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Joined: Apr 20, '07;
Posts: 19 (32% Liked)
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I am in charge of the scheduling for our ED. 4 requests for shifts off are allowed/month. I do not "hold" staff to their week ends, as long as the shifts are covered I allow them to request week end shifts off. We do not have a week end program.
1. Staff Self schedules then I adjust accordingly - when no one signs up for Friday, then I move staff to meet the needs of the dept.
2. 7a-7p work every other week end. 11a-11p work every 3rd week end. Nites works every other week end
3. We have mandatory call... 1 / 12hr. shift a month
4. Holidays are on a rotating A and B Schedule. If too many nurse happen to be working on a Holiday, I use senority to determine who will actually work the holiday shift.
5. Charge nurses "low" nurses in 4 hr. increments. Then the bus pulls up and we sink.
At one time all staff was on a matrix (set schedule) This worked well as long as no one had to go to ACLS, PALS, went on any type of LOA, quit, had jury duty, vacations, etc. It quickly became unmanageable.
I do the best I can to accomondate staff. I track Fridays, week ends, how many shifts staff rotate, who wants to work 3 shifts in a row, who wants to work every other day, who needs every Tuesday off for school, and keep a copy of the self schedule etc. I feel if staff is happy with their schedule, it's one less thing for them to be dissatisfied about.
Our ED is in the "Wave 2" phase of RBC. So far it's involved a GREAT deal of staff time and outside reading (and we've just begun) Not sure how this is going to work in the ED, especially with the constant push to decrease the dept. LOS. Does anyone have a successful implementation in their ED? Any advice would be greatly appreciated. Thank you.
Actually I know a Paramedic who has DNR tatoo'd on her chest just above her cleavage!!! Wonder if it will be honored.... We have all of the same issues as stated above. Our ED physicians are much better regarding honoring the state DRN form. We have problems with the Attending MD honoring the pt. wishes so they admit with orders for DNRCC-Arrest... which means do everything up until the time the heart stops beating. This order buys a tele bed / Unit Bed and everything but chest compressions and defibbing. Doesn't matter that a pt. didn't want all that. Sighhhhhhh
We operate much like ERJodiRN's facility does. The difference is we have a doctor in triage from 12n-10pm. We use the ESI triage system. The triage team is 1 RN, 1 Medic, 1 ED tech and the MD. We do EKG's, draw blood,aerosols, send pts. to ultrasound/x-ray from triage. We also do not medicate in triage which is a dissatisfier. We discharge the dental pains, medication refills, ear aches, etc. right from Triage. Our biggest problem is the number of "Boarded" pts. in our ED..... doesn' t leave much room for the true ED pts. Our average door to balloon time is under 60 min. and we've had several squad pts. who have hadd a 15 min. door to balloon time... (the ED doctor will call the Code STEMI based on the transmitted EKG from the squad) Everyone really likes having a doctor "at the door" It helps the triage team and has increased customer satisfaciton. The triage MD also sees the squad pts. when able to, does a quick assessment and enters orders for these pts. Sometimes the doctors do not agree amoungst themselves... "why didn't you order ?????" That's kind of interesting. The bed / boarding pts. situation.... that's another issue in itself!!!
Joint Commission visited a few wks ago. We have an electronic chart and the "Self Harm" questions are on approx. 20 Chief Complaints -- (Overdose, Depression, ETOH intox, Altered Mental Status, etc. etc.) JC advised us that each pt. who presents to the ED needs to be asked these questions. The exception would be age 3 and under as they do not have the ability to have intent. Do you ask all your pts. the self harm questions? If so, how do you "script" them? Espec. for pts. with minor complaints / problems. Any help, info would be greatly appreciated!!!!
Our chest pain protocol follows the AMI Core Measures and includes all the usual lab work, PCXR, ASA, 1st EKG with in 10 min. upon arrival and a repeat EKG in 1 hour. If a definative "Clinical Impression" has not been made, we have a Clinical Decision Unit in our ED. These pts. receive 2 additional sets of cardiac myeomarkers and an EKG that are done at 4hrs. and 8hrs. from the initial EKG. The ED Physicians manage these pts. and a Cardiology consult is required on all these pts. The Cardiologist will sometimes order a stress test prior to discharge if appropriate. The CDU works great for us. This did help to increase the teamwork between the Cardiologists and ED Physicians
Hope this helps,
We have a physician in Triage for 12 hrs. daily during our busiest times. This has cut down the number of times we need to line and lab. We also have protocols and order sets. I sure hope our physicians would back us up. We save them enough!!!!
