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MunoRN

MunoRN

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Reputation Activity by MunoRN

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Like 49
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Sad 2

  1. Thanks
    MunoRN got a reaction from AbstracRN2B in Another Tragedy at Vanderbilt   
    The initial statement from the DA's office was that she was being charged due to a number of errors, when it was pointed out that it doesn't appear any of this errors meet the legal definition of negligence, a spokesperson for the DA office clarified the legally defined negligence occurred when RV used the override function.  
  2. Like
    MunoRN got a reaction from JKL33 in Drawing labs from CVCs   
    There's a lot of flow going by the lumen openings of a central line which moves the fluids coming out of them downstream fairly quickly.  Even so, particularly with openings that are close to each other, it's still important to stop the other fluids at least while the sample is being drawn.  You don't necessarily need to wait long, stopping the other lumens for only 10 or 15 seconds allows those fluids to get far enough downstream that they aren't going to significantly contaminate your sample.  Ideally you're using a vamp which makes for a quick draw-back of waste and lab draw, then restart the drips as soon as you've gotten the blood.  If you're ready to go when you stop the drips then from stopping them to restarting should take 30 seconds or less. 
    Or, if you've got an A-line then you don't need to stop the drips at all.
  3. Like
    MunoRN got a reaction from Noctor_Durse, ADN, RN, EMT-B in Central Line Placement and Masks   
    The rule is that everyone who gets within 3 feet has to mask, this is taken pretty seriously at every place I've worked including the ER and everyone does actually wear a mask for going into the room beyond the doorway.
  4. Like
    MunoRN got a reaction from JKL33 in Drawing labs from CVCs   
    There's a lot of flow going by the lumen openings of a central line which moves the fluids coming out of them downstream fairly quickly.  Even so, particularly with openings that are close to each other, it's still important to stop the other fluids at least while the sample is being drawn.  You don't necessarily need to wait long, stopping the other lumens for only 10 or 15 seconds allows those fluids to get far enough downstream that they aren't going to significantly contaminate your sample.  Ideally you're using a vamp which makes for a quick draw-back of waste and lab draw, then restart the drips as soon as you've gotten the blood.  If you're ready to go when you stop the drips then from stopping them to restarting should take 30 seconds or less. 
    Or, if you've got an A-line then you don't need to stop the drips at all.
  5. Like
    MunoRN got a reaction from JKL33 in Another Tragedy at Vanderbilt   
    I'm not sure where you're getting that she knowingly removed the wrong.
    The default setting for Pyxis machines is to use predictive text based on the first two letters entered.  This produces the bad habit of entering two letters then hitting the first drug listed, since most of the time that's the one you're looking for.
  6. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  7. Like
    MunoRN got a reaction from cleback in Another Tragedy at Vanderbilt   
    RV failed to check the medication against the order when pulling the med, the physician in this incident failed to check that their signature/initials over the actual site against the imaging/dx that defined the target kidney (or failed to sign the site at all).  RV then again failed to check the label just prior to administering just as the physician in this incident failed to confirm the site just prior to the procedure.
    The details are of the two safety mechanism failures differ, but I don't see how they are two completely different levels of failure.
  8. Thanks
    MunoRN got a reaction from AbstracRN2B in Another Tragedy at Vanderbilt   
    It's a fairly standard safety rule that the practitioner who is performing a procedure check the pre-op imaging/diagnostics to confirm the correct site, I wouldn't say it's any less of a rule than checking the medication label prior to giving a med.  Just as with RV, had he done that, the incident likely would have been avoided, so why is RV alone responsible for her practice while the physician in this incident isn't?
    To clarify the charges against RV, she isn't actually being charged for making a med error, she's being charged for using the override function of the pyxis, which at least at place I've worked is far from qualifying as negligence, it's often an expected part of nursing practice in many situations.  
  9. Thanks
    MunoRN got a reaction from AbstracRN2B in Another Tragedy at Vanderbilt   
    It's a fairly standard safety rule that the practitioner who is performing a procedure check the pre-op imaging/diagnostics to confirm the correct site, I wouldn't say it's any less of a rule than checking the medication label prior to giving a med.  Just as with RV, had he done that, the incident likely would have been avoided, so why is RV alone responsible for her practice while the physician in this incident isn't?
    To clarify the charges against RV, she isn't actually being charged for making a med error, she's being charged for using the override function of the pyxis, which at least at place I've worked is far from qualifying as negligence, it's often an expected part of nursing practice in many situations.  
  10. Like
    MunoRN got a reaction from brownbook in Do I have to disclose mental illness   
    It's certainly not guaranteed that an employers or a nursing board will never become aware of a mental health history due to a variety of circumstances,  one of which being that employers can legally inquire about all medications a nurse takes, and can confirm this through required drug testing, even if the medications are legally and appropriately prescribed.
    I've never heard of a mental health history being an outright reason to deny or revoke a license, but I have heard of that happening when a nurse lies about background screening.
    As for what history should count as relevant, it's pretty well established that it's up to the employer or board to determine for themselves what is or isn't relevant based on a full disclosure.
  11. Like
    MunoRN got a reaction from morte in Written Up   
    Of course two meds that both impact BP are given at the same time or in the same duration of action, the number of different orders that are being utilized aren't what determines if a med isn't going to safely tolerated by a patient, a since med from a single order may be excessive, and 5 different meds given from 5 different orders may be insufficient.
    I'm curious about how you define 'stacking'?  Why wouldn't you give ibuprofen and an opiate "at the same time"?
  12. Like
    MunoRN got a reaction from morte in Written Up   
