bobnurse

bobnurse's Latest Activity

1. 

   Help with Isolation Guidelines for MDRO's

   bobnurse posted a topic in Disease

   Hi, Needing help. Patients with colonized MDRO's such as MRSA, VRE, ESBL, and etc..... Do you isolate (Contact precautions). We isolate (contact) for all MDRO's, c-diff, acinetobacter, ESBL's and etc....I have seen facilities in other states only provide standard precautions for colonized patients. So....what is the current recommendations and can you provide a link so i can use it for reference. I have looked at CDC and it states contact precautions. also, if you have a sample policy that i could review. We are a semiprivate 31 bed specialty hospital and are bedlocked at a census of 23 d/t colonized MDRO's. So i am looking to see if we are right in our current practice of Contact Precautions for everyone or if Standard is ok for colonization. Thanks for your help.
2. 

   Platt RN graduate BSN Options

   bobnurse posted a topic in Oklahoma

   For those who have graduated from the Platt RN program, what are your BSN options. I know they have a BSN program now, but what are the other options. I know U of Phoenix is an option, but do any in-state colleges accept platt graduates. I know they are not accredited, but what if you were to take or have taken all your pre-req from an accredited college. Thanks for your replies.
3. 

   Pharmacy Access by Nurses

   bobnurse posted a topic in Management

   Hi, I am not sure if this is the proper forum, but any assistance would be appreciated. I have recently accepted a position as a CNO for a LTACH hospital. They have a practice here that i believe is no longer acceptable according to JCAHO/CMS. Pharmacy is in house about 10 hours a day and on call the remaining 14 hours or so. Probelm #1. A patient who is admitted after hours: They want the charge nurse to review all medications for appropriateness, interactions, allergies and so forth. Problem #2. Charge nurses have access to a mini pharmacy where they are suppose to mix antibiotics, obtain medications and so forth. This is all without pharmacy verification. I have managed other LTach Hospitals who did not have 24 hour pharmacy coverage and we did have policy that did allow a one time dose of certain medications to be administered. So any help would be appreciated. Also if you could provide a link to literature supporting my disagreement with this practice i would appreciate it. I do have a call into the Board of Nursing. Thanks for your help and assistance.
4. 

   ACLS instructors

   bobnurse replied to KevinS's topic in Entrepreneurs

   Hi, One way is to submit through your board of nursing for CEU's. The AHA does not provide CEU's. Also if you have a good relationship with a ANCC CEU Provider, they can award your classes CEU's. There is some paperwork involved, but not to difficult. You can get this info from the ANCC. Most of your larger hospitals are able to do this. If you have any other questions, let me know. Bobnurse
5. 

   PICC bu$ine$$ info dump

   bobnurse replied to inee's topic in Infusion

   I have been contacted to place piccs at a couple of smaller facilities. I am curious as to how much you bill the facility to place the line. If those of you out there would feel comfortable giving me a ball park figure i would appreciate it. I dont want to charge to much or to little. You can PM me if you dont want it posted. Thanks
6. 

   "Looping" IV Tubing

   bobnurse replied to RN CRNI's topic in Infusion

   Looping IV tubing is simply bad practice. THe problem with it is most nurses dont swab the port before attaching the end of the tubing into the port. This contaminates the tubing. Now if your changing your tubing every 72 or 96 hours,, you have contaminated tubing sitting there being used over and over, becoming recontaminated after each use. We had a BSI issue a year ago or so, and one of the few changes we implemented was the ban of looping IV tubing. We made readily available sterile syringe caps or the nurses could also take the cap off of the flush syringe and attach it to the end of the tubing. Once this practice was established, we went almost a year without a CRBSI. My opinion and my opinion only....
7. 

   Please help identify cheesy, tan residue on PICC

   bobnurse replied to justdeda's topic in Infusion

   Sounds like fibrin and possibly biofilm build up. IF you go to the cathflo website, they have a pretty good base of education, powerpoints and so forth that describe this. I also agree with the above poster that the line should have been fixed or removed. Occluded lines lead to infection.
8. 

