shiloh11

At our facility, the tech in charge of the procedure (CT, US, MRI etc) calls the floor and tells them when they are going to be ready for the pt. They also call our dept to notify the rad nurse. The rad nurse calls the floor and gets report (sometimes not an easy task!) and then the floor sends the pt down via transport. In a case where the pt is a med/surg pt, we meet the pt in the dept, do the procedure, and if they got sedation, we take them back to the floor and give bedside report. If they didnt get sedation and they are stable, they go back up via transport. If the pt is on tele, the tele nurse transports the pt to the dept. (Unless the MD specifically wrote that the pt can go down w/o monitor). The rad nurse meets them in the dept. The tele RN doesnt stay. The procedure is down and the rad nurse takes them back on a monitor and gives bedside report. ICU and critical ER pts come down with their nurse from that dept and that nurse stays for the duration of the procedure. We dont go unless they need an extra pair of hands. We really dont have any trouble with transporting the patients. Our bigger problem is in getting report and being sure that everything was done that needed to be done prior to the procedure (NPO, consents, working IV etc). :Snow:

We do this form on all pts now. For every pt type the form gets scanned to pharmacy and then is placed in the chart. 99% of the time the doctor still ends up writing whatever meds they want in their orders. They arent using the forms at all. To make matters worse, I work in Out Patient Procedures where we do same day procedures, conscious sedation, and infusions. They are now telling us they want us to initiate the form EVERY time the pt comes in. We have people that come 2x/day for up to 3 months at a time. Its absolutely ridiculous to be doing a form that no one is looking at over and over. To make matters worse they've now added a form called Out Patient Summary flow sheet in which we are supposed to write each day if the patient has had any changes (ie: new health problems, medication changes, illnesses etc). Of course we are already writing the changes and any interventions we make in the nursing notes. I swear the people making up these forms dont ever have to actually use them. Do any of you guys have to do this too? A new outpt Lovenox patient ends up taking 30 minutes because of all the paperwork. Its nuts!!

Its pretty tough to prove someone is guilty of something without hard evidence (since she's not charting the early time) even if you know you are right. I would agree that you are probably going to have to do an incident report. I would also discuss it with her privately. Why in the world is she giving the meds so early anyway? How does she justify giving them early (even if it is at the patients request) if they are timed meds? I do think its important that you set up the "rules" you expect people to go by while you are charge. By no means do I mean that you be a dictator or anything but if you establish right off that you do expect people to follow hospital policy, they should have no excuse for doing their own thing (possibly to the detriment of the patient and the dept). I hope that helps a little. Its a tough situation that you're in!

Having worked in both ER and in Outpatient Infusion/Procedures, I would have to agree with Lauralassie. Ideally the patient would be seen by their PMD but often times they cant get in. Our hospital has a fast track in the ED as well so that the triage nurse can determine the most appropriate place for the patient to be seen. It seems like more often than not now days (patients with the symptoms described) wind up on IV antibiotics. This patient was febrile as well. Most of the docs in our ED in this case would do a culture and sensitivity and start antibiotics. Many times they are admitted for IV antibiotics and Infectious Disease consult. Pending the results of the C & S, the patient may be looking at long term IV antibiotics in the Outpatient Infusion Center. This is just one scenario and it really is difficult to say without actually seeing the patient, looking at her history and doing an assessment. It is entirely possible given the history of abscess, spreading redness, fever, dizziness, and nausea, that the patient is becoming septic. Regardless, there is no way to tell what is going on without SOMEONE (PMD, Urgent Care, ED) seeing the patient asap.

We get a $25 gift certificate to the hospital gift shop. This can be exchanged to be used at local shops in the area as well. In the past, when I worked on the surgical floor, the surgeons bought all the staff on that floor $50 gift certificates which were really nice. For the most part, its just been the $25. It sounds like Im pretty lucky compared to what i've read! :Santa3: