Moe12PMs

How often does your facility charting on titratable medications? For example, a patient on Propofol with the following orders: Initiate Rate - 5mcg/kg/min. Titrate Rate - 5mcg/kg/min q10minutes to goal. Parameter Goal: RASS of 0 to -1 We chart RASS every 4 ours when within goal. If the medication is titrated, we need a RASS with each titration until the goal met and then q15min x4 after goal is reached. Same for analgesic IV medications (we use Behavioral Pain Scale (BPS) and numeric as as the measurable parameter. For Vaso-actives, we use MAP, SBP/DBP and HR for measurable parameters. The titration charting is the same with Analgesic and Vasoactives. We chart every 4 ours when within goal. If the medication is titrated, we need a parameter with each titration until the goal met and then q15min x4 after goal is reached. What do your critical care nurses do? What does your facility do? Do you have a policy for titratable medications Any information would be greatly appreciated. Moe Mo

100 % LEGEND.

To me, it is comparable. Nursing and law enforcement when it comes to serving the public. The comparison is purely for discussion and what other nursing professionals think. I used Officer Shelby because after being acquitted, she's teaching other officers about her experience. I think both Officer Shelby and RaDonda Vaught are both showing a lack of empathy for their victims by offering their expertise for their role in the death of a person for monetary compensation. I'm not looking to argue. I use the comparison with my students and colleagues. I'm looking to understand. Why does being acquitted the deciding factor? RaDonda Vaught "went out of her way to avoid every.single.opportunity. she had to pick up on her error." 100% agree. Now, why did Officer Shelby shoot a man after he had been tased? Why did she shoot when she feared he had a gun but did not see a gun? How are you fearful with four other officers by her side with guns and tasers drawn? The other part of the discussion is why are nurses seen as the most trustworthy profession for 22 years in a row on the Gallup poll when medication errors cause far more deaths that police involved shootings (police hooting deaths 1,353 for 2023.) (I hit the databases hard and can only find medical errors at >200,000 in 2022 and those do not specify nurse errors or nursing medication errors). Yet, law enforcement has been up and down on the Gallup list since since 2001 without breaking the top 5. Overall, healthcare professionals kill more people than cops. https://news.gallup.com/poll/1654/honesty-ethics-professions.aspx I have read the media reports on the matter. The following is the best I have read and has been cited in other articles. It is a good timeline. https://www.freshrn.com/radonda-vaught-trial/ I'm not a fan of Mrs. Vaught. Never have been. She made nurses look careless. Her interviews since the conviction do not make her look better in my eyes. Very flippant. What I'm getting from replies is she does not address her errors when speaking. It's a "Poor Me" tour. I understand the anger. If she is not going to discuss her state-of-mind, thought process or emotional state when the error occurred, then I'm not interested.

Understood.

Everyone is telling me that she does not discuss her errors. Then I am not interested. Her podcast appearances do not make her look any better. Some of the banter makes me think, "Well, the patient can't do that with her family anymore. Why are you laughing?" I use the comparison to police officers and nurses because it is the only profession where you can go into work and kill someone. Nurses and police deal with people having the worst day of their lives, people in mental health crisis, people in distress. I used Officer Shelby but one could used Officer Kim Potter or Officer Amber Guyger. I use this comparison with students and colleagues. It's see where the lines people are at based on their perceptions of each profession and for discussion as why these two professions have such different public perceptions. Office Potter would have been a better comparison. She thought she pulled her taser. She understood her error immediately. She was convicted. To my knowledge, she is not teaching classes or a paid speaker. Officer Amber Guyger is serving a 10 year sentence. And becoming a stand up comedian. (I threw up in my mouth a little bit.)

I understand completely that the family may not want to speak of the trauma of the event. This is something they may consider if they are EVER ready. I have heard family members who have come to speak to nurses and healthcare professionals about their experiences and its extremely powerful. Up until yesterday, I had only heard her on podcasts. She did not do herself any favors as I've listened to her. Never addresses her errors. On one, the joking around was just sad. Exploited, possibly. But I do not get that vibe.

