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We have one lady we had to transport 2 hours to a major hospital with a CT scanner that would take her weight and that hospital says when their CT scanner was done they used one at the Zoo. Some major zoo's have equipment for the larger animals that can scan patients 500 lbs and up.

We have decided to implement a sign off sheet by the person taking the specimen to the lab that the specimen was drawn and labeled at bedside using patient identifiers. We are taking a lot of flack from this but due to a mislabeled specimen a few weeks ago we missed a positive troponin and treated and negative troponin as if it were positive. Of course tied that in with the other things like a flu label on a green tube ...

If their VS are stable and they have no complaints they go. Unfortunately we usually get the ones with the "I don't want to go to jail chest pain" after a cardiac panel comes back OK off they go!

One of the ICU's I worked in had a room where I saw someone standing over the bed of a comatose vented pateint, at first I thought it was the resp therapist, next thing I know the resp therapist came walking into the unit. I was telling another nurse that I has seen someone standing beside the bed and she said a lot of strange things happen in that room and one nurse refuses to be assigned to that room.

It can vary from hospital to hospital but in my ED day shift ratios are 1-3 if you have a trauma room and 1-5 for the rest of the ED including fast track in after 11p it goes to 1-5, then 1-7 after 3a. Hopefully things slow down after 3a so not all the beds are full, but we often have patients we are holding either because there are not enough beds in the hospital or they will increase the nurse-patient ratios in the ED so that the floors will not have to increase their ratios if they are short a nurse. Then if we have a nurse call out and can't cover the shift our ratios will increase for hte duration of the uncovered shift.

I have been concerned with patient safety and compliance with NPSG's. In the ED I currently work in I find that it is common practice to carry unlabel med filled syringes to pt bedside, lab tubes are not labeled at the bedside causing many errors and write up's from labs (on pt was treated as if he had an elevated troponin but later realized no cardiac enzymes had been ordered on him,the specimens had been mislabled). Handwashing/hygiene is also not commonly done upon leaving a pt room. Handhygiene, labeling specimens, and not drawing up medications until at the bedside and comparing pt identifiers with the orders had been emphasized in the previous ED I worked at. No one is taking my concerns seriously and we have had a few close calls that I know of. My question to you all is what was done in your departments to encourage complience with these patient safety issues? Knowing these issues are joint commission standards doesn't help becuase they have been joint commission standards for several years and if this department had any visitors from JC during their last visit no problems were noted. I am just afraid something worse will happen to our patients than already have. Any advice or suggestions will be appreciated.