solneeshka

Does your facility keep cricothyrotomy kits on crash carts? I'm getting info that it's not standard, which seems odd to me. Just trying to survey the landscape and see what others are doing.

Any ASC managers out there, or any other folks who would happen to know, care to share how you arranged block times for your surgeons, and more than that, how you calculated room utilization rates? I'm managing an ASC that is a department of a large hospital, and leadership uses the same utilization calculations for us as they do for the main campus. But scheduling works differently, and our availability is not the same. I'd like to propose different calculations but I'm not entirely sure what would be appropriate. It would help to have an idea of standards in the industry out there. We are orthopedics but responses from any specialty area would be helpful. Thanks!

I'm a nurse. I'm involved in negotiating prices for our implants. I know what they cost; we use them and I can see very easily what we pay for them. My question was is in regard to a specific other facility, who I'm told uses a different pricing model than we do, hoping to learn more about how they developed that model. Clinical care isnt isn't the only role that nurses can have. We do all sorts of things, and can add significant value to traditionally non-nursing functions when we step into those roles in the context of healthcare. Vendor contract negotiations, for example. Vendors can't BS me in the way they might be able to BS an accountant (which I also am, BTW) because I've been in the OR with the surgeons who use these items, and I have the relationships with the surgeons to ask them if something is really worth paying a premium over something else. It is one of our surgeons who told me about the pricing model at Cleveland Clinic, which is why I logged on and asked the question. There are nurses who are not involved in direst clinical care who use allnurses. If they were smart, there would be non-nurses in the healthcare industry who would also use allnurses. If someone on the board happens to have the info in my original question, that's what I'm looking for. If not, no worries.

Sorry, I wasn't clear. I'm not looking reimbursement information or or total cost of stay info or anything like that. I know that no one can give out the prices that they pay for the actual grafts. Just looking for the process that they (or, more likely, their supply chain) followed to come up with whatever the prices are that they are willing to pay for the grafts. Different hospital systems use different methods to set pricing, and even within their own system will use different processes for different kinds of products, particularly high-dollar physician preference items (like EVAR grafts).

Anyone out there from Cleveland Clinic who would be willing to field some questions about how you arrived at EVAR/TEVAR endograft pricing? I know you can't share the prices and wouldn't ask you to, just would like insight as to the process of how you arrived at pricing.

Are you sure they *have* to pay for that ACLS? I have to have a license to be a nurse but my facility doesn't pay for it.

As someone who has spent time in management (and thus making hiring decisions), I can say this sounds a little paranoid...what manager has the luxury to say I'm going to hire Suzy over Sam because Suzy will have to go into debt because she doesn't have her BSN yet, and that way she'll be tied to staying here even if she wants to leave? Really? You hire the best nurse for the job, whoever is the best fit. If your facility requires that you only hire BSN's then those are the only applications that you see.

It wasn't a cardiac stent that he got, it was a carotid stent. He wasn't a Cath lab pt, although the stent was placed via groin access. He didn't need the neo to keep his BP safe or at baseline, it was because the surgical team wanted to maintain a certain minimum MAP for the first 24 hours post-op to help make sure the stent remained patent (they do this a lot at our facility, not sure if it's standard elsewhere). If memory serves, the desired MAP was higher than his baseline MAP (not unusual for what we see), which is why it's not unusual for these folks to be on neo drips post-op for the first night. In the morning, we titrate down until it's off and make sure they are maintaining their baseline BPs on their own before they go home. I did draw trops on him, they were all negative. Left to my own devices to conclude what happened, my best guess is just that he's not well-controlled at home (as evidenced by his A1c) and his lantus dose might not be the right one. I don't know how long he's been on it. I hadn't thought about the stress of the procedure and hospitalization affecting his insulin differently, although it still seems like that would have brought his BG up, not down. Mystified.

I haven't checked in to allnurses for a while, sorry! But the only resolution I got was that he did go home the next day, as scheduled. I assume that means there wasn't a concern for some unusual issue that might have caused it, but I don't know for sure.

At the time of the incident, there were no IVF infusing because he was eating and drinking very well. They had been DCed.

Apply! This kind of thing is not that unusual, and you have a great reason to give to your "new" employer - you realize how much you loved working for them in the first place and you want to go back! Keep in mind that it might close doors at your current facility, unless it's very large. But based on what you say, it sounds like the right thing to do.

It's posts like this one that make me glad I work at a gigantic teaching facility. The place is crawling with residents, and on the medicine floors, crawling with hospitalists, even at night. Everything (usually) moves fast; you call for help, it starts coming out of the woodwork. (Unless the team gets lost on the way to the call, because we are that huge - it happened to me on the very first code I ever called - funny in hindsight, not at the time!) We have the number for our RRT posted in patient rooms, so *anyone* can call, even a family member. It does not get overused at all. I would say there are more overhead pages for codes than for RRT. But we all know about it, it's a great ace up your sleeve. OP, I don't remember now if you did suggest rapid response to the other nurse, but if not, there is nothing at all wrong with doing that, even if that nurse is more experienced and you are new. If it were me I would think, "Would I call RRT if this were my patient?" If so, then I would be strong with the language: "Why don't I call a rapid response for you? Here, you go back in with the patient, I'll make the call." Just because another nurse is more experienced than you are doesn't mean he or she doesn't sometimes second-guess themselves. Maybe it was on her mind and just knowing it was on your mind, too, would have been enough for her to go ahead and do it. And yes, as some have noted there are no guarantees that calling a rapid response would have improved her outcome, but the whole point of having a rapid response program is to increase the chances of improving a patient's outcome, so probably, it would have! At least the patient would have sooner been on the radar screen of those who give a higher level of care. You were thinking along the right lines, and the next time it comes up, you'll have a better idea of how you'd like to handle it. That's called "gaining experience."

A lot depends on whether or not you have another adult living in the household. Are you married? If so, does your husband pick up the slack? If so, then your kids will be like a bazillion other kids all across America who don't have full time stay-at-home mothers (that is, just fine). If you are the only adult in the household and have to make other child care arrangements (my situation), it can be tricky. My son has survived, but we've been at the mercy of the willingness of various family members to help out. It would be one thing for my son to be at home without me but with his father until 8:00 pm when I get home; it's another thing for him to be at my aunt's house until 8:00 pm, then I need to get him home and that's when we're just starting our evening routine. Not the end of the world, we've been okay. This may be a short-term situation for you, you never know when something part-time might open up, and if you already have your foot in the door, you'll be better positioned to move into a part-time role. You both will survive!

The BMP glucose was "

In our facility, incident reports for lab specimens are automatically done by the lab. When it happened, I also e-mailed my manager to let her know what had happened (so I could provide the information while I still remembered it). This situation is a little bit different in that what I did (leave the neo running to meet a MAP goal) was in fact what the service wanted to have happen. I think what TakeTwoAspirin is getting at is that the way our system works leaves big possibilities that what ends up being done is *not* what the service wanted to have happen.