Thank you for information. I vaguely remember the online funding campaign. I did not know it raised $250K. Additionally, I did not know the family has not taken civil action against her. I knew about the settlement with Vanderbilt. Then I have no use to hear what she has to say. I want full disclosure for my money.

What about the police officer?

I can understand the outrage. If I was the patient's family member, I would question the reasons for it. I'd be interesting in hearing from the victim patient's family. They would definitely get speaking fees. I would find their experience and advocacy having a far greater impact on healthcare professionals. The victim's family may not have any healthcare experience. As nurses, when the death happened, we knew what questions to ask. Unless you have a nurse or physician in the family, victim's families do not know what to ask. Their perspective would be far more impactful. I am always on the look out for speakers for our facility engagements. I have had nurse speakers who were addicts and were paid fees. It was extremely beneficial. They told their experiences of what happened and the consequence of their addiction. One nurse had developed an opioid habit after becoming a nurse. No previous history of abuse. The other nurse had developed addiction after an injury. Most importantly, we learned how they bypassed the system and went undetected. Both also explain their experience with the RAMP programs they went thru. Both were fired. One lost her license. She is now an addiction specialist. The other got it back after 4(?) years and works in case management. Listening to what she had to do to get her license back was sobering. As far as Ms. Vaught speaking, the nursing and healthcare quality industry would want to hear what she has to say. Personally, I want to know how and why she bypassed all the signs telling her to stop. I also have questions about the safety culture at Vanderbilt University Medical Center. I do not think her speaking is worth $10K. Maybe $1K at most. I could see higher if she was speaking at a corporate event. Based on what I am reading, to looks like she has close to $30,000+ in legal fees and fines. This does not include civil lawsuits. - https://www.newschannel5.com/news/supporters-help-pay-fines-former-vandy-nurse-radonda-vaught-owed-to-state The money may go towards those fees. So I do have a question. If a police officer, who was acquitted of manslaughter charges in the fatal shooting of an unarmed man. Then goes on to teach a class to other LEOs called "Surviving the Aftermath of a Critical Incident" that discusses..."the challenges that I face after my critical incident; the challenges that my husband and I were not prepared for." The officer then also goes on to explain, "So I take what I learned and developed what I call tools and I pass that on to other officers so maybe they can be better prepared to deal with a critical incident." - https://abcnews.go.com/US/protest-erupts-critical-incident-class-taught-oklahoma-officer/story?id=57448147 Is this OK? Is this as repulsive?

Hi All, I am looking for feedback on how you or facility charts PEG tube position on an on-going basis. For example: You have a patient with an established PEG tube. The tube is flushing and functioning well. No major residuals. How do you chart tube length or position to make sure it has not dislodged. I have seen PEGs with and without numbers printed on the tube. Do you mark the tube at the external bumper/flange/retention disk at the skin? How do you or your facility chart that? Do you have a specific place to chart the number in your charting system? Is this even a normal part of the PEG/G-Tube assessment? Any information you can share would be greatly appreciated. Thank you for your time! Moe

How often does your facility complete direct observation auditing of central lines? (checking dressings, BioPatch, securment device, etc) Currently, we are auditing 20 patients a month randomly per critical care unit. Does your facility do more or less? Who completes the audits? Does your facility have a central line team? Thank you!

Thanks! My apologies, I should have been more specific. Does anyone make it an issue if the entire securement device is not under the transparent dressing? Like for and IJ where one is dealing with limited space. Moe

Do you place the securement device for a central line under the transparent dressing or can it be outside the transparent dressing?

Hi all, This is a question regarding CLABSI prevention. What have you/your facility implemented to decrease CLABSIs?How are you tracking that CVC line maintenance procedures are being followed?Do you use CHG baths?Do you have a policy/practice about use of the femoral artery?My asking deals with a group of CLABSIs that have occurred and when I investigated them, I found no commonalities among them. I am looking for ideas to bring to committee. Thank you! MoeNoons