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ED, ICU, Progressive Care, Informatics

Content by SpEdtacular

  1. SpEdtacular

    Written Up

    The OP's "double dosing" is just a symptom of a bad system and stems from multiple issues. Here's what comes to mind for me: Benzodiazepines are not the best treatment for insomnia and if used regularly they can cause rebound insomnia and make the patient dependent on the medication in order to fall asleep. Now granted sleeping in a hospital is way different than sleeping at home so some extra help might be needed, but many of the folks in the hospital that need benzos for sleep were already taking them for sleep when they got there. Technically, the patient saying the doctor prescribed 1mg of Xanax is true and there's a good chance the OP isn't the first (or last) person who did this. The doctor wrote the duplicative orders for Xanax which were then reviewed by a pharmacist before being profiled on the patient's MAR. Ideally this should have been caught by the doctor or pharmacist and one of the orders should have been canceled. The hospital should have a policy regarding duplicative orders and educate nurses on how to address them. It's not clear if that's the case here, but orders like the ones referenced by the OP and orders where there are multiple meds prescribed with the same or similar indications get a lot of well meaning nurses in trouble. For example, there's an order for 2mg of morphine for PAIN and 4mg of morphine for CHEST PAIN greater than 5/10. The nurse decides to give the 4mg of morphine because while the chest pain is only 2/10 the patient's leg pain is 10/10. It seems okay on the surface, but it could get a nurse in big trouble. Or maybe a patient has orders for both Tylenol and Motrin for pain and fever q4 hours. How should you give them? How do you know which you should you try first? Do you give both at the same time or rotate between them every 4 hours? What if Tylenol is for both pain and fever but Motrin is only for pain? If I give Tylenol for fever and shorlty after taking it, the patient wants something for pain, can I give Motrin or do I have to wait since the Tylenol has pain as an indication too? Having a clear policy about these types of orders can prevent this confusion and nurses who are aware of the issue are less likely to second guess themselves when deciding whether or not to give a med and/or get clarification from the provider. When the OP scanned the medications, the EHR should have warned her that it was too soon to give the additional Xanax (it may or may not have done this). Unfortunately, technology bias can lead to an overreliance on the computer to catch mistakes and some nurses (and doctors and pharmacists) assume all is well if the EHR "lets" them do something. Reporting this as a med error or near miss is appropriate, but I sincerely hope the OP isn't being punished for her actions. That helps no one and negatively impacts safety.
  2. SpEdtacular

    2018 Nursing Salary Survey

    I am an informatics nurse not involved in direct patient care so I put the patient ratio for the ED I am responsible for (1:4). Like another poster, I am relatively young and not thinking about leaving nursing at this time but put retirement since I had to pick something.
  3. SpEdtacular

    What is a Sugar Cleanse and Do I Need It?

    The one thing I have discovered about metabolism and nutrition/food science is that we know almost nothing. Increasing your intake of foods like fruits and vegetables, practicing moderation, and avoiding highly processed foods is probably a good rule of thumb, but science doesn't really understand why people react differently to the same foods. Why can some people eat a lot and stay skinny? The amount of calories in food is basically based on how it burns (like literally burns) but the last time I checked my tum tum wasn't a furnace, so does the way we count calories even make sense? Then there's the whole microbiome factor...
  4. SpEdtacular

    Student nurse dismayed by bedside nursing attitude

    I think Med/Surg nurses are amazing people because I could not put up with what they deal with on a daily basis. They have to care for half a dozen or more able-bodied yet inexplicably needy patients who won't do what they are supposed to (e.g. ambulate, incentive spirometer, drink golytely for a GI procedure) and then they get b*tched out by **hole surgeons because the patients flat out refused to do xyz. They are entitled to some grumpiness.
  5. SpEdtacular

    Injection Gone Wrong: Part 3

    Very interesting article. I think the importance of safe injection practices and good injection technique is undervalued and that many people administering the injections underestimate the potential to do harm. An IM injection can lead to complications even when done correctly; I won't inject the dorsogluteal muscle unless I absolutely have to for that very reason, and I often cringe when patients describe how someone else gave them an injection.
  6. I just graduated from Excelsior's RN-MSN informatics program, and I thought it was a great program.
  7. SpEdtacular

    Excelsior MSN Capstone

    Hey there Excelsior MSN Grads, I am nearing the end of Excelsior College's RN-MSN Informatics program, and I hope to take the Capstone course over the summer. I'm kind of nervous because I don't really know what to expect. Any Excelsior MSNs out there want to share their thoughts/experiences?
  8. SpEdtacular

    Social Problems in a Hospital? Please Help?

