James Bond

I have heard nothing new on this. Since the disclaimer from the package insert on the strips says the should not done via a finger stick on ICU patients we are mandated to do it that way. I agree it's probably best for someone who's on invasive drips and probably has a number of invasive lines. However, when you are taking care of a 1 year old that is awake and alert and doing what 1 year olds do the odds are pretty slim someone is going to place an invasive line solely for the purpose of doing POC blood glucose levels. I have seen more then a few children that fall into this category. Unfortunately there still exist no clear definition on what constitutes a critical patient other then an admit to the ICU. If any studies were done on the patient who is not in a shock like state or pediatric age group to validate how relevant this process is for them I would love to see them.

I called and spoke to the FDA in regards to this. The person I spoke to, who was a nurse thought it was a ridiculous idea to either place a central line or stick someone on an hourly basis. I have also yet to see any research that's been done on the pediatric population that I work with in regards to this mandate but that's not stopping implementation. Unfortunately, my facility has implemented this based on location. If your an overflow patient adult or pediatric and located in an ICU bed you will be subject to this. As mentioned before in this thread what, lies at the root of this is a lack of what defines a critical patient. Leave it to the regulators and bureaucrats who in the name of patient safety have found a way to elevate the potential for risk and injury.

I think the greatest challenge to the delivery of care I have faced over the past 30 years is the loss of autonomy. I am unable to do what I know I need to do as the result of the systems that have been put in place. Here are some of the things that have changed the delivery care model. 1) Electronic Health care- Requires duplicate data entry into multiple screens/ The required selections don't always mesh with what you are seeing yet I must select the best option/ Data extraction demands have added complexity and time to complete these screens (ie. asking food preferences, religious preferences, suicide queries, etc), Changing and upgrading software and increasing the complexity before the screens are understood proficiently. As an educator I've had to develop special programs for night shift staff to relearn how to discharge a patient. As with all complex systems there is an increase in time and repetition required to be able to perform the task. 2) Administrative delays- In order to change any of the system problems a proposal must be written and it must then pass through an administrative channel. This process can take up to a year sometimes or it can be lost in a vast ocean of greater priorities. Most of the staff do not know how to navigate this passage so they develop a work around process. According to the IHI work arounds are many times the result of a process that does not work well for the task it is designed for. 3) Reduced staffing levels- In the last 5 years our staffing levels at the bedside and even more so at the support level have decreased tremendously. The one department that has added positions is the IT department as the greater push into electronic healthcare has developed. 4) Equipment availability- Hi tech equipment is great when you have it. Unfortunately as censuses go up and down we must now chase down the items to do our jobs. I have no answer for this since I like the equipment. Unfortunately there is only so much of it to go around so I suppose we'll keep spending time looking. 5) Regulations and Liability- There are so many rules now that many decisions that used to be made in real time in the individual units must now be approved administratively so that we can proceed. These have also added directly to the development of some of the screens that go into our EMR. I will stop here. Unfortunately simplification of process is a lost concept. It allows the individual who is delivering care to do it in a more efficient manor. Much of what the practitioner does today especially with the EMR has been designed by people who want to track and acquire data. It is going to be a challenge going forward to change this so that a system is designed with nursing workflow in mind to foster some of the efficiency and autonomy that has been lost.

I am curious if anyone has noticed any difference in complications when comparing peripheral IV's to saline locks. Preferably I would like to find some sort of evidence based article that illustrates any differences in complictions from either running fluids or locking the site. So I will turn to my peers to see what your experiences might be regarding this topic. * Do you continue to run IV fluid @ a KVO rate to prevent occlusions? * Do you notice any difference in the rates of occlusion when it comes to either method. * Do you follow the CDC's curent guidelines and change pediatric IV sites only when needed * If you've noticed complications, what are they and are they more prevelent with the Saline lock or the continuous infusion? Thanks a bunch for your help on this one

This is a great question. We were recently required to obtain ACLS and NRP for our PICU. I certainly don't mind having the extra knowledge. The lack of consistency in the way it's applied however leaves me scrathcing my head. I have called or emailed approximatley 10 different facilities. Some require ACLS some don't. Some defer to age when considering ACLS and some defer to weight. What I can find on the American Heart website is limited when it comes to identifying age weight dilemma. In essence there does not seem to be anything evidence based that I can find giving a clear guide as to when it is applicable. If anyone out there knows of any evidence based research or statement from American Heart that clarifies this I would be thrilled if they would share it.

Can anyone point me to some evidence that supports using NRP in lieu of PALS for the Pediatric ICU setting? We are being required to do this in our Pedi ICU even though we do not float or attend deliveries. I have been told it's because we have from newborns on up in our unit. By in large the majority of disease processes covered in NRP is related to delivery and stabilization. In one of the few studies I have seen there is virtualy no guidence in regards to this topic. You can see it here in PALS vs. NRP Infant resuscitation outside the delivery room in neonatal-perinatal and pediatric critical care fellowship programs: NRP or PALS? Results of a national survey | DeepDyve While all knowledge is worth something, the more of it you can use in every day life has a greater value.

Unfortunately in todays world of nursing this has become the norm in many places. There are not so many places you can run to anymore to remove yourself from the battle field situations that we have found ourselves in. There are two things that I can think of that will put you and your coworkers in a better position. 1. Educate yourselves as much as possible to the roles and practices you are engaged in. 2. Collaborate among your peers to initiate the changes that need to be made. This is no longer a job where any of us can take for granted that we can come in and do our 12 hours then go home. You will have much more success in addressing your superiors and on up to your political representatives if you do it as a cohesive team. Best of luck

I have for years attempting to get the powers that be have the ED work ofset shifts from the rest of the facility. If I'm working 7-7 they should be working 6-6 or 8-8. I don't see where it would be any difference in cost to have the folks there staggered. I am quite confident that if they were leaving an hour earlier or an hour later it would change the time they sent up their patients. I suppose the only way it's going to happen is when someone takes the lead and JAHCO or some other rating agency decides,"Hey that might be something to look at". Between that and HCAHPS I am sure something is going to have to change.