Latest Comments by jrgrad1912

jrgrad1912 1,264 Views

Joined: Feb 28, '05; Posts: 10 (0% Liked)

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    one pacu rn took it to the ceo and it is going to be reversed(i am not holding my breath). i do not know whose idea it was, the crnas hate it. they have to sit in pacu with us after hours.
    the rn who took it to the ceo said the complaints were like, pt with a small bloody spot on gown. my favorite was the pt was nauseated. the pts do better becauce the crnas give higher and better pain meds. that was another complaint the pts had pain. we told our manager our hand were tied we could only give what the surgeon orders, and if we give a pain med we have to hold the pt for 30 minutes. she is from a big or and did not have to do any thing with pacu.
    it is interesting how little people understand anesthesia.

    i would like to thank all the nurse who replie!d to this. jr

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    Quote from fins
    Just wait until the new policy causes some OR backup because anesthesia hasn't written the d/c orders yet and PACU is full - I'm sure they'll make that your fault, too somehow.
    Thanks for your reply.
    I asked about that. the ACNO said "It does not matter". We have lost so many surgeons on some days we only have 4-5cases!

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    Quote from loricatus
    can't you ask for standing orders?

    we have preprinted order sheets with fill in the blanks for meds. part of the standard preprinting says: "discharge when pacu criteria met." all the doc or crna has to do is sign it & when they forget, we just write it as a verbal order.

    this gives a lot of leeway to the nurses to use their judgement, but still technically be forllowing orders.
    the surgeon still writes a discharge order. this hospital does not have standing orders.
    we have been doing this for a week now and we have no stress! we call the crna and they come and look at the pt. and writes the order.
    now if a patient crashes on the floor or in acu it is the anesthesia's fault. not the pacu rn. i am upset how they handled it. just come and tell us they are changing the way we discharge pts. just a note. they still have not changed the policy!

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    This is crazy! I work in a 150 bed hospital and we have 4 PACU RNs. We were all called to HR and given a written verbal warning for discharging Pts with out an order. We have been discharging PTs by our policy, which uses the Aldette scale . We were informed we violated the Nurse practice Act and worked outside our scope of practice, by not following a standard that requires the anesthesia provider to write an order to discharge. We still have not seen this "standard". We have a new Anesthesiologist and we are sure he is behind it. To fight this would be job suicide and we all have ties in the Community.

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    Who sets up the CPM for the first time on post op total knees? PT has been doing it. We were told we would start doing it in in PACU. PT is going to show us how tomorrow. Also, should there be a policy before we do this?

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    We use Dose/lockout(in Minutes) / 4 hour limit. I agree to alway have it checked by an RN. I work in a 5 Bed PACU and at night I have had the surgeon check it once. My circulator had gone to do the next case and he wanted it up and running. He was cool with it and understood it was our policy. I will not start a PCA without it being checked.

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    Maybe you could suggest the Pt have a betadine shower in private before they put on a gown. This was done here for GYN cases, of course they have to prep the patient after positioning.
    You could check out the AORN standards. AORN my say the patient needs to be positioned before they are prepped. Any part below the waist or table height is not sterile and will need to be re-prepped.

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    There are lots of options
    Intubatable LMAs where you slide an ET tube thru an LMA
    emergency crichothyrotomy kit
    fiberoptic
    we have a device called a bullord(sp) that is lighted and once the provider see's the cords they push the tube in.
    we have a difficult airway cart with all of these items on it and the OR and PACU staff know how to set them up.
    I wonder how good the equipment was. this is a county hospital the patient may have lost the airway long before it was noticed. I still wonder about the
    nasal ETT. It is only done here if the surgeon needs to work in the mouth, like dental work, at the CRNAs discretion.
    My heart goes out to this Family, but 35 million is a lot of money and the lawyer will get at least 11 million. You have to wonder what services will be cut and what state of the art equipment will not be bought, to pay this 20 million.
    here they stop providers call after age 60.

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    Quote from Pam RN
    What do you think about working in a surgicenter. I'm looking into a position at one. I keep hearing the docs are "more relaxed" at the center as opposed to the hospital OR's, "less pressure" they say. Are all the cases short and fast moving? What are the hours like? Which do you like better the OR or the surgicenter?
    About four years ago the Gastro Docs and surgeons started a surgicenter here. they took the staff they wanted and increased the wages to cover the call pay the staff would make here at the hospital. After 2 years the stress is high over there, Half the doctors want to build a 20 bed hospital, money is tighter, and doctors complain about turnover times and wages there. If the surgicenter is laid back and docs are cool, I would think about a change myself. it is not that way at this surgicenter.

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    Does any other hospitals have staff RNs that start art lines for anest? What is your policy? Do you have special training? We had one RN who started art lines and she is leaving. Anesthesia and the surgeons are on the rest of the PACU staff to start art lines.



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