    Check with your local health department. Examples of public health issues are communicable diseases, homelessness, and environmental safety
  9. OP, You can attend community college to take prerequisites and not complete a degree. Many people take gen ed courses at the community college because it is much cheaper and then transfer those credits to a 4 year school and enter a degree program. Formally completing the general science associate degree program will just cost you more money and the degree won't really get you anywhere.
  10. SpEdtacular

    Feel like giving up

    brandy1017 You sound like someone who has not had personal experience with addiction. When someone is an addict it's more complicated than just choosing not to do something because they have an illness. The OP is a poster child for why people don't get the help they need. One of the reasons that laws like HIPAA exist is because of situations like this and in my opinion the OP should absolutely file a complaint because every time stuff like this happens it discourages someone else from getting the help they need because they are afraid they will be punished and then when they don't get help they end up hurting themselves or someone else.
  11. SpEdtacular


    Everything is IVP in a code. You should review ACLS protocols. That's the gold standard for codes. And at the risk of sounding like a Troll, I have to wonder what kind of "extensive research" you did on the subject because it sounds like you've never taken ACLS or seen ACLS algorithms.
  12. SpEdtacular

    Sentinel event

    I would add, make sure the second nurse confirming high risk meds is taking the double check seriously and not just cosigning! Don't give a medication you're unfamiliar with without looking it up first. Otherwise how can you know that your five rights are right? Doctors and pharmacists make mistakes too so don't let yourself get complacent. The Institute for Safe Medication Practices is a wonderful resource and has lots of excellent information Institute For Safe Medication Practices
  13. SpEdtacular

    Penicillin G IM injection?

    Oh have I ever! We give it all the time in the ED for strep throat and syphilis (the syphilis folks get two of those babies).
  14. SpEdtacular

    Feel like giving up

    This is from the article I mentioned: The question was... "I had a patient in the hospital who was a nurse in an outpatient surgery center. We found that she has been abusing drugs for years, and she admitted that she was getting the drugs from work. The physicians taking care of her spoke with our risk management department about reporting her and were told that it would be a Health Insurance Portability and Accountability Act (HIPAA) violation, so nothing was done. What is our responsibility as nurses in this situation? Our nurse manager, citing the physicians' notes on risk management's position, has told us that we do not need to, and should not, report this nurse." This is the response... "You have no responsibility to report the nurse, either to the police, the Drug Enforcement Administration, or the Board of Nursing. In fact, you should not report the nurse because that would be a HIPAA violation. HIPAA protects patient privacy by forbidding healthcare providers from disclosing patient information for any reason otherthan treatment, payment, or healthcare operations. A report to the Board of Nursing would not fall into any of those categories. Healthcare operations refers to administrative, financial, legal, and quality improvement activities that are necessary for a hospital or practice to run its business and support the core functions of treatment and payment. An example would be quality and improvement activities and case management" If this breech occurred in the last six months you can file a complaint with the Office of Civil Rights
  15. SpEdtacular

    Feel like giving up

    Why did the ED report you? Unless you were working and an immediate danger to yourself or others that sounds like a HIPAA violation. I say this because I read an article not too long ago that addressed this situation. Medscape: Medscape Access (you may need a medscape account to read it). Situations like this make me so angry because it stops people from getting the help they need. Either way, I'm sorry you are going through this and wish you the best of luck. Sometimes it seems like the system is setup to make people with mental health and addiction problems fail and/or self-destruct. My husband is in recovery and it was a long difficult road for both of us. Try and stay strong.
  16. SpEdtacular

