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Prior Auth, SNF, HH, Peds Off., School Health, LTC
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Duranie specializes in Prior Auth, SNF, HH, Peds Off., School Health, LTC.

Duranie's Latest Activity

  1. Exactly.... Whether you call something an accident, or a mistake, or whatever term you want to use.... actions have consequences! I particularly like your example, Wuzzie. Because it almost perfectly mirrors the RV scenario— <I wish I could make a table ... oh well, this will have to do. > Rainy night driver (RND)— found herself in an overwhelming, unfamiliar environment while performing a task (operating a motor vehicle) that she had done before without a second thought as to her ability (she had driven before in the rain and at night and been fine) RV— found herself needing to administer an unfamiliar drug in an unusual circumstance outside her normal work area. She didn’t give a second thought to her ability to administer IV push meds as she had done so before and everything had been fine. RND — bypassed warning signs and proceeded to ignore safety rules or not perform any self-checks regarding her options in a potentially hazardous situation. RV — bypassed the safety features of the Pyxis (i.e. manually attempted to type in the drug she wanted but failed to read the full name of the drug that came up, or note that it was different from what was ordered); ignored the warning signs in her way (i.e. the safety alerts on the medication vials, the unusual nature of the way the vec had to be prepared which was very different than versed.); missed performing necessary checks (i.e. 5 rights) RND — Caused the death of a police officer as a direct result of her unintentional, yet careless actions while performing a task (driving) in a high-risk situation, where a responsible driver should reasonably be expected to increase their attention and be even more careful and alert to potential hazards. Up to, and including pulling over for a “Time-out” to review the situation, and determine the safest way to proceed with the least risk possible. RV — caused the death of a patient as a direct result of her unintentional, yet careless actions while performing a nursing task (IV med administration) in a unusual — and therefore higher-risk— setting, where a responsible nurse should reasonably be expected to exercise even more care and attention to the details of her task and be especially alert to potential dangers to the patient. Up to, and including looking up meds that they are unfamiliar with and monitoring the patient more closely, or even calling a “time-out” to review that the order was correct and followed properly, and that care was being given in the safest way possible to minimize potential risk of harm RND — faces criminal charges because her actions, although unintentional and without malice, caused the death of another person. RV — faces criminal charges because her actions, although unintentional and without malice, caused the death of another person. So— questions to those who are so shocked and up-in-arms that RV is being prosecuted: Why does the fact that RV is a nurse have any bearing on the consequences she should face as a result of her actions? She did not provide responsible care to a patient....plain and simple. The fact that she’s a nurse only matters because it provides an explanation for why she was in the situation in the first place. Even without malicious intent, when an ‘’accidental” death could have been avoided by exercising appropriate care and applying basic safety measures, it really shouldn’t be a shouldn’t be a big surprise when charges are brought for manslaughter of some sort— no matter what your job is or whether or not the “accident” happened at work. Do you think that no one , in any occupation, who causes an accidental death in the course of their job, should ever face prosecution, even when it’s a result of (non-malicious) gross negligence? What about negligent deaths that happen because people are so wrapped up in their own world, careless and stupid.... like someone speeding through a school zone, from my earlier example? Should they face charges?
  2. Recklessness and mindlessness go hand-in-hand, though. I’d like to present a hypothetical situation: Let’s imagine, that like most people, I have a thousand things I need to do on what is a particularly stressful day— so I get in my car and as I begin to drive, my mind is on all the things I’ve got going on in my life.... let’s say, I’ve got to get to the pharmacy to get the Rx for my puking kid; and I have to go to the bank to make a deposit so the mortgage payment clears; plus I’m thinking about the parent-teacher conference that I’ve got to reschedule because a schedule change at work means I can’t keep the appointment I set up 2 weeks ago; then, as I clench my teeth, I realize that I’ve got a loose crown, so now I’ve got to remember to call the dentist; and that sets my mind reeling because I know that when our new benefit year starts next week, I’m gonna be paying even more out-of-pocket costs and how are we gonna afford that, and then I think, well, maybe I can refill my own ‘scripts a couple days early and hopefully have the lower copay one last time; and—and—and .... So as my brain is on overload as I drive, I mindlessly fail to slow down in a school zone, and hit a child in the crosswalk, who then dies..... In my scenario, it seems clear that I was a negligent & reckless driver, and of course, I established that was acting mindlessly. But, I had no intent to kill anyone.... I didn’t purposely get in my car with a plan to mow down the first pedestrian I could find. There was no malice aforethought, as it were. Everything I was trying to accomplish at that moment centered around being the best wife-mother-caregiver I could be for my family— coping with all the stresses that get piled on us all at some time or another— And then.... <snaps fingers> I killed a child.... in my mindlessness! You can bet your sweet patootie that I would be arrested and charged with something... whether that be negligent homicide, vehicular manslaughter, reckless homicide, involuntary manslaughter, or another similar crime. And I don’t think I should expect a judge or jury to care one iota about all the stuff going on in my life that I was juggling at the time of the “accident”. In what world would anyone believe that a reasonable consequence for such mindless actions would be having my driver’s license revoked, my car taken away, and/or be publicly lectured on the importance of paying attention in high-risk situations. {Personally, I’d never be able to get behind the wheel of a car ever again, even if somehow I were deemed not to be at fault. And I surely wouldn’t be out car shopping (i.e. interviewing for/ taking a new job).... } I truly don’t understand how someone can argue that negligence/ recklessness and criminality are mutually exclusive. If an electrician negligently wires an outlet in such a way that someone plugging in their hairdryer ends up being electrocuted........or if a contractor fails to check the quality of building materials being used in construction and the structure later collapses and kills someone.........or if an exterminator doesn’t pay attention to where they’re spraying the insecticide and accidentally sprays it in a baby’s crib or play area, poisoning them........ In situations like those I list above, the person responsible for the error/ oversight/ negligence has been prosecuted for some form of manslaughter. There is precedent. So then, when a nurse fails to administer a medication properly in accordance with established and accepted protocols and the patient dies as a result ... shouldn’t there be an expectation of being held to account for the death that was preventable by adherence to simple procedures and checks rather than going about in a “mindless rush” giving drugs which she claims to have been unfamiliar with? When you undertake to do a job that requires you to be focused on the task at hand— no matter what that “job” is.... nurse, doctor, electrician, driver, whatever— the onus is on you to: #1, know what you are doing and #2 take the necessary steps to insure that you do that job properly and safely. If you choose— through mindlessness— to do the job in an unfocused and unsafe manner, then you have to accept that there are consequences for that. Where someone is harmed or killed as a result of mindlessness or negligence in your actions, I think it’s reasonable for a prosecutor to review the case and potentially bring criminal charges. So then, going back to my hypothetical scenario— a driver who unitentinally speeds through a school zone that they failed to notice while in a “mindless rush” to attend to the “impossible workload” they find themselves saddled with that day, and as a result runs over someone and kills them (doesn’t even have to be a child, let’s say it’s the crossing guard)..... by your thought process the driver wouldn’t face any criminal charges because there was no malice???? What, then, should the consequence be?? A speeding ticket? or maybe one for failure to yield to a pedestrian? How about a suspended license? : You must realize that not all criminals are malicious.....
  3. Duranie

    8 Best Apps for Patient Self-Care

    Nice article— it’s a good overview of health apps that can assist with a variety of self-care needs. However, the BEST app I’ve found for medication self-management is CareZone. The reviews complain of ads.... but they aren’t normal ads, just occasional pop-ups from the “CareZone Team” about their mail-order pharmacy, and timed-dose pill-packs. You can close the pop up immediately, so I just ignore it... takes like a millisecond to hit the X in the corner. But for keeping a current med list and setting dose and refill reminders.... nothing else is better. Entering meds is as easy as taking pics with your phone or tablet, and the app is smart enough to populate the appropriate fields in your med list. Just take photos of the Rx or OTC label and it does the rest. You look over the info that was imported, and edit or complete fields as necessary, set the exact times for doses, then hit OK. Thats it. It can also store a photo of insurance cards, FSA cards/account info, & has BP and other info tracking. It is also password or fingerprint/Face ID enabled. Another good feature is the ability to enter profiles for more than one patient—- so a parent could have profiles for each of their children, or a spouse could have a profile for themselves and their so. I have no connection to the app or it’s developers, or their pharmacy. It’s simply the best app out there (and I have tried upwards of a dozen or more) to manage the 15+ meds I must take everyday to stay alive.
  4. Duranie

    Are We Too PC?

    I quite agree. I was in the Seattle area near Easter and there were posters around advertising a community "Easter Egg hunt" activity in a local park. I lived there for >1 year surrounding the period in question, and never heard the term then either.
  5. Duranie

    Are We Too PC?

    At the time this song was first released there was no such thing as a "roofie".... you could "slip someone a mickey" (a.k.a. choral hydrate)... Of course, that did make them sleepy, although relatively slowly. It also didn't have the amnesiac effect of a date rape drug. "What's in this drink?" is more likely related to the fact that it was expected that women's drinks were typically made weaker... most people believed that a dainty woman wouldn't like a strong "man's" drink, and if she did it was implied that she was an alcoholic. So I would take the line to mean: "what are you trying to do, get me drunk?" {just an fyi: My grandmother owned a bar, and she said that there was a time when even women who hung out in bars wouldn't be caught dead doing shots, or even drinking things that were considered masculine, like a whiskey sour or a martini. The novelty martinis were invented so women would feel more comfortable ordering them.} I've been date raped, and believe me, there was no playful banter, no flirtaceous fun, no asking, really, at all. He didn't try to talk me into it, or convince me that we should. He simply made up his mind that we would be having sex, and from that point on, nothing I said mattered. There were no cute comebacks, or witty retorts. Actually, he said very little- "stop fighting... it'll feel good if you stop fighting it" (it didn't) ... "Every woman I'm with says I'm like a god..." (he wasn't) .... and a few other similar self-aggrandizing comments. And I guarantee you, I wasn't making any cute quips either. I sure as h**l wasn't smiling. I think one part of the problem comes from trying to frame things from the past in the context of today's world. The "Deck the Halls" example is perfect: Instead of using the opportunity to explain to kids that the word "gay" has changed in meaning, somehow it is preferable to let children misunderstand the word by using today's common definition. We sell our children short if we don't believe that they can comprehend that language can (and does) evolve. We should use these cultural artifacts to understand the past. Once we understand how society has evolved, we can use that knowledge to make our future better. I do find it funny how many people abhor politics and politicians... but those same people will jump right on to the "Political correctness" bandwagon. Apparently, no one thinks about where the term comes from... The idea being that politicians have to be able to speak in euphemisms and use vocabulary that will avoid possibly offending anyone at all. How's that for irony. And one other point- - there no such thing as "a little rapey" ... it's like being a little bit of a virgin.... It either is rape or it's not. Period. Full stop.
  6. Duranie

    Nurse Gives Lethal Dose of Vecuronium Instead of Versed

    When you take your littles to CT/MRI, don't you take a med box with you? The paralytic could be included in there... maybe it already is, being that it's an RSI drug. In any case, there are nurses every day who function in situations where they don't (or can't) rely on the ability to scan every med before giving it, or depend on a Pyxis to give them the right med. They pull meds from crash carts, med boxes, etc. and by knowing the characteristics of the med they're about to give (i.e. Versed does not require mixing a powder and a dilutant, paralytics have very obvious markings that are designed to make the person administering it take notice, and so on....) and by doing the double checks they are supposed to do, they are able to safely administer these dangerous drugs. It's like when a nurse gives a patient a huge dose of something and it's later found out that she had to draw from 10 vials and use 4 syringes, and that never made her pause and think whether there might be something amiss... it is the nurse's responsibility to know enough about whatever meds she gives to be able to tell if what she's about to do is reasonable. And if it is something she's not familiar with, then she should look it up before she takes it upon herself to administer it. I know mistakes are inevitable... everyone has or will make one... but I DO NOT believe that all mistakes are created equal. I think that the higher the stakes, the higher the bar should be. And the more alert we should be to the possibility of making a mistake. I think it is absolutely possible to have mistakes like this one be avoidable. If Nurse Help-all had done a double check on her own, and taken it a step farther and had Nurse Trainee double check a critical med *with* her, then instead of mistake, it would've been a near-miss. And I'll take a million near-misses to a single fatal mistake any day
  7. What about using something like this: Tile - Never lose your phone, keys, or wallet, again using Tile’s Bluetooth tracker | Tile . I'm pretty sure you can "assign" a tile to an item, and that way you can use multiple tiles to track various items you want to keep track of. There's a keychain or tag type; or there's an adhesive version. I would contact the company, they have probably already implemented their tiles to track company assets for some company or another, and can instruct you on the best way to use their product for the purpose you need. good luck.
  8. Duranie

    WILTW 9/13: Social Calls and Social Justice

    No kidding that things are so much more complicated. I learned some related things: I learned that sellers are now being advised by their real estate agents to not even consider an offer unless the potential buyer has already been pre-approved for their mortgage. Pre-qualified is not enough anymore. Almost all sellers require your pre-approval documentation to be included as part of the offer to purchase. Seriously... So, it's better not to start looking at homes until you get those particular "ducks in a row" because it really, really sucks to fall in love with a house, only to find out that by the time you get pre-approved, (which is pretty much the whole process, so all that's really left is to get the appraisal...) it will probably be under contract to other buyers 😕. Unfortunately, loan officers don't tell you that pre-qual, and pre-app. are different things (unless you know to ask), so when your agent asks if you've talked to the loan officer and gotten "the letter" you think "yeah, we already did that" only to find out that no, you really haven't.... I also learned that if you have a fair amount of equity in your current house, it somehow works out better on paper to keep that home as a rental and then it gets counted as income, and you will be approved for a bigger mortgage than if you sell it. Obviously, this means you have to be honest with yourself about whether you can afford the payment on a larger mortgage... But with a low enough interest rate, the payment might be fairly close.... Just don't assume that, "if I was approved, I can afford it"-- that's what got so many people into trouble before....
  9. Duranie

    Bad management

    well, not completely false, you had gotten written up before... The write-up actually said "for being mean"? More likely it was for yelling at staff. What do you see as "chain of command"?.... Management -->>administration.... Seems like that was going up the chain to me... These two descriptions just don't jive with one another.... Maybe it's because you are posting this in dribs and drabs, or because of your train-of-thought, run-on-sentence, no-capital-letters writing style (Or some combination of both, I think) ... But I don't think you are going to get the answers you are looking for. We can't comment on a situation when you've only told us like 1% of it the first time and only slightly more the next post, and honestly, after that I am no longer interested in trying to decipher what you mean, if you can't be bothered to actually tell us. You don't have to write a verbatim transcript of what was said in order to tell us what happened with enough clarity to get meaningful input. But to expect strangers to give you advice on something that even someone who was there wouldn't be able to figure out with what you've given us (at least in the first post or 2), I think you are asking for the moon. I will offer this: The interactions you've described here, would result in a write-up or other disciplinary action at any job, nursing or otherwise. You would be doing yourself a favor to seek help to learn how to communicate effectively with co-workers. You need to learn how to say what you mean... Not just, "she should have known I meant....", or raised voice means urgency..., etc. Your communication style is lacking, at best... and likely to end up getting you fired someday, at worst. Good luck.
  10. Duranie

    "The Disruptive Behavior of Doctors"

    Here is a link to a MedscapeCME on this very topic-- http://cme.medscape.com/viewprogram/19250
  11. Duranie

    "Your patient in 520 is in pain!"

