PamRNC

We often have pigtail catheters (blue and other colors, 8 French and other sizes) also placed in abscesses or as nephrostomy tubes with a 3-way stopcock attached between the tube end and drainage bag. If/when ordered it is usually to flush forward only with 10ml of NS. Once you've returned the lever on the stopcock to the position that allows the drainage to go back to the bag it drains without milking.

physics & available technology... the y tubing is roller clamped directly under the blood bag and ns bag, it also cannot be used with an iv pump which may lyse the rbcs. if you do need the blood to go through a rapid infuser or warming pump, i think that may require different tubing. to my knowledge at this time there are no iv pumps or contraptions that can automatically open a roller clamp. also, if you are setting up the blood with the y tubing piggy-backed into the lowest port of a ns mainline, again that line will be roller clamped, and not running, so even if you did set it up on an iv pump the pump cannot turn itself on. the blood will back up in this kind of set-up to the point were the tubing is roller clamped, so you can't leave the roller clamp open or the iv pump running. blood and iv fluid are going to take the path of least resistance, which usually means going up the tubing vs down into the vein. nursing to do for s/p blood transfusion... check iv site, auscultate lung sounds, assess patient's vital signs, color, breathing, mental status, pain level, etc. these really need to be done in person. nursing considerations... not all patients really need to have any extra fluids infused after receiving blood, especially chf, esrd and the confused.

I've always stopped other IVfluids, and meds, because we're looking to find out if the patient is going to have a reaction to the blood. Anything else running might make it a little difficult to determine where the problem came from. Also, not as big a concern with Heparin drips which should be just a few ml/hr but with IVFluids you don't really want to put the patient into fluid overload. Depending on your policy a unit of blood should probably run over a minimum of 2 hours to a max of 4. It won't be a problem for most fluids or meds to be held off for that time.

Let's see...I've worked general med/surg so usually have adults and geriatric pts. When I used to start IV's and draw bloods...Thanks for your donation! When untangling IV lines...As a nurse you have to be part spider and part vampire. While giving dc instructions that include no strenuous activity or heavy lifting...Okay, no heavy lifting includes the vacuum cleaner, so that means you get a break from housecleaning and you're hubby will have to do. or Sorry, but you'll have to put off that triatholon, climbing Mt Everest, swimming the English Channel (or any other outrageously difficult activity I can think of) for a few weeks until you heal. When giving safety/ambulating instructions to new patients with IVs...Okay just keep in mind this is your new dancing partner [iV pole] and she/he like to spin a lot. To diabetic patients bemoaning their high fingersticks...You know, stress raises your sugar, just walking into the hospital and wearing that cheesy blue gown alone is guaranteed to raise your sugar. Anything I can say to get 'em laughing and stop worrying about the million and one things hospital/post-op/pre-op patients worry about.

Yes and matter of fact just did. Had my Dad come down from Canada in July for hernia surgery. Everything was great - he was in and out same day, had his post-op check up and then back home. If we waited for it to be done in Canada it would probably be another two years.

Our computer physician order entry system (Eclipsys) has something similar... Order sets that pull up all the general standing and prn meds for a given diagnosis/procedure. All the docs have to do is click on/activate the orders they want (Tylenol, Percocet vs Vicodin, labs, diet, allergies, etc...) and voila! If the docs use it right it will cover everything, A to Z, parameters for prn meds, notifying the docs about abnl VS, etc and so forth.

I am the admission RN for my unit. We recently decided to try something different, everybody took a turn trying out the role for a day or two, but I'm the only one who has stuck with it. (my idea-go figure:trout: ) I work 4 days 12pm - 10pm, try to get discharge paperwork and admissions done. Since we have computerized charting, when I get information about our pending admissions, I can set up the charts before they even get to the floor, and print out orders/medexes to have on hand when they arrive, order/collect any special equipment needed, etc. Our floor is a busy general surgery unit, so we get direct admits, ER admits and post-ops, as well as a few transfers from the ICUs/step-down units. One of the reasons I'm working the odd hours - we call it 'swing shift' - is so that I'll be available on the floor during change of shift report - that lovely time when the other floors feel it's safe to send a patient, or someone who wasn't having any pain when the district RN was available is suddenly in agony, now that he/she is in report. The patient's like it because for a few minutes they have my undivided attention, and the other RNs like it because I handle all the assessment and paperwork, troubleshoot any immediate problems or issues and basically when I hand over the patient to the district RN all they should need to do is say hi and here's your meds/tx/whatever. I won't kid you - it can be a rough gig, Monday we got 12 admits that showed up almost 3-4 pts at a time, after discharging nearly as many people. I can't handle so many in a timely fashion, so the district RNs still need to assess some of their new arrivals, but not all. Even though I may not get to see all of them, I can usually set up the charts, and get the RNs the paperwork saving them a few minutes, here and there. Being a more experienced/technologically saavy RN I'm also available to help troubleshoot/problem solve and cover lunch breaks. I'd love to hear what other places are doing and how they are using this kind of a role.

