Is this backwards or is it just me?

[abbaking]

During my downtime on noc shift, I have a tendency to stock the occupied patient rooms with all needed emergency supplies (ambu bag, suction, flowmeter, tubing, etc). Having worked in the emergency department, I understand the need for supplies right where you need them during an emergency.

During a staff meeting recently, It was brought up that I made sure each bed was fully stocked. Rather than praise my efforts at making sure disaster could be avoided, I was thrown under the bus (yet again).

"In an emergency the code cart has all the needed supplies"

So, let me see if i understand this. A patient codes. The patients bed just happens to NOT be stocked with an oxygen flowmeter or any other supplies. We need to get the code cart O2 tank for something that should have been there in the first place?

IN EVERY CODE BLUE OR RAPID RESPONSE I HAVE EVER PARTICIPATED IN - NOBODY HAS EVER USED THE TANK OXYGEN OR DINKY SUCTION CANISTER. Everyones reaction is what is in front of them - not to the side in a cart. Thats why in every code/rapid response, the main drive is to look for the wall oxygen flowmeter/wall suction.

The unit rooms should be stocked with all appropriate supplies so that care can be provided.

But what do I know - 10 years of bedside experience can't compete with managerial stupidity

An ounce of prevention is worth a pound of cure

[himilayaneyes]

I definitely agree that unit beds should be stocked with needed emergency supplies. However, it depends on what type of unit you're working on now. If you're working in ICU or ER, then you're efforts should definitely be commended. However, if you're working on a tele or med-surg floor, they'll just see it as a waste of supplies. When I used to work tele, we only made sure certain rooms (like for a seizure patient) had suction, only had a cannula in the room if the patient was on O2, ambu bags were never in the room...they were located on the crash cart. What type of floor do you work on now? You should definitely ask your manager what they expect to be in each patients room. However, at the end of the day, the managerial staff is only looking at the bottom line financially.

[raskol]

At my old hospital, as a way to cut expenses, we were not to stock the room. This included linens, alcohol swabs, gauze, anything. It pretty much sucked. Especially as a float, as some floors were more compliant that others with this policy. Hourly rounding was suppose to make my day easier, but I was too busy running around getting basic supplies and becoming off-balanced by how much stuff I was cramming into my pockets. I'm surprised my pants don't fall down.

Gotta love a budget.

[NeoPediRN]

I work in peds stepdown so it's a little different but just about EVERY kiddo has ther own BVM, complete peep/pip dialed in according to age/weight. There's also 1-2 flow meters in each room, as well as at least a suction setup and yankeur. In other hospitals I work per diem, every room has at least one flow meter and an Ambu bag and NC/NRB. It's standard policy there.

[Roy Fokker, BSN, RN]

No, it's not backwards.

But it's hard to make your case against the magic words "because of the recent economic downturn and reduced revenue..."

But just like every "temporary tax" or "limited government program", expect these policies to continue even after said excuse of bad economic times are long gone.

Someone posted something about the almighty 'budget'. OP, I think that this whole thing smells of "resource conservation" gone a touch too far.

It's understandable that management wants to maximise profit while lowering costs - totally get that. Don't disagree with it either. I'm actually all for it.

But there is a limit to how much "cost cutting" you can do before it starts to negatively affect workers.

E.g.: Let's say that your regular staffing levels say 10 nurses + 1 float nurse to pitch in where needed. Cue 'bad economic times' and float nurse is taken away. Staff is instructed to bear with for now to get through hard times. Staff grit teeth, work miracles and somehow manage to do more with less.

Fast forward a few weeks/months/years. 'Bad times' are gone... but management is tempted - if Staff could manage without that float nurse for all this time, surely that position is not needed! That 'temporary' loss of float nurse becomes 'routine and permanent'.

Unfortunately, what management doesn't take into account (or did take into account but don't care/write it off) is that in the process of "gritting teeth" and "working miracles", Staff slowly become run down. Disillusioned. Unit morale takes a beating.

Even a donkey can only be pushed so far to carry so much.

Staff ends up venting (like this thread for instance). With nothing changing, venting changes to frustration, anger and finally resignation/indifference. While this is going on, Press-Gainey scores drop correspondingly. Management responds with seminars, courses, badges, "scripted verbiage" (or should that be "scripted garbage"? You know ... "what can I do for you? I have the time"?), more paperwork ... anything other than acknowledge the fact that: expecting the extraordinary for a short while is one thing, making it routine is quite another.

