Beanyamean

I work in a small, tight knit urgent care clinic/hospital/ED. Recently, one of my favorite doctors passed away unexpectedly. Management has been thoughtful enough to close the clinic for a short period on Saturday so we can attend his memorial service. It will be at a church. I have a bit of a problem though. I don't really own any dress clothing and will not have time (or money right now) to go buy or rent anything before his service. Would it be inappropriate to wear a nice, solid colored (black maybe?) set of scrubs to his service? The only other option I really have is to drive 90 minutes away to the nearest 24 hour wal mart after work tomorrow to try to find some decent dress clothes. I live in a small community with very limited options. I badly want to attend his service as he mentored me in so many ways and was an amazing doctor and friend, but I don't want to look like an ass showing up in scrubs. As I fear people may assume I didn't care enough to dress up. Would people assume that? Would nice scrubs be inappropriate? I am male if that matters. Guidance would be appreciated.

I fail to see where your response is helpful in the least.

Not by any means a manager. If I was it would not be a problem. As states previously I went to "higher ups" with no avail. But we have had a lot of mgmt changes recently. I guess persistence is key.

Here is just a quick count to put this in perspective. Of the 14 containers I was able to check during a "slow" period, 8 of them were at or above the full line. 4 of them very full. 2 of them probably will need to be changed tomorrow. I paged house keeping for the full ones and sent a few emails as I have been gone for a few days. I asked for a key and stock of containers.

I like mastisol because it is something like 10 times "stickier" than benzoin, and it comes in a perfect applicator. We do have Kling/kerlix, Coban, ect. But it seemed to work really well with mastisol and tegaderm. I just replaced the chevron tape with steri strips. Worked like a charm. It was the pts primary IV and we "require" the cannula to be visible. Not a cheap way to do it, but it worked! I feel bad for the nurse that has to remove it all.

I agree with everyone. I personally have no issues changing the containers myself. It takes just a minute or two to do it. Our containers are wall mounted in a locked container that require a key that only housekeeping has. There is talk of giving us a key to put in our med cabinet, and placing spare sharps containers in the housekeeping closet that we all have keys to. We frequently access the housekeeping closet for various reasons and I rarely notice empty containers stored there. One of the clinic nurses mentioned filing a complaint with OSHA which would trigger an inspection, but that would open a HUGE can of worms. The answer really seems simple: give us an easily accessible key, lots of empty containers. Problem solved. Very few of us have a problem swapping it out. Except those that are too lazy/busy/don't care enough to take 5 minutes to do it. Regarding other posts of mine, JC was only mentioned in one of them. This is not the first time JC has been at my facility. Last time 2 people lost their jobs due to non-compliance of obvious regulations. I am asking questions and seeking advice on how to handle them stressing the importance of the situation due to the upcoming visit. I guess I should have just left JC out of it. But it doesn't change how important how these issues could be.

Our hospital is small so there is no number to call. We use an online alpha paging system. Sometimes they come, sometimes not. I try to balance paging them again with understanding that they are busy and understaffed as well. It just seems low on their list, but then if they get the chance the room is probably occupied and they won't go into it and typically won't wait for it to become free so they go do something else and the cycle continues.

This has become an increasing problem at the facility I work at in the clinic, urgent care, and ER area. Our sharps containers are routinely above the "full" line, often so full that you can actually reach in and pull out used sharps as our sharps containers have a wide open mouth at the top, not the flap-type used at other facilities. I understand there are many different types. I ALWAYS activate the safety guard on needles and scalpels when available. I have addressed this issue with my supervisor, infection control, housekeeping (who supposedly is supposed to empty them highly and when we page them) and with our clinical management. I have brought this issue up on numerous occasions. Nothing is being done. This is very concerning as we live in an are where IV drug use is rampant and I would not put it past a patient to pull a syringe out of a container. In addition, if a container is full, I find myself leaving a room carrying dirty sharps in search of a container. We are expecting a visit from JC in the next week or so. And i know they would not be pleased. Who else could I escalate this issue to to ensure these containers are changed to ensure the safety of our patients and staff? It's dangerous and frustrating!

