ABCs or CAB (irony...)

[Music in My Heart]

I work a level-1 trauma center; we see it all from the chronic to the urgent to the sliced and diced. We'll sometimes have multiple DOE patients with similar complaints arrive at the same time.

The other day we had a SNAFU with a DOE patient, registration, and the computer. Just as the trauma docs and nurses had finished up the initial set of orders and charting, we were told that there was a mix-up and that the orders needed to be re-entered. In the meantime, I'd taken the pt to the CT suite with the trauma team in tow. As the patient starts to deteriorate, the trauma chief gives me verbal directions... but the orders aren't showing and the Pyxis won't budge... the trauma intern madly dashes to the machine and types again... "The orders are in!" she yells... but of course, they're still not showing up for me. Meanwhile, the CT folks start ******** that the patient isn't showing up for them, either. Admitting swears they're in and pharmacy says they're waiting for a weight but that meds have been verified and sent to the Pyxis... still nothing for me, though.

Ultimately, I skirt the system by pretending to pull some meds that I can override but actually laying my hands on what we wanted. As things are ultimately sorted out, I return and re-pull as ordered, CT gets the images connected to the patient, and the patient gets taken to the OR emergently.

We managed to make it all work but the computerized system that normally integrates things and smooths it all out really caused some problems.

I was chatting with the trauma attending in the midst of the chaos and related my little ditty that I share...

"You know, before I became a nurse I thought it was all about taking care of patients, meeting their needs, and helping them recover. Now I realize that it's all about keeping the computer happy and making sure that every box is checked and line is filled in... if the patient happens to get good care, that's incidental."

The trauma chief said, "Yeah, it's A-B-C... airway-breathing-computer."

The attending smiled and said, "Remember, it's been changed to C-A-B."

[emtb2rn, BSN, RN, EMT-B]

So sad and so true. My pyxis over-ride patient is "floor".

[SwansonRN]

So true. Computer, call bells, customer service, airway, breathing.

[wooh, BSN, RN]

So true. Computer, call bells, customer service, airway, breathing.

Actually, I believe its "Customer service, call bells, computer, airway, breathing."

[Guttercat, ASN, RN]

As a twenty-year NP told me recently, " Practicing Medicine used to be fun."

[SwansonRN]

Actually I believe its "Customer service, call bells, computer, airway, breathing."[/quote']

My mistake!

[Do-over, ASN, RN]

Core measures, airway, breathing...

[Corey Narry, MSN, RN, NP]

It's been a while since I was an ER nurse in a Level 1 Trauma Center. We had computer charting back then (some form of ED focused EMR). While we did have to wait for meds to show up in Pyxis, what saves us in dire and emergent situations is that we had a dedicated Pharmacist and a satellite Pharmacy in the ED where meds are readily available. I'm sure those days are gone now.

But yeah, I hear you OP, I think nowadays as EMR becomes even more complex we're faced with even more delays because of pharmacy not releasing meds because they were entered incorrectly, and then the medication itself would not scan, etc. And this happens in an ICU setting where in many instances, you give an order for a med to be given stat.

[grizzlegirl]

Oh so funny he needed to be reminded that is definitely CAB now

[grizzlegirl]

It's so hard these days to really work in your field without sometimes checking back and wondering how much time did I give to my patients today. I work in the nursing home off and on trying to find one that is not just giving the medication and charting and forget about the patient well being it makes me sad. That's why I leave the nursing home I don't feel as though my working is fulfilling working there.