RNiel

GH - No, there wasn't an incident. The one CRNA that requested it on behalf of the others stated that it was soon to be a standard of care, but I've not heard anyone else mention it or seen any articles on it. Thanks for the input everyone.

Does your facility use Capnography (ETCO2 Monitoring) - on extubated patients in the PACU? Our anestheisa providers have requested we purchase End Tital CO2 monitors for our PACU to use on extubated patients. It's quite an expense and we are a small hospital with out a lot of money and resources right now. Does your facility use this monitor? Are we behind the times or providing substandard care? Inupt please?!!

Canes - Thank you for your reply. Yes, we are upgrading to Stryker 6 (from Command 2). I don't think we have the Gamma nails or ex-files stuff. Which pump would you recommend for arthroscopy?

Thank you Argo - I think we are on the right track. Our OR is new (two years old). When they built it they were hoping to use is as a drawing card for an orthopod, so it has the proper air exchange. It's also 900 sq ft! You gave me a lot of good advice. We have some positioning equipment, but we need to look it over and inventory it. We were able to go to "the mother house" last week and observe the provider. We got his preference cards and talked to the staff that he works with. His Stryker rep called ours and passed along a lot of helpful info as well. He will be using Smith & Nephew and we will have the same rep, which I can only imagine will be a benefit. Thank you for your thoughtful recommendations!

I work in a 25 bed hospital in a rural area. We have two ORs, but only one anesthesia provider at a time (so essentially one OR). We have just learned that we are going to be getting an orthopedic surgeon with in the next month or two. We have not had ortho in over five years and only 3 of our 6 staff members have previous ortho experience. All of our power equipment is obsolete and will be replaced. Our trays are fairly well equipped (we will need an instrument or two). Can anyone share advice or give recommendations on what we should do or what you would do to prepare? Do you know of any good articles, texts, videos, or other educational tools? This surgeon sounds to be much like the stereotypical orthopod. He stated his two pet-peeves are turn around times and not having what he wants when he wants it. We want to start out on a good foot w/ him and not have him lose confidence in us on the first day. It sounds as though he will be doing knee scopes, total knees and hips, shoulders, rotator cuffs. He probably wont be doing much trauma as he lives over 2 hours away and will only be here once a week, so the trauma would have to be coincidentally timed w/ his arrival. Any thoughts/advice would be appreciated.

This can be a very sensitive situation. I'm wondering if instead of using the term "older nurses" you might has said "nurse's who lack computer skills". Regardless of the terminology, I know where you are coming from. Many people have suggested here that you try "helping" the struggling nurses. I have done that. I have gone out of my way to help them by making cheat sheets and books for them which include both quick references as well as step by step instructions. It has been helpful for some and others still struggle. Some refuse to quit writing every single thing down on a piece of paper before entering it into the computer. I feel very sorry for any nurse who worked in nursing for years, and years, and years because computers (at least where I work) were not gradually added. It was just suddenly in their faces and they had to go from learning how to log on to learning how to use a mouse and when to right or left click. It has been a huge challenge and very intimidating for many excellent nurses. However, the time comes where it isn't fair to provided easier assignments to nurses who can't keep up with charting. The computer isn't going away, it's a huge part of everyone's job now. If you are a nurse that is still struggling you have to take it upon yourself to go to your community college and take a class, or spend some time with a grandchild and ask them to teach you a few things. Heck, get facebook, it's a great way to communicate and learn at the same time. My heart goes out to everyone in the situation. I'm thankful that I am able to help some more "seasoned" nurses with the computer because they are always there for me when i have to draw on their experience and expertise, but sooner or later I am expected to know what I am doing too. It's a tough situation.

I can't remember exactly how it happened, it was a long time ago, but I saw a CRNA's hand slip off of a Laryngoscope during a difficult intubation and hit the patient on the nose. I've never saw it before or since. It was strange. I don't know if the patient had any bruising, but I could see how s/he would have.

We use pre printed count sheets that come in the instrument trays on open cases. We also use pre printed count sheets that are kept in the OR on locals that just have sponge and needles on them. Our manager/policy make us count at least twice (three times on c-sections) on every case including itty bitty local incision, mx/tube insertions, and the raytec w/ KY used on a colonoscopy and EGD! These sheets are an official part of the pt chart.

Our Doc used to use Fleets Phospho more than anything else until the recent study came out. He now uses GoLytely more than anything else. Previously he reserved the GoLytely for people with history of cardiac, renal or electrolye problems and gave the Fleets to everyone else. Now in addition to pts w/ those problems he includes those over the age of 60. Our patients are told to take 30 ml of MOM the night before the prep when they go to bed. The next day it's nothing but clear liquids and the prep. On the morning of the colonoscopy they are mostly all pretty well cleaned out. If the pt has a hx of constipation the doc with increase the MOM to 30 ml for two nights before the day of the prep.