The weekend of... 7-19 to 7-22-19

[Davey Do]

You may have read this post in the "JC/Ligature Points" thread, but for purposes of laziness... er.... a .. I mean "continuity", I'm repeating it here:

"I jumped for joy like some jerk excited over new phone books as I came onto the geriatric psych unit on Friday for my MN shift. Everything was going to be okay now- no more sitting for two hours being a door.

However, new problems have arisen.

Only one of the double doors open, which means some things cannot pass through the single door, like wheelchairs, meal carts, or crash carts.

The doors are to stay locked 24/7, so the staff member assigned to the community room during the patients' waking hours, are locked in there with them. The staff member assigned to work the floor and make rounds use to be able to sit in the community room and walk the hall. Now, an extra staff member is required to just walk the hall in order to make rounds.

The video monitors are down, so staff at the nurses station have no idea of what's going on in the community room. And, like deep space, with the doors closed, 'no one can hear you scream'.

Scary!"

On Friday night, we had four staff members, sufficient enough to cover the desk, meds, the hall, and the community room. However, on Saturday night there were only three of us. I did meds, Eleanor was doing an admission, and Fridgett was to cover the community room AND hall.

"It has been noted that neither doors on the men's and the women's psych units have the community room door locked during the day- only from 2200 to 0700.

So, seeings how this 24/7 locked door thing does not jive with the other psych units, this shift, due to a lack of staffing to cover both the hall and the community room, the door was propped open with a chair."

Fridgett did this of her own accord and I supported her decision:

"We'll see how administration responds to this when and if they review the video monitors that may or may work outside of the geriatric psych unit.

I'll keep you posted!

Stay tuned.

Fine tuned."

[Crash_Cart]

16 minutes ago, Davey Do said:

Only one of the double doors open, which means some things cannot pass through the single door, like wheelchairs, meal carts, or crash carts.

I suspect the inherent flaws in this engineered design will serve to be effective in cutting off the food source which may be helpful in reducing the energy levels of any agitated residents. Perhaps even effectively reducing the need for any ativan and haldol on the unit.

I worked in a similar locked geriatric environment we called a Cognitive Support Unit, or if you like acronyms, - CSU - which of course is a catchy alphabet soup designator not to be confused with CSI the TV series. Although, I do admit we often conducted investigations looking for contraband food due to hoarding and we did have a special task force assigned to investigating reports of missing dentures from the bedside.

Our impenetrable doors to our geriatric bunker required an entry code for passage not unlike Cheyenne mountain I suppose. Of course, everyone always forgot the code in the usual manner. We also had a policy in place when everyone started remembering the code, that's when it was time to change the code again, so this process was able to repeat itself indefinitely.

Although this door was not initially designed to keep staff members out, this door code matter often resulted in many instances of them banging and beating on this door trying to get in, usually during shift change when they were running a little late. Observing the frantic, attention seeking nature of this exhibited behaviour, I was never really sure if the staff member wanted in because they needed to be admitted to the unit, or if they were just coming into work. I always approached them slowly and cautiously to be sure.

[NurseBlaq]

Who in administration approved those bootleg doors knowing they didn't work? They need to come in and be the 4th person since they paid for a nonworking product. I despise reckless management. Let you drop a cup of water and they have a full tantrum but they'll put you at risk to lose limb and license without a concern in the world.

[RNNPICU, BSN, RN]

Have you considered placing a mannequin for that fourth person?

Sorry for the sarcasm, it really gets me when changes are made are never tested for functionality, useability, and efficiency.

1. Doors that don't allow for fluid passage and unable to accomodate equipment - Huge safety risk. DOH JC could have a field day with this - albeit there is a door

2. Not being able to hear someone scream - YIKES!! again security

3. Inability to have a funcitoning door - again security.

At least there are or are not working secuirty cameras.

I wonder what happened in the design - no measurements for basic medical equipment?

Even in things such as hair dye or other things, it states on the bottle to test a small area first to test for a reaction. But yet locked doors that don't function, can't hear, and don't allow for easy egress can be utilized without testing?! Awesome.

Love the solution you came up with

[Davey Do]

10 hours ago, RNNPICU said:

1. Doors that don't allow for fluid passage and unable to accomodate equipment - Huge safety risk. DOH JC could have a field day with this - albeit there is a door

I need to jump on this and vent, RNNPICU because I have lost all respect for surveying and so-called bulldog agencies after an event in 2016.

The geriatric psych unit underwent a renovation and some relatively invasive construction was done. There were multiple safety risks, such as exposed sharp steel stud and screws, exposed plumbing & electrical wires, and power tools left in patient access areas, which I brought to administrative's attention. To make a long story short, basically I got Ramma-Lamma-Ding-Dong from them. I informed administration that I was going to outside entities.

I informed OSHA, Public Health, and JC, complete with photographs via email and snail mail. It took at least two weeks for all three entities to survey the area, after the construction was completed, and they reported to me that no safety risks were found.

I remember speaking to an OSHA representative on the phone and asking him why he didn't go by the photographs. "Well", he said, "We have to go by what we see at the time of our visit". I asked him why it took more than two weeks to act. He answered, "That's pretty much standard. If you would have said it was an emergency, we could have been there within 24 hours".

I got the same sort of response from PH and JC. I did, and continue to do, what I believe are prudent moves. After I've done what I could, I let it go, but keep copies of everything.

