Radiology tech: "this patient has q0600 portable chest X-rays part of his old ICU order set. They normally DC these but they didn't DC his. Do I really need to do this?"
#2:
Me, to a different radiology tech: "we just discovered he might have foot fractures and I'm putting in orders right this exact second. Do you mind grabbing images of his feet while you're here?"
Rad tech: "the order wasn't already in so your, have to get that later."
Me: "the order is in right now."
Rad tech: "no."
Two seconds later, does the images anyway, because she realized it meant she'd have to come all the way upstairs again.
#3:
Respiratory: "Earlier MD asked for a different patient to have ABGs done at 0800" (after RT's shift would be over) "so we can just do this patient's in a few hours, too, right?"
#4:
Lab, after walking the whole unit to find me: "that patient has a PICC, why can't you draw her?"
Me: "I don't have orders saying I can."
Lab: "I saw her get drawn off that line last week, you need to draw her."
Me: "her line isn't being used for labs. I don't have an order saying it can be. I CAN'T use it. You need to draw her."
If it weren't the same people trying to get out of their orders every time, I'd figure they were just confirming things, but I am absolutely convinced they're trying to get out of doing their job, and they're trying to get the RN's "okay" so they can pass the buck to us, I am so done with this! If they want to questions orders, they should call the people writing them. :\
I agree! If its too hazardous then I shouldnt be allowed to clean it up either right? Its not like I had super special training for cleaning up bodily fluids....pretty much just wear PPE and know where to dispose of it. Surely housekeeping is capable. Why don't they?
Improper medication and IVF disposal can result in hefty fines from the EPA.
We have blue, black, red and yellow sharps and meds disposal containers at all hospitals in my region as required by the EPA.
Housekeeping is not permitted to dispose of any kind of IVFs, empty bags or IV tubing for this reason. It would be unreasonable to expect them to know that nitro goes in the black box, Cytoxan goes in the yellow box, propofol in the blue box, etc.
Preach it! This is a bit different but it reminds me: labs were coagulated, had to be redone. Big, big deal. So I document details and ask the lab tech for her name so I can document chain. Anyway, she says,"Don't put my name down, I send my specimens immediately." A half hour later, I get a call from my supervisor. The lab supervisor called and said the way I said it was "offensive". You can't win. The nurse is where the buck stops. It stinks sometimes. Stick to your guns and carry on!
Preach it! This is a bit different but it reminds me: labs were coagulated, had to be redone. Big, big deal. So I document details and ask the lab tech for her name so I can document chain. Anyway, she says,"Don't put my name down, I send my specimens immediately." A half hour later, I get a call from my supervisor. The lab supervisor called and said the way I said it was "offensive". You can't win. The nurse is where the buck stops. It stinks sometimes. Stick to your guns and carry on!
Nursing was not involved in this error. I am wondering why does nursing have to write the adverse event report? I will only report what I have seen or heard. Shouldn't lab services take responsibility for issues within their department? I see this as a misuse of your time.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Nursing was not involved in this error. I am wondering why does nursing have to write the adverse event report? I will only report what I have seen or heard. Shouldn't lab services take responsibility for issues within their department? I see this as a misuse of your time.
Because if nursing doesn't write it, it won't get written. And if it doesn't get written it doesn't get investigated. And if it doesn't get investigated, lab techs continue to throw out every third specimen claiming "the tube wasn't full" or "it was clotted" and patients continue to have to get re-stuck.
In where I am, SLP never does diet orders. They claim that their area is only type of diet (pureed, soft, etc.), everything else like low sodium, carb counts, the likes, belongs to registered dietitians. The latter claim that they only can make "general recommendations" in terms of protein, carbs, etc., but everything where exact calculations needed like dialysis, then belongs to "service specialist". One nephrology consulting group employs their own RD, who comes at the best once a week after being called a dozen of times. Another one will use hospital RD, but only after a doc will give his blessing for doing so.
As a result, families were told to bring whatever food they like because there were no dietary orders for days in a row and patients had to eat something. There were couple of cases when it was easier to ask for TPN because our wonderful pharmacist could do the job right away. The cost of TPN, I was told, is in excess of $1000/24h. Hefty price of someone's unwillingness to do the job they are paid for.
Katie are you serious?! Is this inpatient? (I'm assuming it is.) Why in the world are the hospitalists not ordering diets for these patients in the meantime? I can't imagine what kind of patient satisfaction scores you'll have when the facility won't even feed the patients!
Speech therapists can and should order aspiration precautions and a specific dysphagia diet to be modifier to a diet order. If they can click a box to bill Medicare they can click a couple more.
Many do not care if the patient recieves any nutrition or chokes and aspirates. I think a report to risk management is justified.
Last HCAPS scores, as we are told, 95+% "positive. How it comes to be this way - well, in this environment you just learn to do it all Telling the truth, most patients either come while still pretty much on ICU level care and so NPO or with orders made already. The changes sometimes become a problem, but hospitalists will write something like "renal" diet and it is not that difficult to figure out things from there by calling or catching an appropriate person at appropriate time.
this is what drives me crazy. SLP doesn't care for a second if a patient wants to eat that awfully looking, tasteless goop. All they care for is "preventing aspiration"... as if it could be prevented altogether. RD doesn't care for a second if that everything-free diet is eatable or what their protein supplements taste like. And I am caring for people who become severely malnourished as a result. Risk management does nothing, as all parties do precisely what they supposed to do!
We recently saw a real scurvy - result of "uniformely soft, no pieces allowed" very low potassium, low protein, no salt diet (which turned out to be mostly toast and cookies with sweetened tea) in outpatient dialysis for months in a row. USA, 2015, patient was not desperately poor, had home care services. The facility and home care were reported to the State... will see what happens, but I suspect that it will be nothing.
Because if nursing doesn't write it, it won't get written. And if it doesn't get written it doesn't get investigated. And if it doesn't get investigated, lab techs continue to throw out every third specimen claiming "the tube wasn't full" or "it was clotted" and patients continue to have to get re-stuck.
Incident reports generally go nowhere in many hospitals.
This is a medical management issue. It is more effective to inform the intensivist and have him call the lab supervisor and set some expectations. That supervisor will throw her staff under the bus when the medical staff are unhappy and her job is on the line.
Improper medication and IVF disposal can result in hefty fines from the EPA.
We have blue, black, red and yellow sharps and meds disposal containers at all hospitals in my region as required by the EPA.
Housekeeping is not permitted to dispose of any kind of IVFs, empty bags or IV tubing for this reason. It would be unreasonable to expect them to know that nitro goes in the black box, Cytoxan goes in the yellow box, propofol in the blue box, etc.
Yes absolutely. But what about bodily fluids? Puke, poop, pee? Those are the things that I don't see why they can't be involved.
Telling the truth, most patients either come while still pretty much on ICU level care and so NPO or with orders made already. The changes sometimes become a problem, but hospitalists will write something like "renal" diet and it is not that difficult to figure out things from there by calling or catching an appropriate person at appropriate time.
icuRNmaggie, BSN, RN
1,970 Posts
Improper medication and IVF disposal can result in hefty fines from the EPA.
We have blue, black, red and yellow sharps and meds disposal containers at all hospitals in my region as required by the EPA.
Housekeeping is not permitted to dispose of any kind of IVFs, empty bags or IV tubing for this reason. It would be unreasonable to expect them to know that nitro goes in the black box, Cytoxan goes in the yellow box, propofol in the blue box, etc.