    Ehlers-Danlos Syndrome

    Hey OP, My younger sister has Ehlers-Danlos Syndrome and was on disability for a while because of it. She used to do EMS but having to lift and move people caused serious problems with her shoulder (dislocations, surgery) and her ankles (frequent sprains and strains). She is now pursuing a degree in social work and absolutely loves it. She still gets to help patients but doesn't have to risk hurting herself doing lifting and moving. I agree with the other poster about asking local nursing programs if they would be able to accommodate you, but it might be difficult because patient care can be very physically demanding, and if you do bedside nursing, lifting and moving patients is not something you can avoid indefinitely. Do you have an idea what kind of nursing you would be interested in doing?
  17. SpEdtacular

    nurses with Bipolar Disorder

    That there is the key! You can't always change the way you feel, but you can change the way you think, and changing the way you think can help you deal with those feelings.
  18. SpEdtacular

    nurses with Bipolar Disorder

    I made it through paramedic school and nursing school. It's not easy, but it can be done!
  19. SpEdtacular

    nurses with Bipolar Disorder

    Hey OP, I have been dealing with Bipolar II since I was 12 and know how you feel. In addition to taking my medication religiously, I do a whole lot of venting to my poor husband, utilize my cats for intensive pet therapy, and try not to let me get the best of myself by keeping things in perspective, which doesn't always work (I was recently set off by an encounter with a difficult patient and it took me about a week and a half to get it out of my system). I avoid overworking myself and doing things that disagree with my condition (e.g. night shift), which it sounds like you are trying to do already. Once in a blue moon i'll take a mental health sick day (which I always feel guilty about even though I probably shouldn't). Having a regular routine is really important and will help protect against your depression crippling you. I also spoke with my doctor about dealing with exacerbations of my symptoms and every now and then I take an extra half a Seroquel (but please don't do anything like that without talking to your doctor first!). I don't know exactly what aspect of the job is making you stressed, but sometimes when a job is extra stressful it's because you're in a toxic work environment. In that case, changing jobs may be what it takes to even things out. Sometimes a bad work environment isn't as obvious as you'd think either. I worked at a hospital that was poorly run, but I loved my coworkers to death. They were nice people and wonderful, competent nurses, but the stress from the way the place was run was making me and other staff members physically ill. My new job isn't stress free, but it's not toxic. Even if it's not a toxic environment, it could be that you're in the wrong line of nursing. Being a med/surg nurse is very different from being an OR nurse and being an OR nurse is very different from being an ED nurse. All of those things are nursing, but they require very different skills and attract people with different temperaments. It's important to find your nursing niche. It's frustrating having to deal with limitations caused by mental illness (like finding a full time day position as a new grad because you can't work nights...) but it doesn't mean that you can't still be an awesome nurse.
  20. SpEdtacular

    RN to MSN

    I am close to finishing Excelsior's RN-MSN Informatics program and have really enjoyed the experience. Courses (not credits) run about $1800.
  21. I have heard that corrections nurses are very independent but don't know from experience. ICU nurses are fairly independent but in the hospital in general I think it depends a lot on the docs you're working
  22. SpEdtacular

    NTG and bradycardia

    I have had a patient's heart rate drop from the 80s to the 40s because her chest pain turned into an inferior wall MI, but in that instance it stayed dropped. Although it doesn't sound like it was the case with your patient, a patient having a right-sided and/or inferior wall MI can become bradycardic and nitro can cause the patient to decompensate because the patient is preload dependent. The patient might have vagal-ed too, I have had that happen especially after starting IVs, or it could have just been a coincidence. There's always that.
  23. Our providers go the DEA website and print them a list of all the prescriptions for controlled substances they have had filled. There are other clues too, like what I call the triple T allergy... When the patient is allergic to Tylenol, Tordol, and Tramadol it kind of makes you wonder...
  24. SpEdtacular

    Are you a new informatics nurse?

    All of it I guess. Just excited to be trying something new and challenging :)
  25. SpEdtacular

    Are you a new informatics nurse?

    I am enrolled in the RN-MSN Informatics program at Excelsior and will be starting the informatics portion in the summer!!!