EEG1

At our hospital, no hand/wrist jewelry is allowed at all. No rings, watches, or bracelets allowed.

Great job for doing the right thing in this situation! I agree that taking VS is an assessment, not a treatment. And as nurses, we make assessments all the time without even laying our hands on people...whether they are our patients or not. What if this had been a fellow employee who was experiencing these symptoms? Would you have told them to just go to the ER or would you have taken a couple extra (and possibly life-saving) minutes to take VS? At our hospital, we can call a "Code Assist" for any non-patient (visitor, employee, etc.) who, if they were an inpatient, would need a rapid response or code blue called.

Overseeing passing meds to 12 people and being accountable for 6 students seems like unsafe practice. Even in my last semester of nursing school, we did not pass meds every week. We had 8 people in our clinical group and our instructor would pick 4 people to pass meds to their assigned patients that week. Each student would have 1 or 2 patients to care for. Then the next week, the other 4 would pass meds. This way, the instructor and students could safely pass all meds and still have time for discussions, teaching, etc. And for the students who were not passing meds that particular week, we were usually assigned one more patient to provide total care to (minus med admin).

Hardest part: Knowing that you have done everything you are humanly capable of doing for someone, and they still aren't satisifed. Dealing with it: Putting my day's work behind me and not bringing it home with me to bother me there.

My hospital uses Bedside Medication Verification (BMV) for med administration which also integrates with our computerized charting in Meditech. I cannot imagine using anything other than a barcode scanning system for med admin. I have personally experienced preventing med errors because of using this system. You must still keep in mind the "5 rights", but the barcode scanning is an extra way of ensuring patient safety. In our system, we scan each med, scan the pt's ID band, then scan our own name badge. Of course, there are some downfalls about using BMV (mostly just inconvenience...like having to take a COW with you when you want to give any meds). But the good things about BMV far outweigh the bad. I could go on and on about the good and bad of barcode scanning, but here are some highlights: Good: 1. Charting is done right then and there when you are with the patient so you don't forget to do it later. 2. Our system allows us to pass meds then chart pt notes with just the click of a button. 3. The COWs we use have locked drawers that we can keep meds and supplies in. 4. If I have to give a blood pressure med, for example...I scan the med, then a box immediately pops up with the pt's most recently documented blood pressure. Another example would be giving heparin...the little pop up box shows me the pt's most recent PT/INR if available, etc. 5. When giving pain meds, a box pops up to fill out what the pt is rating his pain level 0-10, what type of pain scale he is using (numeric, FLACC), and where his pain is located. After giving the med, a reminder shows up on my status board next to the pt's name of what time I need to reassess the pt's pain level (exactly 1 hour after giving the pain med). Bad: 1. The cows are large and difficult to push over doorways. 2. Sometimes pt's make comments about how they feel like they are an item from a grocery store being scanned. 3. If a pt has (what seems like) 1,000 meds to be scanned during one med pass, sometimes I feel like I spend more time looking at the computer screen than actually looking at the pt! All barcode scanning systems are different, and these are just a few of the things that really stick out in my mind that are good and bad about our system. In general, I think barcode scanning systems promote patient safety and are a great piece of technology that should be used as often as possible.