Some cartoons inspired by real events came out of the situation, though:

[Davey Do]

12 hours ago, NurseBlaq said:

Who in administration approved those bootleg doors knowing they didn't work?

I believe, NurseBlaq, you're referring to the fact that only one of the doors open. It is not because they don't work, the reason why one door doesn't open is because the psych unit director instructed the installers to make it so.

The installers replaced a guide pin where the latch slides to lock/unlock the door with a bolt that has a lock tight nut on it.

Drawn from my memory:

[RNNPICU, BSN, RN]

45 minutes ago, Davey Do said:

I informed OSHA, Public Health, and JC, complete with photographs via email and snail mail. It took at least two weeks for all three entities to survey the area, after the construction was completed, and they reported to me that no safety risks were found.

I remember speaking to an OSHA representative on the phone and asking him why he didn't go by the photographs. "Well", he said, "We have to go by what we see at the time of our visit". I asked him why it took more than two weeks to act. He answered, "That's pretty much standard. If you would have said it was an emergency, we could have been there within 24 hours".

I got the same sort of response from PH and JC. I did, and continue to do, what I believe are prudent moves. After I've done what I could, I let it go, but keep copies of everything.

I sometimes wonder what really happens. I remember once hearing that a family complained about pain control and they were on site in a hot second, supposedly.

What constitutes an emergency in their eyes? A nail gun left unattended in a psych unit ? In any unit that would be a write-up. How can you safely secure that!? SMH. Sigh.

Keep doing what you are doing. I do think that sometimes ideas and suggestions for improving safety can be good, but you do have to test to find the flaws in the execution.

[Davey Do]

11 minutes ago, RNNPICU said:

I sometimes wonder what really happens. I remember once hearing that a family complained about pain control and they were on site in a hot second, supposedly.

What constitutes an emergency in their eyes? A nail gun left unattended in a psych unit ? In any unit that would be a write-up. How can you safely secure that!? SMH. Sigh.

Keep doing what you are doing. I do think that sometimes ideas and suggestions for improving safety can be good, but you do have to test to find the flaws in the execution.

Thank you RNNPICU, this I will do.

I've also heard that PH has been there, as you say, "in a hot second" for other matters. I don't know...

BTW: The tool left in the community room wasn't really a loaded nail gun. I used that one for effect. What was really left in the community room was a 5 foot fiberglass pole, with a sharp metal tip on the end, used to "snake" electrical wires.

I found the tool leaning up against the wall by the nurses station when I came in for my 8 hour MN shift. I asked what it was doing there and one of the nurses said, "Oh- we found that in the community room and asked Margie the supervisor what we should do with it and she said to just leave it in the hallway so the construction workers will see it when they come in in the morning".

I locked the tool in a conference room after taking a pic of it with my cell.

[NurseBlaq]

9 hours ago, Davey Do said:

I believe, NurseBlaq, you're referring to the fact that only one of the doors open. It is not because they don't work, the reason why one door doesn't open is because the psych unit director instructed the installers to make it so.

The installers replaced a guide pin where the latch slides to lock/unlock the door with a bolt that has a lock tight nut on it.

Why would he do that? He doesn't feel the patients need to eat or are y'all supposed to walk all the trays in? Do they eat in another room since meal carts can't get through there? What if there's a code in the community room? Why set staff up to fail like that? There are too many problematic variables. At least leave the "key" to unlatch the door at the desk so it can be used when necessary, especially in case of emergency.

[TriciaJ, RN]

I feel for you, Davey because I know how this whole thing plays out. When OSHA or the Fire Marshal come out to inspect, they will be shaking their heads with dismay over how perilous the situation is. Then when the official report comes out, it will state that no problems were found.

Later on, when someone is killed in the fire, or could not be resuscitated for lack of a crash cart or died availing themselves of the free ECT, management will shake their heads with disbelief. "Why didn't anyone tell us about this?" they'll wail. "How can we fix anything when no one tells us about it?"

Just be very careful that the person who is killed isn't you, and keep copies of everything in your safe deposit box at the bank.

But the one thing you can breathe a whole lot easier about: no one will have commited suicide using a chair. And that's what really matters.

[Crash_Cart]

You can't lock people in during an emergency. The door has no mechanism to immediately release the latch at the top of the door into a fully open position for evacuation.

Usually it has to have some kind of crash bar installed on the outside of the door which restricts the residents from leaving, but yet permits it to release open from the outside during an emergency. Pushing this crashbar causes the fire alarm to sound.

Here's what OSHA says:

"29 CFR 1910.36(d)(1)

Employees must be able to open an exit route door from the inside at all times without keys, tools, or special knowledge. A device such as a panic bar that locks only from the outside is permitted on exit discharge doors."

What gets me is why isn't someone in the safety department all over this?

This is only intended to illustrate a working example...

[Davey Do]

On 7/24/2019 at 5:10 AM, NurseBlaq said:

Why would he do that? He doesn't feel the patients need to eat or are y'all supposed to walk all the trays in? Do they eat in another room since meal carts can't get through there? What if there's a code in the community room? Why set staff up to fail like that? There are too many problematic variables. At least leave the "key" to unlatch the door at the desk so it can be used when necessary, especially in case of emergency.

She. The post ipso facto director is a she. There are serious concerns about her perception of reality. And yes, somebody holds the door open and the trays are walked in. No, the patients eat in the same room as before. As far as a code, it remains to be seen. And yes, setting staff up to fail is the Wrongway. The Wrongway Regional Medical Center way.