    It doesn't seem particularly confusing, leaving aside the issue of whether this is an appropriate way to prescribe and use benzos (it's not), the only thing that matters is how the prescriber intended for the order to be interpreted, which in this case sounds like is was a continuation of a home med. 
    The most likely way it was meant to be interpreted would appear to be that the patient takes Xanax 0.5mg throughout the day, then takes an additional 0.5mg at hs, which would mean you interpreted the order correctly.  
    Would it make more sense to people if it was written "0.5mg q hrs, MRx1 at HS" or "0.5-1mg q 8hrs".  I think people are getting into the weeds with the semantics of the orders and missing the intent of the order(s).
  13. Like
    MunoRN got a reaction from LikeTheDeadSea, BSN, RN in Nurses Are So Bossy...   
    I don't think it's unreasonable for a nurse to appropriately limit unnecessary distractions in order to ensure a patient's safety.  You're free to decline appropriate safety measures by declining medical treatments all together. 
    Typically, PACU's don't outright ban support/family members but this is determined on a case-by-case basis.  A patient-family member dynamic that suggests more than a tolerable amount of drama (such as what your post screams out) wouldn't be allowed to ensure safe and effective care of yourself as well as other patients.
  14. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  15. Like
    MunoRN got a reaction from brownbook in Do I have to disclose mental illness   
    Discrimination only occurs when an opportunity is denied due to something that isn't in any way job related, and the current established legal precedent is that nurses can be asked about mental health history for the purpose of ensuring that there are no barriers to safe practice.  One could certainly argue that mental health screening questions do little to avoid future incidents that may be in some way mental health related, but currently it's a legally accepted question to ask.  For nurse licensing this step is often left to the licensing board by employers, but for nursing students the clinical site facilities essentially take on the roll of ensuring 'proper' screening has occurred, which is typically what nursing schools are enforcing on behalf of their clinical sites as part of their clinical agreements with them.  
    https://www.nurse.com/blog/2017/10/11/rn-concerned-about-disclosing-psychiatric-treatment-to-state-board/
  16. Like
    MunoRN got a reaction from LikeTheDeadSea, BSN, RN in Nurses Are So Bossy...   
    I don't think it's unreasonable for a nurse to appropriately limit unnecessary distractions in order to ensure a patient's safety.  You're free to decline appropriate safety measures by declining medical treatments all together. 
    Typically, PACU's don't outright ban support/family members but this is determined on a case-by-case basis.  A patient-family member dynamic that suggests more than a tolerable amount of drama (such as what your post screams out) wouldn't be allowed to ensure safe and effective care of yourself as well as other patients.
  17. Like
    MunoRN got a reaction from chare in Do I have to disclose mental illness   
    Both nursing boards and hospitals can legally ask about pertinent mental health histories, you can quibble over the exact wording of how it asked and how you have to answer, but generally for those in "safety sensitive" rolls such as nurses (and nursing students), mental health history is legally considered a pertinent to the role of a nurse. 
    Since nursing programs have to abide by the requirements of the facilities where students will be doing clinical rotations, usually the same requirements as an employed nurse at the facility, this may require things like drug testing (which can legally include prescribed medications) and mental and physical health screenings.
    There is certainly the chance that such information will be used to discriminate against a student, although this can be legally challenged, but lying about it or failing to disclose this type of information is reportable to the BON which can prevent you from ever getting a license at all.
  18. Like
    MunoRN got a reaction from LikeTheDeadSea, BSN, RN in Nurses Are So Bossy...   
    I don't think it's unreasonable for a nurse to appropriately limit unnecessary distractions in order to ensure a patient's safety.  You're free to decline appropriate safety measures by declining medical treatments all together. 
    Typically, PACU's don't outright ban support/family members but this is determined on a case-by-case basis.  A patient-family member dynamic that suggests more than a tolerable amount of drama (such as what your post screams out) wouldn't be allowed to ensure safe and effective care of yourself as well as other patients.
  19. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  20. Like
    MunoRN got a reaction from LikeTheDeadSea, BSN, RN in Nurses Are So Bossy...   
    I don't think it's unreasonable for a nurse to appropriately limit unnecessary distractions in order to ensure a patient's safety.  You're free to decline appropriate safety measures by declining medical treatments all together. 
    Typically, PACU's don't outright ban support/family members but this is determined on a case-by-case basis.  A patient-family member dynamic that suggests more than a tolerable amount of drama (such as what your post screams out) wouldn't be allowed to ensure safe and effective care of yourself as well as other patients.
  21. Like
    MunoRN got a reaction from LikeTheDeadSea, BSN, RN in Nurses Are So Bossy...   
    I don't think it's unreasonable for a nurse to appropriately limit unnecessary distractions in order to ensure a patient's safety.  You're free to decline appropriate safety measures by declining medical treatments all together. 
    Typically, PACU's don't outright ban support/family members but this is determined on a case-by-case basis.  A patient-family member dynamic that suggests more than a tolerable amount of drama (such as what your post screams out) wouldn't be allowed to ensure safe and effective care of yourself as well as other patients.
  22. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  23. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  24. Sad
    MunoRN got a reaction from Elaine M in Another Tragedy at Vanderbilt   
    There was also a new lawsuit a few weeks ago against Vanderbilt for wrongful death due to a stroke resulting from placing a central line in the carotid artery instead of the jugular, this was an unsupervised resident physician placing the line. 
    Like the Vecuronium incident, this wasn't helped by excessive diagnostics/treatment, the central line was placed because Vasopressin was ordered, even though the patient's BP when the Vaso was ordered was 131/77 and the patient had never been hypotensive.
    https://www.wsmv.com/news/family-sues-vanderbilt-university-medical-center-for-wrongful-death/article_4a38adaa-3eb5-11e9-959d-ff3ace513708.html
     
  25. Like
    MunoRN reacted to Chisca in Tube feeding and hemodialysis   
    https://www.jrnjournal.org/article/S1051-2276(12)00226-9/pdf
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