no more NS at chairside!

workingmomRN · Jun 12, 2009

It sounds like your surveyor had to really look to find something to ding your clinic for on the audit. I can't see what the problem is with pulling saline from the saline line. We use it during rinseback & the patient is receiving it intravenously. Sounds like a lot of wasted NS.

corky1272RN · Jun 12, 2009

Woa!!! Interesting! Well, it will probably be a hassle till everyone gets used to it. But the cost will be the thing. See if you can't order vials of NS similar to the vials of sterile water. We had 50ml vials of sterile water then we started ordering the 10ml vials. Just a thought. :rolleyes:

GeauxNursing · Jun 12, 2009

well apparently Davita and FMC lobbied the State and got that ruling overturned, so forget everything I said. We were just going to have to use liter bags in the mean time because Davita wasn't willing to shell out for the 150ml bags, or pre-filled syringes, or vials.

But I guess it's all good now! Whew.

Lacie, BSN, RN · Jun 12, 2009

:madface:We were also told Medicare wont pay any longer for the NS bags and IV tubing for administration of antibiotics and iron. We did mix our Ferrlecit in 250ml saline bags now they have to push it. More pts suffereing n/v and b/p drops even administering slowly. How they can say saline and lines arent paid for in antibiotic admin is beyond me? How are we supposed to administer it then. Pts that bring thier own albumin now have to also bring thier own tubing for administration. We also limit cath care to once a week now in lieu of every treatment. Have to tear off pieces of tape and attach to our fingers then take it to the pts chairside to use and put on the chairshide table. I would think this would be a bigger issue of contamination then carrying a roll lol. Who is making up these new rules? Some paper pusher with no common sense.

GeauxNursing · Jun 12, 2009

wow. that wouldn't fly in my clinic. When one person goes on abxs, it seems that other ppl do, too! We have only 2 pumps in the clinic. and sometimes 4 ppl at a time are getting abx! With no tubing...that just wouldn't work.

We use Venofer, and we push it into venous chamber. we don't infuse it. The rule is 1mL/min. I try my best to adhere to it. They hate that iron, don't they? I'm sure I would, too. One lady is very sensitive to it, her BP drops and she gets a HA. it's a troublesome drug, lol. And it stains.

On a happy note, I started a new buttonholer today! Woohoo!

pricklypear · Jun 12, 2009

OMG. Where do they FIND these people? Do they even really know what they`re talking about???

GeauxNursing · Jun 12, 2009

The surveyors you mean?? I know, really.

When our survey was going on, we had a lady with us from the regional office who pretty much WROTE Davita's P&P. She was right behind the surveyor as she walked around, asking us questions (right in the middle of turnaround, of course), making sure the surveyor knew what was going on. SHe would ask, "Ok, now what are you doing with that? Ok, show me how you use it. Ok, where do you record that information? How do I know this machine passed all it's tests?"

I was checking pH and conductivity, and initialing all my machine checks at the chairside computer. Davita lady comes up behind her because she starts to questions Well, how does that information get into patients chart? Etc, etc. Blah blah!

When I was returning blood, I filled my 10mL syringe and then flushed the line, then hooked up arterial line to NS line. She was just baffled! Questions, questions. Davita lady showed her P&P, this is the way we have done it forever, this is the way EVERYONE does it, here it is, Of course it is an approved method! They were going at it for a while.

Darn surveyors. But we did excellent.

pricklypear · Jun 13, 2009

I`m glad you guys did well in your inspection! It just baffles me that these state surveyors don`t know even what they are looking at. That`s like me going into a machine shop and making up rules on the fly. I was hoping when I got away from hospital nursing that I was getting away from the bull**** of that kind of mindless regulation. I guess not.

GeauxNursing · Jun 13, 2009

Well she came on a patient complaint. SHe should've just tried to validate the claim, in a 3 day time period. But instead, she decided to do a full-out survey since we hadn't had our federal in over 5 years. And there are at least 3 brand new clnics in the DFW that I know of, that are waiting on their Medicare certification, so they can actually Take some patients and get the clinic rolling!

Why there are 3 new Davitas in the metro Dallas area is beyond me. There are probably 10 in total, just Davita. And they wonder why they can't find the staff? BUt that's another thread entirely!

diabo, RN · Jun 15, 2009

Several years ago when we moved all of our meds, including NS, to a designated medication area, we would stick a bag of NS with a fistula needle and draw from that, wiping with alcohol and re-capping each time. That way the bag only gets stuck once. We now use pre-filled NS syringes, They're quicker, sterile, and close to the same cost when you figure all the syringes and needles. :twocents:

Lacie, BSN, RN · Jun 15, 2009

Several years ago when we moved all of our meds, including NS, to a designated medication area, we would stick a bag of NS with a fistula needle and draw from that, wiping with alcohol and re-capping each time. That way the bag only gets stuck once. We now use pre-filled NS syringes, They're quicker, sterile, and close to the same cost when you figure all the syringes and needles.

We used to do same until state said this was a "no-no". We now use 10cc syringe and draw from thier saline bag just before end of treatment at the chairside with needle/etoh. Syringes in thier original package until we are ready to take off. No re-entry no waste. Actually it has made it much easier as the techs do this when prepping their take-off materials. Therefore no need to worry about labeling or syringes sitting there for any period of time. We used to do as you described but techs kind of got tired of just pre-drawing syringe after syringe then the need to label each and syringes of saline just sitting there for hours.