80sNurse

Does anyone have experience using Up-to-date for Pharmacy information where you work? Is it a look-up for pharmacy information, or integrated into your system? Does nursing have access to it where you work (and do nurses use it?) Users' input most welcome. Thank you!!

(stated but not charted) "positive Cheetos sign"

what did you decide to do?

agreed! I'm fondly remembering an elderly gentleman I cared for in nursing school who said he had "cadillacs" in his eyes

anyone else out there have a policy requiring blood culture bottles be wiped off on the tops with alcohol wipes before use? and of course I'm talking about brand new, just opened bottles. our hosp policy requires this, and I think it's an unneccessary step that adds manipulation to an already sterile area. amer college of path book I have from a few years ago doesn't call for this step at all. just a little pet peeve I have to do (or feel really guilty about NOT doing!!) every day of my job :) ! If you're comfortable telling me where you work, that would help too. many thanks!

favorite allnurses post ever, thanks!! will keep enjoying reading others' responses

HAPPY ENDING: We got single dedicated small counter-top warmer & put in 0.9 & LR (labeled with date put in & date expires) so now I have the warm stuff whenever I want it when using rapid infuser isn't appropriate but still don't want to chill my patient YAY!!

Anyone have comments/recommendations re: pulse oximetry for carbon monoxide? I've heard about these devices, want to know if other EDs are using (EMS, too!) because we're checking into getting one and there doesn't seem to be a lot of options out there. I'm talking about (lighted/finger) pulse oximetry, NOT capnography (we already have/use that) and of course we have lots of regular pulse ox readers (in every room). THANKS!!

thanks, all! yes, we have & use level 1 & ranger; but we don't pull out the gear for as many non-trauma pts as I'd like. yes, we did date our fluids & keep in sep compartment from blankets, but JCAHO still nixed it. trying to see if JCAHO is inconsistent, AND trying to do increased use of (cost effective) warm fluids. keep those comments comin!

Our Level I trauma center was told by JCAHO last year that we can no longer keep bags of IV fluids in "fridge style" warmers on the unit (like where blankets are kept but separate compartment). As a result, I think we're using warmed IV fluids much less often than we should & am looking for opinions from other EDs. Management says we should use the rapid infuser & our "Ranger" warmers (YES: we continue to use for traumas), but we end up using them in far fewer situations than we could - perhaps due to no more speed & simplicity of just pulling out room temp fluids. It was nice to use readily avail warm fluids for all kinds of pts - dehydrated little old ladies, babies, even a kidney stone pt who might feel chilled after a few liters. I'm tired of making my patients (mildly) hypothermic/increasing their oxygen demand & decreasing their comfort... What do you do in your ED?? ...thnks...

I started in ER 7 mos ago & HAD NEVER started an IV!! (they didn't ask, I didn't bring it up) but had tons of central line experience. Preceptors were v. patient/knew I had come back from years out of nursing & figured it was a part of my being rusty. Here are some ideas... > practice with the start kit/supplies away from bedside to really get comft handling gear > look on you-tube > I recited verbal steps in my mind for the insertion (eg. "poke, lower, in a bit, withdraw stylet/advance, secure..." > LOOK first... if the person looks like they're going to be really tough, consider asking an RN to take a look with you/shadow. I would ask like I wanted site advice, and end up with a reinforcement of technique too. >For extra practice, offer to do the second set of blood cultures on someone else's patient, such as a new admit. Easier, less pressure. >Little things can make a difference in making vein visible that we're sometimes too rushed to do - pt lying fully flat, arm lower than bed a couple mins before tourniquet. Look & feel with no glove, taking your time first. Sometimes I also clean FIRST while looking again (then again before the stick) I never slap. >Sit down next to patient - leaning over with sweaty gloves stressing out made me feel like passing out Before you know it it'll be just one more thing you do while you're talking to the patient. I was so stressed when I started about this!! I knew it would be ok the day a mega-experienced RN missed an 18 and I tried a 20 and got it!

...I would also highlight your IV/blood draw skills - home care nurses do many, not all settings provide this much opportunity w/little backup ...I also agree w/part about assessment skills ... highlight your abilities to operate in a fast pace re: references - mine were never checked! they cared that I had names & titles provided, but I never give phone number out until after an interview (why subject your kind references to all these calls?) and it ended up they never bothered checking, go figure good luck!

I'm curious too... where did you end up? I'm a BSN just took refresher course & am being IGNORED by the hospitals you mention (including Rush & I used to work there!!) V. interested in how it all worked out, and what has the staffing been like? thx!

Maybe I'm not keeping all my childhood vaccinations straight, but aren't our kids ALREADY routinely vaccinated vs. one of the Hepatitis strains that is (primarily?) sexually transmitted? (any outpatient peds nurses out there?) When my 17-year-old was a toddler this was new, and I remember thinking how strange it was to be giving vaccine to a young child to protect him from a possible future sexual partner-acquired disease. I'm sure this vacc won't even cross his mind whenever he becomes sexually active (but hopefully condoms more than cross his mind...) :typing

I have 3 sons & would like to have them have the vaccine, but not (yet??) covered by insurance. Hopefully it will be before they become sexually active. Hope ID & Peds organizations embrace guys getting vaccine for good of innoculating overall population (for those who choose to do so, of course), then maybe insurance will cover...