pacurn75

Whose course? Some are offered by people not associated with ambulatory based organizations. Look at what is covered and who is speaking. ASPAN and some others have courses that cover a lot of the areas, but they will not go into the specifics. Their feeling is that they are trying to get people to think for themselves and rely on their experience/knowledge. Plus, I was once told that there is a test-bank of thousands of questions and they just couldn't "teach" to cover the ones that were on prior tests as they might not be the same ones that will be asked in the next version. I took the exam and studied by reading through the book and finding the areas that I wasn't as familiar with and zeroed in on those things. Don't let the review book scare you as it is a BIG book, but it covers a lot. Plan ahead and allow yourself time to skim a chapter or two each night and when you find an area that slows you down, do a bit more digging there. The test is really about critical thinking skills and basic core knowledge. They also have a practice test for about $50 that you can take on-line and see how your test taking skills are. It also gives you a sample of how the questions will be asked. Good luck!

The last conference I went to mentioned that they are now starting to screen the "sample" for all the usual culprits (ie giardia, ova, parasites among others. Speaker said it was recommended by their IRB to help CYA. ) before giving it back to the patient for their protocol. Are you guys doing that? The national stats from all who voluntarily reported is 95-97% have a radical improvement with 1-4 treatments. I say hooray! for those poor people who have suffered so long.

Recovery time is very variable and will be based on procedure length, sedation used and condition of the patient. Most facilities are going to criteria-based discharge scores that allow the patient to be discharged when they meet criteria. It must be approved by your anesthesia staff no matter what area you practice as TJC charges them with the rules pertaining to anesthesia and sedation. That being said, even under terrific conditions, it does take 15-20 minutes, at the very least, to get report, take 2 sets of vitals, DC the IV, give discharge instructions and whatever else you might need to do (set up appts., tests, assist with dressing). 30-45 seems to be the going average in the locale where I work when I talk to others at conferences. No one will ever fault you for keeping them longer (other than waiting relatives :)). I also mentioned 2 sets of vitals. The last TJC we went through made a lot of fuss over whether we were able to ascertain of the patient was "stable" if they only had one set of VS after the procedure was done. I believe the comment was made, "how do you tell which way the patient is trending?" We have set our machines on q5min because of that. If they come out waving and wanting to "get outta Dodge", then we use the 5 minute results and get them through as fast as is safe. If they are more snoozy, then we back off and record them q 10-15 min based on their needs. Hope this helps

This is really getting to be a problem for all specialties that do same day procedures. I work in both PACU and GI. At a recent conference, we talked about it and boy, what a discussion. Some things to consider: If you call the police and say they are impaired, you may risk a HIPAA violation. Signing out AMA it probably the most rational thing to do as regards your practice. Some facilities are even refusing to send patients home with their driver if the driver appears impaired. The one reader is correct, you cannot stop them as it would be construed as false imprisonment. At our facility, we have just gotten very particular about confirming a driver and our physicians are refusing to do the case if there is no confirmed driver that we can contact. We will do our best to call the patient's church, groups, or friends to see if they can help, but we do not sedate if they don't have a driver. If they say they have someone coming, we even call them before we start to confirm. Unfortunately, there have been too many cases to count where the supposed driver knew nothing about needing to come.