Latest Comments by tmylen

tmylen 486 Views

Joined: Apr 5, '04; Posts: 4 (0% Liked)

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    I went in the room to check the IVF (icu) and noticed the amound on the pressors was different and lower than the previous amount. The daughter of the pt stated she changed it because she felt it was not needed at that rate any longer. She is a nurse and worked on one of the floors in the hospital. I took her in the hallway and basically had to counsel her. I was shocked any RN would do this.

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    Well, I didn't and don't read everything word for word. I focus in on problem areas and scan the rest. I read the doc's plan, look at labs related to the diagnosis, lytes and CBC, the first part of the H&P to make sure I have all the co-morbid diagnoses, verify that the meds I am going to give have current/active orders, and check for new orders/nows and such. Then I'm off to do my assessments. I constantly refer back to the chart as necessary. Invariably, I find orders undone, meds not delivered, etc. That's what takes up to much time. Sometimes I think we could handle more patients if the ancillary services kept up with the pace. But one patient having problems can chew up a lot of time.

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    Hello to all! At the hospital where I work, the glucometer or accucheck machine is a modified palm. It has a barcode scanner and test strip insertion port built into a case that encloses the palm. When we do an accucheck we scan the patients wrist band, scan our ID badges then proceed to do the accucheck. It's a nice little setup. There is a hotsync cradle attached to a modem that transmits the info to the lab. The lab ensures the machines get their daily QA routines done.

    My hobbies are electronics and computers. I can program palms using NSBasic or CodeWarrior. I also do embedded computer programming. Zilog has a nice chip that has an IR port and ethernet link built into the chip. It would be very easy to use generic palms to capture clinical information for transfer to the hospital's system using the IR port. Hospitals could buy generic palms, load a program onto them, attach a barcode scanner to the serial or usb hotsync port and have a tool that could capture bedside information. Using barcodes decreases errors and the software on the palm could mask and encrypt the data to conform with HIPAA. Instead of using the IR port or hotsync to transfer info you can also get palms with wireless elthernet capabilities including Bluetooth. But if you stick with the hotsync/IR method, then clinicians could use their own palms with hospital supplied software a barcode attachments. It could even be used with medication administration to reduce errors.

    This technology is already out their. I can use it as an amateur so you know that it can be used by the professional system developers. I don't know why it isn't more widespread. Especially now with the HIPAA, hospital error rates in the news, and JACHO zeroing in on process improvement and tracer methodology. Maybe hospitals consider it to be an escalation of technological complexity that they don't see an easy way to manage. They would have to add IS staff that had the additional skills in this area which may not be an overly populated manpower resource at this time.

    Just my two cents. I have looked at the other sites listed here and it is coming along. It just seems that a company would introduce a middleware capability that could talk with any hospital system. Maybe I'm naieve (sp?) in this area.

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    Quote from Peeps Mcarthur
    A definition of "medical care" would be that under the direction of a physician, so wouldn't that be any care that the physician has written orders for? Can you give an example of something which a physician has written an order for that a nurse is more qualified as an expert in? I guess I can't see what patient care, that is not under a physician's orders, would be needing a nurse to testify as an expert in that nonphysician domain of expertise.

    Of course, psychosocial cause and effect is completely foreign as it is barely mentioned in a physician's training, as far as I know. Since it's not part of a physician's expertise they have no business in overseeing it, or presenting as an expert to testimony about it.

    The incidents that I can see in a court of law would be things like medication errors. In a case where the order was written incorrectly, dispensed in the wrong dosage or form or administered in error. In the foodchain from doctor to pharmicist to nurse administering it, who is the expert? Wouldn't a physician be testifying as to the validity of the order, correct mixture, route and timing of administration? If we are talking about what a nurse should be held accountable for in regards to this medical care, wouldn't an expert in phamacological inteventions be indicated?

    I know this is only one example, so it certainly is not the whole argument, but shouldn't physicians be so called 'experts' in patient care? I believe I know what the overwhelming response on this board would be to that question but I think it needs to be pondered with more than just the typical knee-jerk reaction to expand the nursing empire at all costs.

    At any rate, nurses seem to think that it's a good thing. I'm wondering why.
    If the only care that a patient received had to have an order for that care written by a physician or other surrogate, the patient would be considered to have received a sub-standard level-of-care. The BON in any state delineates a "scope of practice" for nurses. A nurse licensed by a State BON can, independently of a physician's order, initiate nursing care on a patient in any setting for which they are qualified. No, a nurse cannot write a prescription, nor can a pharmacist. A nurse cannot operate as a physician, a pharmacist cannot operate as a nurse, and a physician cannot operate as either. In most states, a physician cannot operate a nursing home unless he is licensed to operate a nursing home.

    For your medication example, if the nurse administers an incorrect order then the nurse is accountable for administration of that order. Now a court may decide liablity based on "any and all". So the hospital may end up paying as they usually have the deepest pocket. That lhas NOTHING to do with the accountability. I believe your argument is overly simplistic and mixing apples with oranges. There is no food chain where the phsician is the at the top and eats everyone else as he sees fit. A hospital becomes liable for the actions of a physician practicing poorly in their hospital when they become aware of the sub-standard pattern of practice. Does this make the hospital the ultimate "expert" on the standard of medical practice? No it doesn't, in case you didn't know. This isn't a "knee-jerk" reaction, this is precedent set in prior rulings. There are "prevailing standards of medical care" in the "community", the definition of which, is the court's attempt to apply some type of standard against which the application of medical care in a particular set of circumstances can be compared. This "prevailing community standard" is based on the what a prudent provider would do in a similar circumstance in the community. Now the community may be defined various ways based on what aspect of care the court is trying to analyze. This standard applies to all providers. Not just physicians, not just nurses, not just pharmacists. But if it is a nursing act that is being evaluated, then the standard that applies consits of what a prudent nurse would do in a similar circumstance in the community. It's not what a doctor says a nurse should do in that circumstance, it is what prudent nurses, practicing nursing, would do in a similar circumstance. In your medication example, a prudent nurse is required to know the right drug, right time, right dose, etc. A pharmacist may know this also. A physician may know this also. A physician does not determine what a nurse should do in a particular circumstance. It is prudent nurses, practicing nursing in the community, operating under a license issued by the state, who set the standard used by the court.

    Now every provider is required to bring a certain set of knowledge and skills to the table when they are practicing within their scope of practice. This knowledge is different for nurses than for doctors. The skills are different also. Nurses are not failed doctors anymore than doctors are promoted nurses. Doctors don't take "Nursing Systems I and II" and then go on to medicine. Nurses don't take "Medical Care 101 but not 102". Medicine and Nursing are appled science which equals technology. True, the science overlaps in a lot of areas. True, the outcome and goals of care overlap in a lot of areas. But Nurses apply the science in a different way than doctors. And Nurses frequently apply a broader range of applicable science to the care of their patients than doctors. Nurses just don't treat kidneys, even dialysis Nurses don't just treat kidneys. True, the Nephrologist and the Dialysis Nurse share the outcome of cleansing the patient's blood of certain waste by-products of metabolism. The physician's order only states what dialysate to use, how much water to take off, etc. And the physician wants the patient to survive the process, go home, and have some modicum of a normal life. But he or she doesn't write "Modicum of Normal Life QD". The patient probably spends from 5 to 7 daytime hours, three days a week at that facility. This is truly part of his or her life. And they are usually dropped 2 to 3 pounds by the end of the session. They get dog-tired and exist in a circumstance that is ripe for depression and not even a modicum of a normal life. So who brings the patient through this weekly gudge routine? The Nurse. If you can't imagine the range of clinical tools, experience, and empathy that requires then you have no business dicussing this. A court proceeding is a world away, or more, from this person's life. And this Nurses's.

    I've said enough. Patient care is much more than orders and protocols. The Nurse brings a unique set of knowledge, skills, experience, and behavioral repetoire to bear on the care of a patient at any point along a wellness continuum. Research studies showing the positive effect Nursing has on patient outcomes are just now starting to appear in the literature. Look up Omaha criteria on any web portal and you will see. Good luck in your EMT career. It sounds like that is exactly the place where you should be.