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traumaRUs MSN, APRN

Asst Community Manager

Welcome to allnurses.com. I'm the Asst Community Manager. Please let me know what I can do to make your experience more enjoyable.

Reputation Activity by traumaRUs

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  1. Like
    traumaRUs, MSN, APRN got a reaction from NRSKarenRN, BSN in PAs Do Not Like Us   
    I work with PAs also. While Mary Doe, PA might not "like me" its not because I'm an APRN but rather a personality conflict. 
    Too frequently we generalize
  2. Like
    traumaRUs, MSN, APRN got a reaction from NRSKarenRN, BSN in PAs Do Not Like Us   
    Hmm...again its not an us (NPs, APRNs) against them (PAs, MDs, other APRN specialties)....rememmber its us against the patients!
    Lol - but really its not competition
  3. Like
    traumaRUs, MSN, APRN reacted to tnbutterfly, BSN, RN in RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?   
    In the news today following the arraignment, it was stated that the TN BON, after a nine-month long investigation, found no reason to take disciplinary action against RaDonda’s license. I will be posting another video in this thread that gives more information about this.
    Merging this discussion with another thread about the arraignment was started yesterday.
  4. Like
    traumaRUs, MSN, APRN reacted to tnbutterfly, BSN, RN in RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?   
    A group of nurses plans to appear in their scrubs at Vaught's arraignment hearing on February 20th show their support. Included in this group is Janie Harvey Garner, founder of Show Me Your Stethoscope.  
    For those who are interested in showing their support by attending the arraignment, here are the details:
    When?
    Wednesday, February 20 @ 9:00 AM
    Where?
    Justice A. A. Birch Building
    408 2nd Ave N,
    Court Room 6D
    Nashville, TN 37201
    Judge: Jennifer Smith
    What is Arraignment?
    Once the accused is represented by counsel, the more formal part of the arraignment, the reading of the charges, takes place.  The accused is expected to enter a plea: usually guilty, not guilty, or no contest. The no-contest plea means that the accused is not admitting guilt but will not contest the charges. 
    What is the verdict going to be???
    In the following video, Janie Harvey Garner talks more about the arraignment process. 
    Related content:
    Nurse Gives Lethal Dose of Vecuronium Instead of Versed
    Nurse Charged With Homicide
    Nurses Call the Governor of Tennessee
  5. Like
    traumaRUs, MSN, APRN got a reaction from Davey Do in Question of legality   
    You have received solid advice -please report it. Take care.
  6. Like
    traumaRUs, MSN, APRN got a reaction from caycar123 in 56 and considering NP school   
    What is your MSN in now? If a clinical focus, what classes would you need? Just the three Ps and clinicals?
    Do you have experience with housecalls in the NP role?
  7. Like
    traumaRUs, MSN, APRN reacted to AnnieNP, MSN, NP in Resume tips for AP nursing?   
    I have to agree with Trauma here.  While in school I was offered several positions from local practices who knew me for 15 years, based on my ER / ICU / CCU experience. They had no idea what kind of NP I would be.
  8. Like
    traumaRUs, MSN, APRN got a reaction from NRSKarenRN, BSN in NTI 2019 - ABCDEF Bundle - Some Questions and Answers   
    In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts.
    These recommendations have been incorporated into a single bundle of best practices, known as the ABCDEF bundle: 
    A - Assess, prevent, and manage pain  B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed:
    Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? 
    Institutions are using many different methods to implement the ABCDEF Bundle.  One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process.  We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient.
    Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example?
    A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy.
    Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal?
    Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients.
    Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse?
    We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. 
    Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient?
    Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. 
    Resources Utilized by Joanna Stollings:
    Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

    Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration
    AACN news release: Practical Advice for Implementing the ABCDEF Bundle
    Society of Critical Care Medicine
     
