SteffaDee

Hi there, I just finished training for a new EMR/documentation system for the hospital I work at that is going live in about 10 days. It's called "Meditech Expanse" and I was wondering if anyone had any tips or tricks I should consider; especially for administration of IV fluids in the ED.

In the past I have been provided with and/or made copies of forms and documents that are frequently used. That way you can become familiar with them on breaks or when you go home etc. I consider it like research time as it makes me more proficient at my job.

An ER doc I've worked with will sometimes write orders like "Gown" when the patient is complaining of an ankle or elbow injury, etc. Or "Move to Minor Procedure Room", when the room is already occupied by something more serious and/or I can easily bring suture supplies to wherever the patient is. Really??

I believe its supposed to be "tapered" dose, which is when the dose gradually decreases until they are no longer taking the medication (ie. Prednisone 50mg PO Daily x3 days, then 40mg x3 days, then 30mg x2 days, etc.).

I would do 2,3, and 4 all at the same time! Bring the BSC, give the Lasix while counseling on better medication adherence, and monitor while waiting on labs. Once the BSC has been used, I'd then obtain a urine sample and advocate for a drug screen. Since she's on Lasix at home anyway, but has missed doses, I wouldn't be too worried of her K+ level. She needs to be diuresed because she's symptomatic. If the labs did show a decreased level it could be corrected anyhow.

In the hospital where I work, whenever a patient is being transferred internally, any sending floor is required to pneumatically tube a written Transfer Report form (organized in SBAR format) to the receiving floor at least 30 minutes prior to transfer. The nurse is responsible for reviewing the form in that time and if there are any concerns or pertinent questions, the sending floor is called for clarification. With a Transfer Form from the ED is also a carbon copy of the orders, so we know what is going on with the patient being admitted. ED admissions to CCU receive verbal reports though. An elevator was strategically placed from the ED to the CCU (on top of one another), and the CCU nurse will actually come down and receive that verbal report in person. If CCU is not able to come down, the ED nurse is required to accompany the patient upstairs to CCU themselves. A policy was created due to crashing during transfer. And the Transfer Report form is still sent 30 minutes prior!

Of course, the following can be facility specific. So make sure to look up your policy. Your primary should be NS or the ordered fluid and your secondary is the medication. The secondary should be above the level of your primary (at my facility we use little hooks for this). With this set-up only one channel is required. And always make sure the medication is compatible with the fluid it is infusing though. Refer to Photo here: Intravenous infusion | definition of intravenous infusion by Medical dictionary Gravity is what allows the entire amount of medication to flow from the secondary bag, to the patient. Keep in mind the medication is "heavier" than the saline it flows through. That is why the drips are necessary; to regulate this effect. Keep in mind different IV medications are required to be infused over different times; refer to the IV manual. Therefore never administer medications as secondary lines to boluses (I make exception for some narcotics as you want them infused quickly anyway if were going to give via IV push). If one medication is to be given over 30 minutes and one over an hour, you'll have to give them back to back, as you are correct in assuming that they infuse at different rates within the cording. I would select the 30 minutes one first. Naturally, you can also use two different IV sites as well. If you saw back drawing, I can only assume its because the primary and secondary were at the same level, therefore causing gravity to interfere with the downward flow of the medication. When I read your post, I mainly keep thinking: If the medications are compatible, why not put them together in the same secondary minibag? Instead of x2 50 mL minibags in a Y set-up, use a 100 mL minibag and put the compatible medications within using a single line. Again, make sure you review best practices and facility policies and procedures.

LinkedIn sometimes has job postings for nursing positions, or try looking at online job posting sites like Monster.com or Jobs.com, and such. Your state or province may also have a database where facilities may post job openings specifically for health care professionals. Keep in mind, statistics show that it takes two to three years for new nurses to land their dream job. You may have to work in public health or long term care before getting that coveted position in the hospital. Lastly, sometimes you need a little job search break. Take a week or two off then start fresh! Good luck with your search! Don't give up!