Joules

Speaking of worms http://www.agora-inc.com/reports/610SPRPT/W600DC46/home.cfm ENJOY!!!!:chuckle

Actually, working conditions on my unit @ PCMH would not be that bad if it weren't for all the paperwork.

Just curious, is paperwork this bad all over? How is the paperwork at your facility?

have you ever felt like you were suffocating under a mountain of paperwork? at my hospital, pitt county memorial hospital, in greenville, north carolina, somebody just has too much time on their hands. the paperwork has become unbelievably atrocious. it is like a very bad joke that just isn't funny anymore. everytime i come to work, there is yet another new form hanging by the time clock. the latest round of paperwork diarrhea started when our hospital was recently audited for medicare/medicaid chart compliance and failed miserably. now our hospital is in danger of loosing all medicare/medicaid funding. so, tptb are frantic. result: we now have this "hot pink" monster of a form that has to be filled out on all new patients, either by the unit clerks or rn's. it has now become our job to police the doctors, to see that all orders are being signed off in a timely/legal fashion, history and physicals are on the charts within 24 hours of an admit, pre-procedure and post-procedure notes are on the chart, etc. etc. etc.--we have to call the docs to come in to fix what they didn't do, if the chart is found lacking:( we have the usual bothersome critical pathways, now with each carepath, also have an infection pathway and a skin care pathway, to fill out on each patient daily under the threat of a bad eval if not done. we have computer charting also, and our patient admission record has become a nightmare!!!! link after link, with sublinks literally being added daily to fill out on new admits. it has gotten so complicated and burdensome, that there is very little time left for patient care. we are supposed to be clocked out by 7:15 each shift, no exceptions. on a very busy day, there is absolutely no time to fill out all this paperwork. jchao is coming to audit the hospital in a year, and i foresee a very unhappy year as the frantic "suits" are trying to get everything in compliance. i don't know how much more of this i can stand. sorry for the down post; just need to vent:o :o

An incident at my hospital not too long ago. It was a significant drug error, but the pt recovered without permanent harm, thank God. ICD checks are performed on the cardiac unit in the early day shift hours, usually b/n 7 and 8AM. The electrophysiologist who performs them has the pt NPO post MN and would write this cryptic order "Brevitol ***mg to floor @ 6AM." You would have to order it from the pharmacy and have it in the pt's med drawer, locked up, and ready for the doctor to use, when he arrived on the floor. Brevitol is an anesthesia drug and only to be administered by the doctor or an advanced practice nurse. This information was not on the drug nor in the order. Apparently the nurse on duty one night, not familiar with this drug, read the order and administered the drug, full amount, at 6AM! The pt went into respiratory distress, had to be bagged and vented. Needless to say, our facility has revised its Brevitol policy, posters are up everywhere about it, and the pharmacy only sends it to the floor under very strict guidelines. (The pharmacist first calls the nurse and explains the drug and that only the doctor can administer it. This info is now written in big red letters on the outside package of the drug.)

My pet peeve are those asinine doctor's orders "Resume home medications" or something to that effect. This sort of scenario really compromised a pt (and got a nurse in really hot water) in a small facility in which I worked years ago. The particular doctor involved was NOTORIOUS for prescribing TONS of medications for ALL of his patients (the MARS were a nightmare--3 or 4 pages each...). Well, the nurse receiving a new admit was confronted with the order "home medications...." which she dutifully tried to sort out and write as a "voice order" from the doc. She was already stressed out and harried that day by her pt load. Turns out, she just happened to leave off one of the pt's meds (out of 20 or so that he was on)... Synthroid!!! The error was never caught, and after awhile, the pt went into a myexodema coma!!! Of course, the nurse caught the flack, not the doctor who was too lazy to write his orders in the first place. So, whenever I encounter one of those types of orders (whether admitting or discharging a pt), I simply refuse, telling the doc "prescribing medications is outside of my scope of practice." I then tell the doc it is HIS call to order each med he wants.