How much waste do you see?

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So after the MM 'sicko' thread, me and some of my co-workers got to talking last night about the whole univ health care issue and what's best. We all agreed that, on our unit esp, we see a lot of dollars that could go elsewhere and we see a lot of wasteful spending in our system. We basically take patients that are dead or near death. We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me. In other units perspectively, how much wasting of healthcare dollars do you see?

Specializes in Critical Care.
A life is a life and you chose nursing to save/preserve life, right?

Waste is drawing too much meds and throwing out half of it.

Waste is staff thinking that the utility closet is their shopping store.

Waste is not recycling all of the non hazardous stuff hospitals throw away.

etc.....

Waste is not giving dying patients the right to die with a little dignity, no matter who they are or where they came from.

Just my opinion.

Indeed. There are definite flaws in taking a utilitarian approach to health care.

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Specializes in MICU, SICU, PACU, Travel nursing.

We were just talking about this at work the other day. A nurse I was giving report to was once a manager and privy to expense reports. She told me the generic boring paintings they have on the walls cost over 1,000$ each (!!!) and that administration is supposed to periodically pick some new ones to "redecorate" and they are allocated big bucks to do this. I was pretty grossed out needless to say since this same facility "saves money" by sending home our 10 dollar an hour employees (CNA's, secretaries,ect) when we arent perfectly full and works the ones left to death.

And yeah the gowns wasted by all these "precautions". Half the time I have been all over the room/patient for like a week and then all of a sudden I am supposed to gown up 6 times an hour because they have MRSA in their urine with a catheter in or something else ridiculous. What a waste. I would love to see some hard clinical evidence/studies that show using all these plastic gowns actually decreases spread of MRSA. Mind you I do not mind wearing them when dealing with body fluids, but think if I am just checking a pump or something its kind of overkill.

And to the OP, I know what you are trying to say and I actually agree that, regardless of ability to pay, many people who in ICU should be left to die simply with dignity sometimes, and yes it would save some money. BUt I dont think that a person's ability to pay for care should reflect the care received. Realistically sometimes it does unfortunately, which I dont think is right but reflects our current profit driven state of healthcare. :typing

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Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me.

PiPhi, I know you weren't trying to make people mad but this post made me very upset. I don't care if a person is an "illegal" or if they can't pay a red cent towards their bill. Anyone of us at any given time could be in the exact same situation if circumstances reversed. Its not your job to worry about whether or not the hospital gets paid. You are going to be paid your same salary whether your patient lives in a mansion or on skid row. If you want change campaign for system-wide heathcare reform, don't campaign to take nonpaying patients off the vent.

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Specializes in ICU/Critical Care.

Taking someone of the vent because the patient or their family couldn't pay the hospital bill is one thing, taking someone off the vent because the situation is futile is another. Let's not confuse things. Just because someone is illegal does not mean that we do not treat them. That would just be ethically wrong.

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Specializes in PICU/NICU.
So after the MM 'sicko' thread, me and some of my co-workers got to talking last night about the whole univ health care issue and what's best. We all agreed that, on our unit esp, we see a lot of dollars that could go elsewhere and we see a lot of wasteful spending in our system. We basically take patients that are dead or near death. We save patients that are homeless and leave them on vents for months at a time where we know we will never get that money back when they die. We also see the same with illegals. About 1/2 of our patients do not have any form of insurance (so they wont be paying) and they still get to sit on the vent and rot until they die for thousands of dollars a day. This is a huge waste to me. In other units perspectively, how much wasting of healthcare dollars do you see?

Ok, I it is extremely expensive to treat an ICU pt that will most likely not recover- but whether it is the expense of the insurance company or the taxpayers, don't we just have to? I mean, NO -hospitals are not being reimbursed for these types of pts and some hospitals that serve the indigent/illegal population are in real trouble- some have even closed up shop. But, I think we have to give the family of the noninsured the same choice to keep "doing everything" just as we do the ones who are actually paying. Wasteful? Maybe, but ethical..... yes!

I'd rather see us penny pinching on other things like using only enough paper towels that it takes to dry your hands, turning off computers, using less paper- stuff like that.

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Specializes in Cardiac, Adolescent/Child Mental Health.

I wasted blood tubing the other night. I grabbed the wrong package and opened it before I realized it wasn't the regular IV tubing.

:crying2:

The guilt's been eating me alive.

PS to the OP: Seriously?

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Did people get cultural values in school? It is not my decision who should be on vents. If the person making the decisions for the person says keep on vent. That's it. My values system needs to be left at the door. I worked in a culture that believed you did everything for prolonging life. That is not my value system. I have no right to impose mine on them.

I do not see that as a "waste". I agree with others that we waste tons of money and resources and that too much money is spent on making certain areas look pretty.