     
  9. Like
    traumaRUs, MSN, APRN got a reaction from Emergent in Pit Bull Service Dogs   
    We volunteer with a service dog training facility - breeds are very selective and pit bulls or pit bull mixes would never make it for the above-mentioned reasons. 
  10. Like
    traumaRUs, MSN, APRN reacted to J.Adderton in The Future Nurse Bully- Is it You?   
    Bullying and nursing have a long and well documented history.  The American Nurses Association defines nurse bullying as “repeated, unwanted harmful actions intended to humiliate, offend and cause distress in the recipient”.
    "I easily recall my first nursing job and my assigned preceptor. During the first week, my preceptor instructed me to call the on-call cardiologist to report a patient’s conversion to atrial fibrillation.  However, she provided no guidance on the assessment data (including vital sign trends, labs and medications) I needed to have ready for the notoriously thorough and rude physician. I remember hanging up the phone- red faced and teary eyed- as my preceptor stated “congratulations on your first initiation”.  
    My experience is not unique.  Research has shown 85% of all nurses have been bullied at some point in their career.  In addition, 60% of new nurses leave their first nursing job due to some form of harsh treatment from other nurses.
    When I taught my first nursing course and clinical, I quickly identified potential future nurse bullies.  The humiliation and distressed inflicted by these students caused the same level of damage and distress as in other nurse settings.  I also discovered some faculty failed to model desired civil behaviors. Instead, faculty modeled bullying behavior through rigidity, being over critical and treating students unfairly.  Do you remember hearing these words in nursing orientation, “look to your left then right and understand most at least 1 of you will not be here at the end of the semester”?  As if nursing school wasn’t competitive enough, faculty introduce the fear of failure into an already stressful environment.  And so it begins.
    If you are a current nursing student this article provides you an opportunity to reflect and evaluate if you have behaviors that could lead to future bullying. You may also identify bullying at the hands of a classmate.   Let’s look at common characteristics of bullying and relate to the experience of nursing school.
    Have you ever tried to control or dominate other nursing students?
    Examples of this bullying behavior:
    Interrupting another student in class, lab or clinical. Encouraging another student to break rules or act in an unprofessional manner. Asking another student to not tell or report behavior such as cheating, clinical errors or other rule infractions. Providing unsolicited criticism of another student’s performance. Have you ever verbally intimidated another student?
    Examples of this bullying behavior:
    Assigning an unfavorable or offensive nickname to another student (often timid or weak) or simply engaging in name calling Making insults under the guise of a “joke” Telling ethnic jokes or using slurs Gossiping about other students or sharing information told in confidence Making outward signs of frustration with another student such as inappropriate sighing or laughing Speaking in a loud or aggressive manner Have you ever blamed another student for your poor performance?
    Examples of this bullying behavior:
    “Thanks for asking so many ridiculous questions in class.  I failed the test because you were so distracting.” “I studied with you and look what happened!” Have you ever found fault, sabotaged or withheld important information from another classmate?
    Examples include:
    “John thinks we have an hour for lunch instead of 30 minutes- let’s not tell him.  Jokes on him!” “Why are you always nervous before clinical?  No one else is acting like you.” Making unfair assignments in group projects or clinicals Withholding information that would be helpful/beneficial to another student. Have you ever intentionally or unintentionally demonstrate behaviors of cyberbullying?
    Examples include:
    Confronting another student on public online social media Singling out another student by excluding on message boards, chats and class-related media Using social media to gossip or talk negatively about another student? Other covert forms of bullying:
    Eye Rolling or other gestures for the purpose of intimidation, embarrassment or threat Excluding a student from a group (i.e. cliques) Using profanity Being confrontational There are overt bullying characteristics that lack subtlety and are easier to recognize and often occurs in front of other people.  Threatening is a direct form of bullying and is intended to scare or coerce an individual into certain actions.  Coerced actions may be engaging in verbal and physical altercations, withdrawal or avoidance of people and places.  
    Note:  This article focused on subtle bullying behaviors that are sometimes difficult to recognize.  Physical violence is a clear and dangerous form of bullying.  It is also less common because the consequences are higher- being expelled, arrested or other legal issues.
    Did you experience bullying behaviors in nursing school or are you experiencing as a student now?  Share your experience.
    Reference:
    Violence, Incivility and Bullying
  11. Like
    traumaRUs, MSN, APRN reacted to Rose_Queen, BSN, MSN, RN in LPN's Certified in Anesthesiology..   
    Agreed. There are many posts by this member in various forums, including advanced practice. I'm afraid OP is not fully informed of what can be done with a BSN without the actual RN license. Anything obtained in further education would not, in fact, be nursing at all. Food for thought, OP.
  12. Like
    traumaRUs, MSN, APRN got a reaction from Davey Do in Blast from the past...   
    Lol - I can relate. I watched an old Bonanza episode recently (in B&W no less) and while mindless...it left me with a smile. 
  13. Like
    traumaRUs, MSN, APRN got a reaction from RNHopeful-2019 in TCU BSN Fall 2019   
    Moved to schools/programs
  14. Like
    traumaRUs, MSN, APRN reacted to Melissa Mills, BSN in Medical Marijuana: Understanding the Six Principles of Essential Knowledge   
    You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions.
    Medical Marijuana Overview
    If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs.
    Current State of Legalization
    Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do.
    Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute.
    Principles of a Medical Marijuana Program (MMP)
    States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state:
    Health providers do not prescribe the drug
    Physicians certify that the patient has a qualifying condition under state law
    Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition
    Pharmacies do not dispense medical marijuana products
    Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card
    Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver.
    Endocannabinoid System Overview
    Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN).
    Pharmacology of Cannabis
    Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include:
    Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include:
    Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient
    It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug.
    As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act.
    Approaching the Patient
    Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug.
    Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.