I figured with most of the maintenance meds that this is not a problem at all. There is what I consider a "shady" standing order/policy authorizing refills. Controlled substances I am still not comfortable with. My concern with JC is that I am technically grouped with the "clinic" as we are a rural hospital. It's difficult to explain, but JC is within their right to ask me about polices for the clinic side. I occasionally float to the other side to help out but am not trained to do their med refills. Ours are just handled differently because our patients are not chronic. I care deeply about my hospital and would hate for anyone to get into any kind of trouble, let it be a provider, RN, support staff, or the facility itself. We provide a great deal of care for our small community and we are all the community has. I am just the type of person that checks the drug book, online reference, and with an RN before I administer a new med I have never used before. I document very well, check out dates constantly, stay current on my CME, ECT. I am sort of anal. I am not out to get anyone in trouble. I just like to look out for my friends as the facility I work for can be pretty...difficult at times. Thank you everyone that has responded.

I guess I just don't see how the MD,PA,NP is involved. I will give an example. I was out of a PRN med I take. I walked over to the nurse of my PCP. I asked the nurse for a refill, The nurse said "sure" typed in my info and refilled my benzo script. My concern with the audit is our hospital is small and they tend to ask all of us about P&P and I want to be able to justify my answer, and of course there are postings all over the walls. Just get the feelings something isn't right. Also, I occasionally get a refill request come across my desk but they are handled a little differently than the clinic, more like the old fashioned way. I am just looking out for my friends on "the other side."

Thanks for all the great replies! Not sure why I would ever start an I/O just because I was having trouble dressing a perfectly patent peripheral IV... My institution does prefer that you are able to completely view the cannula. I was able to get it secured well. Unfortunately the hospital I work at is not supplied as well as it should be, so we have to improvise and make do with what we have. But you guys sure had some great advice!

This has been bothering me, so I have decided to pick the brains of the almighty allnurses.com group. My clinic now uses an EMR system including RX refill requests. This is how it is currently set up: 1- RX refill request comes in (fax, phone call, pt shows up, ect) 2- RN/LPN/MA enters request into electronic system 3- RN decides on quantity, number of refills, SIGNS the refill request according to protocol (current labs, recent visit, ect) 4- RX is sent to pharmacy The physician is not involved unless it is a narcotic or the pt needs labs or falls outside of the "protocol." I am not involved in this process as I work in the urgent care/ER sector of the hospital. I am just curious what everybody thinks about this. Does this fall outside of the scope of practice? Is this considered prescribing? Obviously if you can call a refill in this should be a legal practice, but it is difficult to explain why it seems wrong. probably because I have overheard at least one clinic nurse talk about trying to authorize narcotics, which the system did not allow them to do. This practice was developed because it was too time consuming for the providers to deal with the volume of refill requests received daily. I am mostly concerned because we are getting a JCAHO visit in a few days. What do you guys think?

Today in the ER I assisted with a patient who was extremely diaphoretic. After my coworker inserted an IV into the patients hand. They called me over for assistance as they were unable to apply any type of dressing. The patient was extremely diaphoretic. After trying Tegaderm and various types of tape. We were unsuccessful at securing the IV site. After much trial and error, I was finally able to secure the IV site by shaving the IV site, using a shield barrier prep, alcohol swabs, Mastisol, Steri-Strips, and Tegaderm. Does anybody have any other easier ideas as to what to do in the case of an extremely diaphoretic patient?

I am a pretty avid follower of the forums here but I've never really had too much of a reason to post as I have always found the answers I am looking for. However, Today at work I administered a steroid to a pediatric patient. In my haste to administer the medication I did not realize until after I injected it that it was expired by about 2 months. Since it was a pediatric patient I had the medication double checked by a provider. The provider also did not notice that it was expired. I realize this does not excuse my error. What do I do? Do I report this to my supervisor? Do I just let it go? Should I bring this up to the provider? At this point I am the only one aware of the error. The way we document does not require us to document expiration dates. I realize that I need to pay more attention to what I'm doing. Not looking for a lecture just looking for guidance. Thank you for your advice.