Unfortunately several of our nurses had to transfer from the ED to ICU to obtain "critical care experience" The programs they had applied for did not recognize all their years of ED experience. (Nurse Anesthetist)
None of us in the ED agreed with this.
We have a MD in triage from 12n to 2200 daily. The triage doc sees all pts. and enters orders. ESI Level 5 are discharged from Triage. Our MLP us used in the "FastTrack" area. We also occassionally have problems when the "doc in the back" wants an additional test. Most often we call the lab for an "add on" so pts. aren't stuck again. We are in the processess of remodeling so we can start IV fluids and give meds in triage. If ordered, we sent to ultrasound and CT from triage on days when the main ED is full.
The triage MD also does a quick assessment on all Squad pts. and enters orders as well. All this had decreased our LOS, LWOT and increased staff and pt. satisfaction.
I am the Application Administrator for HealthMatics ED which is owned by the same company as EmSTAT. "HMED" has an awesome tracking board and is VERY easy to customize to meet your hospital's work flow. The support from the vendor is outstanding!!! The system is easy to use, contains MD and nursing documentation, over 1,000 Aftercare Instructions, holds up very well in legal situations, is easy to modify to comply with JCAHO rules and regulations, has a charge feature, sketch drawing, Quality components and the reports are endless, both standard and custom reports that you can create!!!!! I can go on and on. I like EPIC but I love "HMED" You can contact them at Allscripts.com
I can't believe so many of us have the exact same experiences!!!! I would love to know why Administrator feels this behavior by pts. is acceptable and it is expected that we take it!!!! As I've said before in the Press Ganey posts, our raises are determined by Press Ganey scores so we not only have the pressure from Administration but Press Ganey as well. Along w/ posting Press Ganey scores, our director is now posting the names of all the nurses listed on those charts!!!! Does wonders for our moral!!!! .......... NOT.
I feel everyone else's pain. Diversion in our area is a voluntary county wide program that our hospital does NOT participate in. As others have said, every aspect of the ED backs up, sometimes 3/4 of our pts. are admits being "held" in the ED. The waiting room will have 20 some pts., we will have hall beds everywhere. We have a doctor in triage so he/she will order a work up including meds in triage but unless there is a place to watch the pt. in the triage area, we can not give the med. So the pt. gets to the treatment area 4hrs. later w/ orders for meds that are also 4 hrs. old. Makes me feel real comfortable (NOT) Also, the long waits, etc. negatively affects our Press Ganeys (which is another thread)
How sad!! This is absolutely a HIPPA violation. (In addition to being a staff nurse I am also responsible for our EMR. Whe requested I run reports to monitor for inappropriate viewings of charts.) Our nurses / staff know not to go into any chart they need to "think twice about" going into. They will even go as far as to document a note as why they went into a chart IE: cultures reviewed and negative.
As fellow members have stated -- Why did they draw a blood alcohol level?
I would be contacting Human Resources and the Risk Manager for starters.
I agree with asking which medication could be stopped for a short time while the blood was infused. Also, we use the EZY I/O in our ED in extreme emergency situations.
We see 50,000 pts. We have a "greeter", physician, 2 medics (or 1 medic & 1 LPN) and an ED tech in Triage. Labs, EKG's, IV's, CT Scans, venous duplex studies, etc. are done in Triage. Meds are ordered by the Triage MD but only given if there is room in the triage area to monitor the pt. Sore throats, simple UTI's, back pains, tooth aches are are usually discharged from triage. We document using the HealthMatics ED computer system. The only drawback to the system is entering the numerous home meds, doses, etc. When the dept. gets busy, Triage will back up & pts. wait. It does help that the pt. was seen and had a quick initial evaluation by a physician.
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