     
  15. Like
    traumaRUs, MSN, APRN got a reaction from jeastridge in Nurses with Attitude   
    Having been the bearer of bad news for years now to many patients/family members its all in how you approach it: I always ask what they've been told about the situation or what is your understanding of this situation? What kind of questions do you have? 
    After I understand what they understand (whether right or wrong), then I steer the conversation to the meat of what I want to discuss. 
    There is no reason for me to get emotionally involved because in order to do my job, I have to remain an objective observer. 
  16. Like
    traumaRUs, MSN, APRN got a reaction from Davey Do in Question of legality   
    You have received solid advice -please report it. Take care.
  17. Like
    traumaRUs, MSN, APRN reacted to Susie2310 in NTI 2019 - ABCDEF Bundle - Some Questions and Answers   
    Thank you for this very useful and informative article.  I also clicked on the link you provided and watched the You Tube video/s where former ICU patients described the severe difficulties they experienced after discharge. I found it very helpful to hear patients tell of their experiences.
    I hope that more ICU's will implement the ABCDEF care bundle which includes open visitation in adult ICU's and has been shown to improve patient outcomes and to be beneficial to patients and their families.  Open visitation for patients has been demonstrated separately to improve patient outcomes and to be beneficial for patients and their family members.
    I also did an internet search for "ICU ABCDEF Care Bundle" and found some studies that focused on it's implementation in various ICU's.  It was interesting to read about the medical/nursing staff's perceived barriers to implementation.
  18. Like
    traumaRUs, MSN, APRN got a reaction from Davey Do in Question of legality   
    You have received solid advice -please report it. Take care.
  19. Like
    traumaRUs, MSN, APRN got a reaction from Hoosier_RN, MSN in NP Schedule   
    Have you had a sit-down with the manager? If not, this needs to be done. This is a business and you need to address these issues. All places of employment have issues - some can be resolved, some (like your 1 hour commute) can't. If THAT is the main reason, I would say start looking. 
    However, the other issues are resolvable:
    1. Noncompliant pts require careful documentation. All practices have these pts. You can't care for them more than they care for themselves. Your documentation will cover you. 
    2. If multiple co-morbidities are concerning you, since you are a primary care practice, you take care of the complaint of the day and turf the other stuff to specialists. Leukemia care to the oncologist, HIV to the ID folks, etc.. Again, if you need dosing assistance or drug interaction info, ask the pharmacist, call the other care providers. 
    3. We currently have 3 pregnant providers - I've gained another 40 pts to see weekly - however, I am compensated. 
    4. MA - document and fire them if they don't want to work. 
    In order to be thought as an equal provider, you have to look at this as a business. The manager does, I assure you. Either make changes that you can make or leave. However, be very aware that every practice has issues.
    Best wishes - let us know what you do....
  20. Like
    traumaRUs, MSN, APRN got a reaction from NRSKarenRN, BSN in NTI 2019 - ABCDEF Bundle - Some Questions and Answers   
    In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts.
    These recommendations have been incorporated into a single bundle of best practices, known as the ABCDEF bundle: 
    A - Assess, prevent, and manage pain  B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed:
    Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? 
    Institutions are using many different methods to implement the ABCDEF Bundle.  One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process.  We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient.
    Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example?
    A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy.
    Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal?
    Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients.
    Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse?
    We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. 
    Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient?
    Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. 
    Resources Utilized by Joanna Stollings:
    Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

    Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration
    AACN news release: Practical Advice for Implementing the ABCDEF Bundle
    Society of Critical Care Medicine
     
     
  21. Like
    traumaRUs, MSN, APRN got a reaction from NRSKarenRN, BSN in NTI 2019 - ABCDEF Bundle - Some Questions and Answers   
    In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts.
    These recommendations have been incorporated into a single bundle of best practices, known as the ABCDEF bundle: 
    A - Assess, prevent, and manage pain  B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed:
    Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? 
    Institutions are using many different methods to implement the ABCDEF Bundle.  One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process.  We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient.
    Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example?
    A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy.
    Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal?
    Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients.
    Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse?
    We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. 
    Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient?
    Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. 
    Resources Utilized by Joanna Stollings:
    Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience

    Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration
    AACN news release: Practical Advice for Implementing the ABCDEF Bundle
    Society of Critical Care Medicine
     
     
  22. Like
    traumaRUs, MSN, APRN got a reaction from Davey Do in Blast from the past...   
    Lol - I can relate. I watched an old Bonanza episode recently (in B&W no less) and while mindless...it left me with a smile. 
  23. Like
    traumaRUs, MSN, APRN got a reaction from Hoosier_RN, MSN in NP Schedule   
    Have you had a sit-down with the manager? If not, this needs to be done. This is a business and you need to address these issues. All places of employment have issues - some can be resolved, some (like your 1 hour commute) can't. If THAT is the main reason, I would say start looking. 
    However, the other issues are resolvable:
    1. Noncompliant pts require careful documentation. All practices have these pts. You can't care for them more than they care for themselves. Your documentation will cover you. 
    2. If multiple co-morbidities are concerning you, since you are a primary care practice, you take care of the complaint of the day and turf the other stuff to specialists. Leukemia care to the oncologist, HIV to the ID folks, etc.. Again, if you need dosing assistance or drug interaction info, ask the pharmacist, call the other care providers. 
    3. We currently have 3 pregnant providers - I've gained another 40 pts to see weekly - however, I am compensated. 
    4. MA - document and fire them if they don't want to work. 
    In order to be thought as an equal provider, you have to look at this as a business. The manager does, I assure you. Either make changes that you can make or leave. However, be very aware that every practice has issues.
    Best wishes - let us know what you do....
  24. Like
    traumaRUs, MSN, APRN got a reaction from Katillac in Conflict of Interest   
    Can I ask what country you are in? "Patron" is not used in the US, neither is a "town council" utilized for personal problems. 
    Perhaps this is a cultural issue.
  25. Like
    traumaRUs, MSN, APRN got a reaction from Katillac in Conflict of Interest   
    Can I ask what country you are in? "Patron" is not used in the US, neither is a "town council" utilized for personal problems. 
    Perhaps this is a cultural issue.
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