of the worst. and things tend to flow very well with that many hands on.

I think during the trauma if so many arent needed a few fall back. Im tncc certified but im not part of the trauma team. I still hop in and help where i can, and thats usually about the amount i see. 4+ with a physician