I have been an ICU/CCU RN now for 20 years. I have worked in a 48 bed ICU/CCU at a University(trauma 1) and was the Team Leader for several years there and ICU/CCU, 30 bed ICU(trauma 2) and was a coordinator/charge RN. 2 1/2 years ago I moved to a smaller city and took a job in the ICU/CCU. The manager stated when I was hired that I would be started on the heart program the first week. When I moved down and started she kept saying soon. I started in Jan 2011 and finally took a heart in Sept 2011. It is a 14 bed ICU/CCU. Once I started taking the hearts I noticed that the RN's that I was following were making many errors. They were marking that all swan ganz were at 60cm, when checked they would be at 50,54, 62, etc.... rarely at 60cm. No one was checking the placement. It was pointed out to me that that is where they all should be by the charge RN. I know that this is not true that it is based on the height of the patient and proper placement into the pulmonary artery. Over these past few years many patients are placed on Amiodarone, or Cardizem, for Afib, SVT etc... The manager had been made aware of this and she stated that 55cm is the standard and it should be based off this!!!!INCORRECT!!!! These same nurses where charting that NG/OG placement was verified, yet no piston syringe. 12 hours would go by with no NG output. Ng's found in mouth, lung etc. Manager aware and states that they could tell from chest xray or from wall suction. Told by charge RN to pull artline at beginning of shift due to dampened artline. when pressure bag checked, no fluid. Told that that does not affect monitor, but it did when bag was placed. There are RN's taking IABP's that do NOT know what it does. They leave the patients unattended, obviously they have never had a patient get up and tear renal artery or aorta. I've never had happen but it happened at one of the hospitals I worked at. These same RN's are the charge nurses and coordinators here. There are many other errors with medications. The manager keeps covering up for these RN's as they are her friends. I no longer take hearts at this facility, I transferred to another hospital. My friend still works in this ICU and I have to float here. He is a recent heart RN but he is now seeing the errors. He also has pointed these out to manager and is now being restricted on taking the hearts and harder patients. I am afraid for patient safety, but do not know where to turn as the manager and her manager are aware of these issues. Should I call JAYCO?
The Amiodarone and Cardizem are being placed because the nurses are messing with the swan ganz. When it is against the wall of the r ventricle or coiled it causes irritation therefore at times leads to Afib or Svt, etc... I would be mortified if something happened to a patient. This is why I am on this site to find out what I should do as the management seems not to care. They condone such behavior and these nurses are now going into management themselves. 2 are now day shift house supervisors and 1 works for the CV surgeon ie: his NP and another is working with the cardiologist coordinating their patients. It is very far into management in this facility. It is a giant corporation with a lot of hospitals around the country.
I would send an anonymous letter outlining instances you've seen (no mention of date or pt or else they might track it back to you) to the unit manager/director, the CCU/ICU RN Educator, top RN & top DR & top administrator in your hospital, and also the hospital's lawyer (sorry, my brain is fried and just not coming up with the proper titles for each of these). You might copy all of them at one time, or individually (you decide in what order), but I would say that you are prepared to inform JCAHO and other hospital quality agencies, if you haven't already, though that might be perceived as a threat.
Good thing you're no longer doing hearts there yourself, but if problems exist in one type of patient, are the rest of the patients any safer? Scary situation and disgraceful professionalism. Definitely the educator needs to get to work!!
I would discuss this with risk management. I would discuss this with risk management at the corporate level if no response. Make sure you have policies in hand that back up what you are observing.
Make sure that when you do your initial assessment, that any errors (tubes misplaced, etc) are corrected and documented accordingly "per MD order" I have also seen the policy and procedure added to the chart so everyone is on the same page.
I am not an ICU nurse. The thought gives me stress. Not my cup of tea. Great admiration for those who are. BUT I am a type A to the book kind of a nurse, who gets nuts when someone puts in a tube, whistle, wire---then just sorta leaves it--never to be thought about again beyond "yup, it's there".
Management heavy facilities, when management have not one clue about ICU nursing is indeed difficult. And these seem to be critical errors that can cause a patient harm. So it needs to be reported to QA/risk management.
One clue you gave is a huge health system that have facilities across the country. You need to get out of there quick! And yes all of this needs to be reported to the state.
RN45RN45
2 Posts
The Amiodarone and Cardizem are being placed because the nurses are messing with the swan ganz. When it is against the wall of the r ventricle or coiled it causes irritation therefore at times leads to Afib or Svt, etc... I would be mortified if something happened to a patient. This is why I am on this site to find out what I should do as the management seems not to care. They condone such behavior and these nurses are now going into management themselves. 2 are now day shift house supervisors and 1 works for the CV surgeon ie: his NP and another is working with the cardiologist coordinating their patients. It is very far into management in this facility. It is a giant corporation with a lot of hospitals around the country.