Think of these poor souls on vents as practice for you to teach the newer nurses the proper sterile techniques of suctioning. They are human beings before they are homeless, undocumented, uninsured, under insured, or just PIA.

Years before you were born we called these poor souls GOMERS. Do you still do that? It was cruel and I now regret feeling that way.

Concentrate on saving electricity, recycling, encouraging organ donation and we will have less waste.

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.

I really didn't want to put an ethics spin on anything, and I am ONLY talking about futile things. I never meant to not treat people who can be treated that cannot pay. I mean look at how much $$ is spent on end of life care!! Studies have shown that the last 6 months of patient's lives cost the most as far as medical care than any other. Many people have chronic diseases that can not be cured or even helped, yet we stick em in hospital beds on vents because its the "right" thing to do. When a month goes by were still doing basically nothing new for these patients, just waiting for them to get septic so we can spend more money helping with that. Do you think of how that money could have been spent on research and development of better drugs and treatments for those who had a chance? Either way, insured or not, someone is paying. I am sorry but that, to me, is rediculous and an extremely poor use of resources.

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Specializes in ICU/Critical Care.
I really didn't want to put an ethics spin on anything, and I am ONLY talking about futile things. I never meant to not treat people who can be treated that cannot pay. I mean look at how much $$ is spent on end of life care!! Studies have shown that the last 6 months of patient's lives cost the most as far as medical care than any other. Many people have chronic diseases that can not be cured or even helped, yet we stick em in hospital beds on vents because its the "right" thing to do. When a month goes by were still doing basically nothing new for these patients, just waiting for them to get septic so we can spend more money helping with that. Do you think of how that money could have been spent on research and development of better drugs and treatments for those who had a chance? Either way, insured or not, someone is paying. I am sorry but that, to me, is rediculous and an extremely poor use of resources.

This is why doctors should communicate to families when things are futile. At my hospital, in my ICU, we still do everything by the book, but when the interventions are not working and the effort we put in to save the patient, this is when the doctor should pull the family to the side and tell that to the family. Had a patient last week come in with a stab wound to the back. Just by looking at the small stab wound, one would think the patient would survive but in fact the knife nicked an artery or the aorta..Doc called the family immediately because no matter how much blood, fluids, pressors we gave, the patient had an SBP of 40 and sats were in the 50s.

This is why hospitals have ethics committees, some utilize them more than others.

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Specializes in PICU/NICU.

On our unit, everything that is left in a patient's room after they leave is thrown out.... rolls of tape, unused tegaderm, packaged 2X2s, packaged suction caths, packaged yankauers, and always a few of those prepackaged 10cc saline flushes are very common leftovers.... these all go in the garbage due to "infection control issues". We try not to bring too many supplies into the room, but you know how it is- you grab some stuff and go.

It just makes me sick to throw this stuff away! Does anyone else have this policy???

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.
This is why doctors should communicate to families when things are futile. At my hospital, in my ICU, we still do everything by the book, but when the interventions are not working and the effort we put in to save the patient, this is when the doctor should pull the family to the side and tell that to the family. Had a patient last week come in with a stab wound to the back. Just by looking at the small stab wound, one would think the patient would survive but in fact the knife nicked an artery or the aorta..Doc called the family immediately because no matter how much blood, fluids, pressors we gave, the patient had an SBP of 40 and sats were in the 50s.

This is why hospitals have ethics committees, some utilize them more than others.

OK, you have me intrigued because we really dont do this nearly enough. So, in this case, was the pt at this level for a while or less than 24hrs? And, hypothetically speaking, IF this patient was able to get to the OR and wound fixed and no more bleeding, sats ok and bp ok, but the pt had severe neurological problems from poor perfusion to the brain and the pt was in a vegitative state and would not recover, what would your unit do? Family consult and try to explain the situation? How long, if the family said they would not want to remove support, would they allow the pt to remain on life support if the pt could not go to an outside facility for whatever reason? Indefinately?

On our unit, its more of a "well lets wait and see" approach and nothing ever gets done for months at a time, and its irritating.

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Specializes in Trauma ICU, Surgical ICU, Medical ICU.
On our unit, everything that is left in a patient's room after they leave is thrown out.... rolls of tape, unused tegaderm, packaged 2X2s, packaged suction caths, packaged yankauers, and always a few of those prepackaged 10cc saline flushes are very common leftovers.... these all go in the garbage due to "infection control issues". We try not to bring too many supplies into the room, but you know how it is- you grab some stuff and go.

It just makes me sick to throw this stuff away! Does anyone else have this policy???

You throw EVERYTHING away? Man that is pretty bad. We have carts in the room and the same stuff is used over and over, since most if it is in sterile packaging.

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