If there's one thing that truly frightens me, it's not the venting, it's not the frustration, it's not even the outright anger - it's the indifference. When Staff become nothing more than indifferent automatons mouthing scripted lines and working 'according to the plan' no matter what.... well....

All through nursing school, this truism is drummed into our heads: "Treat the patient, not the numbers".

Maybe someone should remind management to: "Treat the nurse, not the Press-Gainey scores".

Sorry if this response got off into semi-rant mode and made tangential reference to the original post...

cheers,

[mama_d, BSN, RN]

Depending on what unit you're on, I see both sides...

Definitely yes on the flowmeter, and for seizure/aspiration risk yes on a complete suction setup. If you're not in a critical area, ambu-bag might be a bit far (unless it's a trach pt).

The flowmeters are a pet peeve of mine, as well as not having the wall suction unit. It sucks when you're RRT or coding a pt at 0200 and have to run into other pt's rooms trying to find stuff that should be readily available.

We're not even supposed to leave alcohol swabs in the pt rooms...guess how compliant we are with that nonsense. :)

[morte, LPN, LVN]

I think that hospitals should be designed with cubbies with thru access from room to hall with doors on either side. This is were disposable supplies would kept till needed, so they don't need to be thrown out when the patient leaves....flowmeters, absolutely should be in ea room! and any other cleanable item.

[GreyGull]

If there is no expectation of the BVM being at bedside, the RRT and code teams should know that and where to get it.

Infection control has also been a factor. There is nothing more disgusting than "clean" equipment hanging on a suction canister or flowmeter in use with multiple hands touching it. Even that which is in bags must be tossed when the room is cleaned. Even standby trachs that have not be opened must be disposed of if they have been inside the room. That is at the cost of up to $250 each.

In the ED it is sometimes common to open the nasal cannula package to be ready and slip the open package over the flowmeter. TOTALLY GROSS! Those flowmeters rarely get cleaned properly and now whatever crap (sometimes literally) is on that flowmeter will go into someone's nose. These open packages may stay on that flowmeter through several patients as the O2 equipment from EMS is used. But, several hands will be touching the flowmeter with that open NC package.

Also, when some disposable equipment just hangs around, it becomes outdated and unusable. The cost to go around every 6 months and throw out 200 BVMs in individual rooms is quite expensive and time consuming. Who's cost center?

[Deb123j]

I totally agree c the OP!!! I don't care how much $ it costs when you are talking about peoples lives! We are talking about hospitals here!!! I have worked trauma and now ICU, in both units we have everything we might need...just in case.

There was a young woman on another unit who vomited, aspirated and they had NO suction in the room. Not a very pretty outcome. Our trauma docs REFUSE to send patients to that unit now, even if the trauma unit is full.

[Jenni811, RN]

At my old hospital, as a way to cut expenses, we were not to stock the room. This included linens, alcohol swabs, gauze, anything. It pretty much sucked. Especially as a float, as some floors were more compliant that others with this policy. Hourly rounding was suppose to make my day easier, but I was too busy running around getting basic supplies and becoming off-balanced by how much stuff I was cramming into my pockets. I'm surprised my pants don't fall down.

Gotta love a budget.

Same here. we are not to stock the rooms because then everything in it needs to be thrown out after the patient leaves because of infection control issues. Everything should be in the crash cart, i've never had an issue with things not being in the crash cart that i needed. Yes there are things that are needed during a code, but its usually something that isn't kept in the crash cart, such as more IV tubing, secondary tubing etc. This is what my coworkers are for.

[ZippyGBR, BSN, RN]

In my opinion

number of beds = minimum number of flowmeters and suction set ups plus the set up on each crash trolley

[canoehead, BSN, RN]

I think the point the OP had in mind was to suction the aspirating patient, and avoid the code and crash cart altogether. I've never had to use suction where I didn't need it immediately (except NGT of course).

You can set up the suction and leave the Yankauer packaged and tacked to the wall. Or put a clear plastic bag over the entire suction/O2 set up so it stays clean while patients rotate through the room. You can have a NRB tacked to the wall too, still in it's package. I'm with the OP- we need emergency suction and O2 long before the crash cart comes in the room. If they were needed emergently I wouldn't care if the packaging was dusty or had been touched by multiple hands.