   Lpn

   bobnurse replied to TYJESS's topic in Infusion

   Have you looked at the military base. You probably could get a position at the military hospital or one of the clinics. Back in my day we called it the CPO office (civillian personell office). This is where you would apply for civillian jobs. There might be a way to look at possible open positions now and land a position before you get there?
9. 

   PICC Insertion Business

   bobnurse posted a topic in Infusion

   Hi, Ive been offered several times over the past year to come and place piccs at smaller specialty hospitals. I think its time i pursue this. Anyone out there have their own picc business? I have a few questions if anyone out there might be of assistance. 1. Liability Insurance: Does the CNA insurance offered in the nursing journals cover you for this type of business? What type of liability insurance do you have? 2. Contracts: Anyone with a sample contract they are willing to share? Thanks for your help. You can PM me and we can share info if you would like to go that route.
10. 

    PICC nurses...do you read your own tips

    bobnurse replied to mrsbratmom's topic in Infusion

    Im just curious reading this as we might look at the possibility of the PICC nurses providing a initial read of the xray and the radiologist will read it at a later time (hours later) to confirm tip placement. Does anyone know if the Infusion Nurses Society addresses this within their practice? Does anyone have a policy that they might like to share that allows this and what do you do for competency for the RN who will be providing the initial read. You can PM me if you'd like. THanks
11. 

    PICC lines-infusion pump required?

    bobnurse replied to veinnurse's topic in Infusion

    I personally feel that all infusions should be administered via pump through picc lines. Just think about it. Your administering blood through a picc and the flow is decreased...Patient coughs, tubing kinked or some other external/internal force. There is no alarm to tell you this. So you come to check on the patient and find that the picc is now clotted up. Same thing with drugs, dextrose, lipids, or precipitates will build up in the line and cause occlusions. Just my 2 cents, but i think it will extend the dwell times of your piccs by using pumps.
12. 

    Ethanol 70% Sterile

    bobnurse posted a topic in Infusion

    Hi, Ive been reading about using Ethanol for declotting lines with lipids. Is anyone doing this out there and where do you get the ethanol? Thanks
13. 

    Fyi

    bobnurse replied to Tippy-ta-ta's topic in Nursing

    I personally dont see why we dont train the students. I think it would be a great idea to incorporate CPR into the school system. The AHA has a CPR in Schools program.
14. 

    administration of sodium bicarb

    bobnurse replied to texan_nurse's topic in Nursing

    Hi, We routinely give bicarb when indicated. I have never heard otherwise. Not sure why there seems to be so much concern about hanging bicarb or magnesium? I guess you might look at the indications for administration. Like in a code or prearrest situation, are you ACLS? Also, you have not indicated your level of licensure. That can make a difference as well in many states/hospitals.
15. 

    Fyi

    bobnurse replied to Tippy-ta-ta's topic in Nursing

    I dont have a link. I am a BLS Instructor and was going to help with providing free Heartsaver CPR for the teachers. I am sure you can do a search on it. I can pm you the city where it happened if you want. On a side note, i can tell you that i dont think its a lack of cpr instructors, but a lack in the budget. They still have to pay the teachers to attend the classes (workshop). I have heard this as to the reason why they arent offering it/or werent offering it at the schools. Its odd that in our state daycares are required to have cpr/first aid but not schools/teachers.
16. 

    Fyi

    bobnurse replied to Tippy-ta-ta's topic in Nursing

    About 5 or 6 years ago in oklahoma a child died in the early morning d/t choking on her breakfast. The teachers were not BLS trained and stood there and waited for EMS/Fire to arrive. The child did not make it. This made the news and was a pretty big thing, but as you can see, it did very little as far as requiring BLS/First Aid training for teachers.