AHarri66

I miss Falmouth Hospital! I worked the Med-Surg/Tele floor, and even though some days were rough, it was far better than where I ended up. (I moved South, and the hospitals here are verrrry different.) I can't wait to come "home" to the Cape for a visit...

I rarely get out on time, but I aim for it every day. As altomga said, it depends on the # of pts I have, and their acuity/needs. I do try to cluster my duties, and I try to chart as I go; ie. meds and assessments together, then charting as soon as I leave the room. It doesn't always work, but it keeps me organized so that I spend my time constructively.

The ONLY thing we infuse with TPN is lipids, and that is attached below the filter.

I know an intact male who occasionally gets "yeasties" under the foreskin. He buys some Monistat, applies it for the required time, and *Viola!* Yeasties are gone. Same bug, same drug.

I can't offer any links, but where I come from, 2 strikes and you're OUT. (Although I know a few *achemm!* that will try a 3rd time under extenuating circumstances.)

Charissa, I'm going to have to jump to Renerian's defense here. My niece has battled anorexia/bulemia for 15 years. Thankfully, she's doing quite well now, but the 5 or so years while she was "active" were hell on everyone, including my sister, who is her "natural" mother. If you have ever lived with anyone with this type of illness, or any kind of addiction, you would know that while you love and support the individual to no end, everyone has a breaking point. It is very difficult to stand there offering help and guidance and have it ignored, while you watch the person you love wither away in front of you. I don't think being a step-parent has one bit to do with it. I've felt the same frustration with some of my patients who refuse treatment, yet come back with the same problems over and over again. I think your statement was a bit callous.

Actually, the procedure you are refering to is called "infundibulation." "Female circumcision" is the removal of the "hood" over the privy parts, usually when it is too large and hinders sensation in adults. What gets me is here we are as a society continuing a surgical procedure (let's call it what it is) on neonates that was begun because of ignorance of the infectious process. And most of the time now it is done for "esthetic" reasons. Even many of the Jewish faith nowadays perform a symbolic circumcision, in which a drop of blood from the foreskin is produced, leaving the foreskin intact.

My oldest son (13) is circ'ed, my youngest (4) is not. I think it's ******** that infants don't "remember" the pain. For the entire time my oldest son was in diapers, he would scream bloody murder at each and every change, curling into a fetal position. Of course he doesn't remember now, but for almost 3 years it was h*ll. Also, after watching a couple of botched circs in school (ugly messes they are!), I decided there was no way I was risking that happening to my youngest's body. The MD who performed one of the circs I observed told us that the practice of circumcision came about during WWI, when it was erroneously thought that the foreskin made a man more likely to contract VD. The advent of antibiotics shot that out of the water. A point to consider (according to statistics): fewer babies are being circumcized nowadays, so that the curve is actually greater against. For those of us (like myself with my oldest son) who want baby to look "like Daddy," young boys are more likely to be exposed around their peers (locker rooms, school bathrooms), so if they are circ'ed, they will soon be the "different" ones. I realize I'm going a bit "off" here, but if I were to have a cause, this would be it. I also realize it is a matter of individual decision...I just think it should be left up to the individual with the member. To expand upon Browneyedgirl's comment: we look at infundibulation/female circumcision as "mutilation," why do we not look at this the same way? There is little evidence (less than 1% chance, I believe) that foreskins pose a "health risk." That would be like performing a mastectomy because breast cancer is a risk! Okay, okay...I'll shut up now. :imbar

I was also taught to use filter needles. Our facility has begun using a neat product...filter straws. They're great, and no sharps! :)

Ooops, sorry! :imbar I work on a Med-Surg/Tele floor in an acute care community hospital. We have moved from a system where the unit secretary transcribed orders to the Medex and the charge nurse (usually) or primary nurse signed them off and set the schedule. Then we went to a system where the unit secretary transcribed, and the primary nurse signed them off and scheduled. Now the primary nurse is responsible for transcribing, signing off, and scheduling his/her own orders. There is no policy in place for second-check EXCEPT for 24hr checks, which are done on the night shift. The reason for the change is supposedly to cut down on transcription related errors, but a bunch of us are wary, mostly of the second-check procedure. Just this weekend I found three transcription related errors, and those were only the ones I found. Thankfully, there were no adverse effects! :uhoh21:

Our facility has recently made changes regarding medication transcription (among a million other things, it seems!), and I was curious how other places do it. Who transcribes medication orders where you work? What kind of second-check procedure do you use, ie. another nurse, charge nurse, 24hr checks, etc. If you could mention what type of facility you work in, that would be helpful! Thanks all!

First off, Good luck, Zee! I don't know if this applies to the CCRN exam, but I assume it does. If your CD "guarantees" a passing grade, then your scores on the CD tests are likely to be lower than your CCRN exam grade. The NCLEX CDs are set up that way; if you can (even barely) pass the CD test, then you definitely pass the actual exam. It saves them from paying out on the guarantee.

Coug, you obviously don't read things very closely, because this thread wasn't about every time a drug is given, it's about whether a hospital has a policy for double-checking certain drugs. Your inability to read something this simple could very easily translate over to a drug error. Did you ever think that hospital policies are written because of research done into the causes of med errors??? Or is it because all of us other nurses out here are just not as smart or competent as you, and we never learned our 5 Rights???

Gee...I've had patients on 40 units of NPH before, nothing unusual about that. Also, we had an incident not too long ago where the order was transcibed in such a way that the "U" for units looked like a "0" in "40". It spurred changes in our transcription protocol, as well as in the way MDs are required to write the order. Our policy requires double-checking insulin and heparin, also, both gtt and sq. We only have to sign off on the heparin gtt. We double sign off on PCAs and epidurals as well. Personally, whenever I give IV digoxin (or any other IV cardiac med), I have another nurse check my calculations just because. No one is perfect, even nurses, and my patients' safety is far more important than my ego.

Our hospital allows direct admits with no trip thru the ER, or even admitting, for that matter. We're trying to change that, however. We have recently been piloting a program that utilizes an Admitting Nurse, who performs initial assessments, initiates a care plan, and (hopefully) gets the ball rolling as far as IV starts, labs, and other admission testing before the patient hits the floor. We don't have an IV team, and have floor-based techs who do phlebotomy and EKGs. Our tech leaves at 1 pm, so after that those responsibilities fall to the nurses. The program seemed to help quite a bit during the month or so it was piloted, especially for the late afternoons. I hope they decide to continue the practice.