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Med Surg, Home Health, Dialysis, Tele
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corky1272RN specializes in Med Surg, Home Health, Dialysis, Tele.

corky1272RN's Latest Activity

  1. corky1272RN

    Frequent flier narc users

    The patients shouldn't be coming to the ER for a Rx refill , but if they are taking tramadol at home for back pain then they aren't going to get dilaudid in the ER . If they injure themselves that is a different story . Seekers usually don't fill out surveys with satisfaction anyway (they didn't get what they want, it wasn't on time, it wasn't fast enough, etc). The nurse won't have to look up the meds that are approved, supposedly it will be in our computer system, and the ER physician will base his orders on the approved meds. The nurse will only follow the orders like usual. This definitely won't stop the frequent fliers seeking narcotics but hopefully it will deter them.
  2. corky1272RN

    Frequent flier narc users

    The hospital system where I work is starting a program called the "Super user program". It is specifically targeting frequent flier pain seekers, but can also include patients coming in to the ER frequently for other issues. The patients are "nominated" by staff and administration. There is a board of various hosp admin that will look at the patient's past visits, medical diagnoses, etc to see if they qualify for the program. Pts will be notified via certified letter. In the program the patient will have to find a pain management doctor (we have partnered with a local clinic for the uninsured). The pt will have to enter into an agreement with the MD for managing their pain, the physician will notify us. When the pt comes into the ER, we will only give the pt meds listed in their agreement. It sounds like a good idea but I am just wondering if it works. Anybody heard of a program like this or experience? Did it work?
  3. corky1272RN

    Vital Signs Taking at ER

    Why was this relative being told anything to begin with? If they are within earshot when the VS are being communicated out loud then that is one thing, but to come and specifically ask... The patient stated he/she didn't want to know what the BP was or the fam member didn't want the pt to know? Unless designated by the pt to make medical decisions, that fam member can't direct the pt's care. I would like to say that that could be a problem versus the other
  4. corky1272RN

    IV Benadryl

    How fast did you give it? I have never had anything happen like that but it might have just been an adverse drug reaction.
  5. corky1272RN

    Different Piggyback Antibiotics, Same IV Tubing??

    Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.
  6. corky1272RN

    Rude nurse?

    CapeCod Mermaid, I couldn't stop laughing at your post. It sounds like something that could happen on my former unit.
  7. I had a pt that had PO and IV pain meds ordered PRN. The order comment included by the MD was "only give if pain not relieved by PO". So when the pt asked only for the IV, I informed him that the PO had to be given first then the pain would be reassessed in 1 hr. He wasn't that happy, but accepted it (I guess he really had no choice). However the nurse that I relieved that day was coming back the next day, we got to talking about the order the next day. She was just like "I don't care I just give it" , basically she just gave the IV not the PO then the IV. That was her decision but the MD did write that order comment as a type of parameter.
  8. corky1272RN

    Orders to hold meds?

    To me it also depends on what the pt is in there for. I had a pt that was in the hospital for SOB, she was stable respiratory wise, but there were some other issues. She started refusing her IV solumedrol, definitely something to call the physician on.
  9. corky1272RN

    Pain Medication addicts

    All the time, any nurse that has worked in the hospital has seen this time and time again. What is your question?
  10. corky1272RN

    Pain meds and low BP?

    The nurse has to rely on her/his critical thinking and assessment skills. You cannot be forced to give narcs if you think it is inappropriate. Go to your charge nurse if the pt starts hollering that she isn't getting it. If the pt is asleep when it is time for a scheduled narc, chart that and reassess later. Even if the pt isn't falling asleep/drooling when it is time for a scheduled or PRN narc, I don't give more than 1 or 2 at a time (depending on the meds/situation), even if they take it all at home at the same time. I just explain that it is different in the hospital and I have to make sure that it is safe. That is my job. Some understand, some get very angry. I have had times where I wouldn't give certain meds at the same time. The pt became very angry, I explained the situation to my charge nurse, he agreed with me. But even if he didn't agree, he would either support me or give them himself. BUT if he decides to give the meds, he will take over the pt. Noone better demand that you give meds to a pt, because it is your license it anything goes wrong. I try to know beforehand if there will be an "overlapping" of meds. I will talk to the pt and let that person pick which ones are given & omitted. One time the house supervisor even got involved, she disagreed with my decision but still backed me. Suggestions that it is ok to give a bunch of narcs together just because the person takes it at home that way is a flawed way to think. You must keep in mind that the pt is getting other meds in the hospital that aren't taken at home that could increase (or decrease) the efficacy of the meds. Plus the person's current medical condition can change their tolerance. As for the BP, don't look at the #, look at the pt (and trend). You have to keep in mind what is the pt's normal, that is part of the critical thinking.
  11. corky1272RN

    Refilling water pitchers

    It should be ok to take the plastic pitcher out of the pt's room to refill unless the pt is on isolation. I don't understand what people are talking about cross-contamination since it's touch-free, the mouth part shouldn't be in contact with anything. But since it is your hospital's policy, my earlier point is moot in this case. My suggestion is using one of those pink bathing basins, fill it with ice only, maybe 3/4s of the way. It will slowly melt, the water can be poured in the pitcher or cup. I'm not sure if this is a good suggestion or not, but it is the only one that I could think of at the moment.
  12. corky1272RN

    insulin per sliding scale

    In my hospital oral anti-hyperglycemics are not held just because they are in the hospital. The pharmacy takes in account diagnostic tests that require contrast and will profile or hold based on that. The physicians keep an eye on it, the radiology staff always question us on whether the pt is a diabetic. So there are multiple checks in place. Pt really need to keep up their oral meds if possible. When a pt is NPO, I will not cover if
  13. corky1272RN

    Is 7 the new 5?

    Believe me that Magnet status has nothing to do with it!
  14. corky1272RN

    Vented tubing for lipids?

    Some facilities do use filters for lipids but not all. I used to work at an LTAC that used a bigger filter for the lipids (the TPN had it's own filter seperately), but at the hospital that I work at now, the lipids are not filtered. Maybe it is their protocol, maybe a different type or brand, not sure if the LTAC even does it anymore. My current hospital started using the bags of fat emulsions about a year or 2 ago, the bags are better.
  15. corky1272RN

    Patients who come in with night bags packed....

    Baggage is one thing, but what am I supposed to think when the family is bringing a large box fan? The pt is definitely expecting to stay!
  16. corky1272RN

    My heart is set on the emergency field but...

    You just started nursing school, so you have plenty of time to figure things out. Nursing is great because it has so many areas to choose from. You may think right now that you want the ED but once you do clinicals, you figure out that just isn't your cup of tea. Death is not a fun thing for a nurse to experience,but it is part of the cycle of life. Everyone deals with it differently. By graduation time, you should be able to figure out what area of nursing you prefer. :loveya: