rookreck

My hospital would like to develop an insulin protocol. I am in charge of researching if medical surgical floors are safe and appropriate for insulin drips. I have mixed opinions. While, I think that the patients may not be critical enough to warrant and ICU bed, I do think that an ICU staffing pattern would make for a much safer environment

I just have to get in on this one. I work in a 120 bed community hospital also. I have been pulled to the floors 2 times in the last 9 days. It should have been 3 times, but I complained to my boss and I think that she felt bad for me and didn't pull anyone last night. The ICU nurses are pulled 10 times more often in my hospital than floor nurses. We actually have float nurses that get paid 2 dollars more an hour and that was supposed to prevent so much pulling, but that hasn't helped. If a floor is short nurses then we are not allowed to take time off with or without pay, we have to go. We are considering many options. My boss is considering several options. They took one of our positions and gave that to the float pool. But we are still getting pulled. When a couple of nurses leave we are considering not replacing them and taking on call for 8-10 hours a week. That would be on call for our unit only. Also I work in a unionized hospital and we have considered going to the union and insisting on getting an extra 2 dollars and hour (same as the float nurses) every time we are pulled.

I work at a rural community hospital in Pa. A little over 3 years ago the state of Pa required that interventional cardiac caths be done in a facility that had open heart surgery programs. But for a little more than 2 years now,they are doing a pilot program and facilities without open heart programs are now doing interventional cardiac caths. We are doing interventional cardiac caths with great success. If a patient needs to go for surgery they are transferred by air to another facility. The program was only to be a trial for 2 years but the state of Pa. extended the trial. Our facility is hoping that the state will go ahead and approve the program. We are a 40 minute drive to the open heart program. When we get an acute MI , it is a great feeling to help the patient right away. After all time is muscle.

At my facility if the time of the onset is known and is a new occurence we anticoagulate and try to use drugs (IV Cordarone) to convert them. If the patient has been in afib for a long period of time we slow them down with Cardizem and Lopressor and anticoagulate them and send them home. After a period of time the patient is brought back in and placed on IV cordarone for 24 hours and if they don't convert to NSR then we cardiovert after the 24 hours and the patient is sent home on po cordarone.

I think if I worked in a large institution that a physician or an intensivist would be given the task of writing the protocol. I don't know if any of you have worked in a small facility. I work in a 120 bed hospital. We have one 8 bed intensive care unit. We have no residents and no intensivist. So we dont' have all the resources of a large facility. That is why many times staff nurses develop the protocols and policies. Physicians always review and critque them and have the final approval. I used to work in a large facility and it is totally different. In a small facility, when you have a bad patient the attending physician at home has to rely on the nurses assessment skills and judgement. In a large facility, you have the residents to fall back on . Although that isn't always a huge help. I think what I am trying to say, is that small facilities have to use the nurses as resources, since they don't have as many physicians.

The management at my hospital uses the staff nurses for project management in many areas. It is actually very rewarding. I won't be doing this on my own. I will discussing the project with a pharmacist, pulmonologist, and anesthesiologist. Also there is alot of evidence based medicine on this topic. I am actually proud to work at a facility that uses staff nurses for different projects. I have been a nurse for 16 years and I think that I am up to the challenge.

It is all weight based. I don't know the exact amounts.

We give a bolus with the initial start of heparin. So 99% of the time the first ptt is greater than 110. We then hold the heparin for 1 hour and decrease by so many units and repeat in 6 hours. It just seems like the patient is the one that suffers, by getting so many sticks.

At my institution we have weight based heparin protocal orders. We have a lot of trouble getting a therapeutic ptt. The patient gets stuck every 6 hours until we get 2 therapeutic Ptt's in a row. Then the Ptt goes to daily. It just seems like the patient gets stuck a whole lot more with protocols. Does anyone else have problems with this?

In my institution we insert og tubes in all intubated patients. Our pulmonologist feels that ng tubes cause sinusitis which causes pneumonia. I have tried to insert og tubes in patients that are not on the ventilator and AAO and I think the patient gags far more frequently and is more uncomfortable.

I am a staff nurse at a small community hospital. My boss would like me to develop a protocol/policy for sedating mechanically ventilated patients. I would apprectiate any copies of policies or protocols. Thanks G