Have you checked out IHI.org? http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/ImprovementStories/AccuracyatEveryStep.htm

oh yes!!! i want a stress ball - make that twenty, gotta pass 'em out to my co-workers!:biggringi you got questions? we have answers... http://www.allnurses.com or http://www.allnurses.com bringing all nurses together... all around the world i haven't quite finished reading the posts, so please forgive me if someone else had these ideas.

I joined in '96. I was probably searching the web for something on nurses or nursing - couldn't tell you what or why. Probably just passing time. Have to say though, I've had a grand time coming back here and reading or posting to the different threads.

Depends on how many credits of your RN program and other prior education/experience will be counted towards the program in the school you decide to go to. Many colleges will offer you credits for life experience if you complete some kind of portfolio for them. The length of time it takes depends entirely on you, and how many classes you are willing/able to handle at a time. Other considerations may be if the school gives you the opportunity to test out of certain classes. Run a search for RN to BSN programs, and check out the student boards here. Good luck and congrats for planning on going for your BSN.

I love computer physician order entry. Orders go in whether they are picked up or not. That said I've worked in other hospitals where we had to pick up our own orders or had unit clerks to pick up the orders. Relying solely on the unit clerks (except for the truly organized and exceptional ones) was just not always a smart thing to do. When I worked nights as a manager I basically spent a good portion of busy nights being the unit clerk, everything from picking up face sheets from admitting, putting together and stuffing charts, to re-writing MARs, and picking up new orders as well as 12/24hr chart checks. DIY order pick-up is the only way to be sure nothing gets missed, mis-spelled, and picked up correctly and completely. Besides even if the clerk picks it up, I still had to look at the chart before signing the MAR/Careplan.

If you are using a PDA with a recording function that should work as well. Check out the PDAs and Nursing forum, do a search and see if it has been discussed. https://allnurses.com/forums/f234/

In the meanwhile, this may be the closest we get. Maybe some of our other computer savvy nurses can create and produce their own online shows? http://www.nursetv.com/ :icon_wink

We use Eclipsys for our RN and ancillary documentation, labs are imported to it from the Cerner system, Physician order entry is in it and communicates to other departments including Pharmacy, lab, radiology, etc. The system is great for paperless charting, and we have access to old charts from previous admits in the system, which means if the nsg hx was completed on the last admit it can be copied and then updated for the current admit. We can also print specific notes or sections as needed. The docs should be charting in Eclipsys, but only a few services are. There is still a paper chart for that and some really ancient paper flow sheets we had to use during an unanticipated downtime. The charting follows the idea of the sections in a paper chart. For instance under the tab flowsheets you have: Vital Signs, I&O, Respiratory, Neuro, Treatments, Patient Education, and a couple of others. Each flowsheet can be modified for your patients' needs, either by adding or removing individual parameters or by using a macro. The macros are templates which place parameters on each of the relevant flowsheets without having to go back and forth from sheet to sheet. So for a med/surg admit with a few keystrokes you could set up the flowsheets to include fingersticks, POx, foley output, peripheral IV, safety and braden risk assessments, etc. The care plan is comprised of including standards of care or protocols on the assessment flowsheet, and in one section of the flowsheet we detail the plan of care for that shift. Most of the charting can be done by selecting items from drop down lists and clicking on it. If those things don't apply then you can type in what you want. The items in the system get updated on a regular basis, and for progress notes there are templates for some of the more common notes. The only problem is there doesn't seem to be any way for me as a staff nurse to have input into some of the changes going into the system. For instance I think there should be a template for a blood transfusion note to make them more uniform - we got pegged by CMMS on a visit recently for discrepancies on blood transfusion notes. From what I understand Eclipsys is based on an older computer system called UNIX. My floor has about 20 computers around the entire unit (and somedays it still doesn't seem like enough). Most of the computers are at stationary, there are a few on carts throughout the unit, but only one has a wireless connection to the system and the battery which should make it a mobile unit has been long since fried. The oncology unit does have computers built onto their medication carts (I wonder if they'd notice if I traded one of theirs for one of ours?).