    I agree. Sometimes it is also because they are not getting enough med to really relieve their pain fully, and are afraid of even worse pain if they miss any at all. Most often these are pts who are opioid-tolerant and are getting doses recommended for opioid-naive pts -- nowhere near their baseline dose @ home. {Why don't surgeons look @ that & figure it out, call pharmacy for help with appropriate dosing, or get a pain consult!?}:angryfire (Happened to both my mom & my sister when they had terminal cancer.) Or... it could be that the pt. is finally on top of their pain and desperately don't want to have it get bad again. I know when I've had surgery, my biggest fear/concern is waking up in pain, either immediately post-op, or later on the floor. This most often happens when my pain is relieved, I fall asleep, and wake up later having missed my next dose. Invariably, the nurse will come in & say "well I just checked on you 1/2 hour ago (or 45 min ago, or whatever) and you were sound asleep. Now you are telling me your pain is at an 8," and do one of these:icon_roll. I'm like "yeah... I'm sure 1/2 hr ago when my pain was just coming back, I was able to sleep but I guess in that time it finally got bad enough to WAKE ME UP!!! Please get me my shot..." I:heartbeatthe nurse I had after my bladder reconstruction who (after I asked if she could) came in to give me my IV pain meds on time all night so I wouldn't have that happen. She came in quietly, and I would open my eyes to see her there and smile and whisper "Thanks," and go back to sleep. I:redbeatheher - she was an:angel:.
  12. Duranie

    Catheter Bag Position

    Actually, you may not have to disconnect the legbag at all. If it is not the hard plastic, twist-to-open type, you can use a connector and tubing to attach it "in-line" to the night receptacle (bag or bottle, as the case may be) thus preserving the integrity of the system. I think it's COLOPLAST that recommends this method with their legbags. I used this technique with my own urostomy for nearly 1 year. The bonus was being able to use a shorter length of extension tubing to reach the legbag, and being able to secure the various tubes exiting my body extremely well (with duoderm and tape) to avoid any inadvertant tugging or pulling. FWIW, personally, I preferred the bottle for overnight drainage. I am now "tube-free", lol :yeah:Yay!!!
  13. Duranie

    "Your patient in 520 is in pain!"

    In some cases it is because they have a legitimate reason to be in pain, like post-op or kidney stone, etc. It is unethical to allow a patient, even an addict, to be in uncontrolled pain (unless it is b/c you need to avoid sedation for eval of CHI, etc) Some docs will try non-narc meds first (i.e.torodol & APAP) or even other modalaties such as TENS or epidural anesthesia. If you are concerned, bring it up with the doc next time they round (as a concern in the interest of the pt., not accusatory;)) I personally think PCA is a good compromise if the pt is truely in pain (after lengthy discussion of this topic with an experienced anesthesiologist)... a small loading dose, then small frequent doses when they push a button, erring on the lower end of what may be needed, and increasing if there are objective s/s of pain... it's the larger amts of narc hitting their system all at once that creates the high -- given in small amts over time, diminishes that rush. Keep in mind though, that pts who are opioid dependent for any reason (pain pt. vs. addict) will need larger than typical doses to do any good. Sometimes enough to make you go !! In some hospitals, a "Pain Team" or anesthesiology will manage these pts. Sorry this ended up being so long....
  14. Duranie

    Help! I have a difficult wound to dress today!

    Try using elastic net "panties". They are frequently used in OB. They will hold the kerlix in place and keep it from falling down. To address the toileting issue you can cut the netting to create an open crotch. Just be sure to make the cut a lot smaller than you think you need because it will stretch. You can always snip more later to make it just right. Depending on how far down the thigh the dressing needs to extend, you may need to use standard elastic net bandage retainer to hold the thigh portion. Good luck

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