Thrifty Facilities?

[indigo girl]

Ever work in a facility where there are no TB syringes? I had to give

morphine injections to a dying patient the other night and, was surprised to

find that this place used 1cc insulin syringes for this and for heparin and PPDs as well, I would presume. I was told by the staff that it was a major issue to ask for any IM syringes.

I can understand being thrifty, but most LTC facilities are privately owned, sometimes by a group of investors or in this case by a family, living far away in a sunbelt state. This is just one example of their cost saving measures.

They also have the very cheapest, flimsiest gauze face masks that wouldn't protect you from a good sneeze or anything else.

It is not unusual to postpone obtaining urine specs because there are no

cath kits or the components to make a kit. It is becoming harder each year

to work in these places. I pity the staff since I work thru an agency and

don't have to deal with this on a daily basis.

[traumaRUs, MSN, APRN]

Its not just nursing homes either. I work in a for-profit hemodialysis unit that allots two and just two 4X4's to cover the needle insertion sites!!!

I found this out by accident when I was examining a pt and he started to bleed and I grabbed a few (maybe 3-4) 4x4's and was rudely told that I was "wasteful."

Gee whiz....next time I'll have the patients bring their own!

[SuesquatchRN, BSN, RN]

Heh.

I needed surgical tape Monday. Was given ONE roll.

I put it in my pocket or I'll never see it again.

[GardenDove]

Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.

[SuesquatchRN, BSN, RN]

Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.

Wasteful of what? I should stint on the Betadine? Suction with a sterile trach kit less frequently? Reuse disposable gloves?

Seriously. Where would you suggest we stint?

[GardenDove]

You don't think medicine is wasteful? I see appalling waste everyday. I don't blame it on individuals, but our system is incredibly wasteful of materials and resources, in my opinion.

[SuesquatchRN, BSN, RN]

I don't see waste of material in my facility, no. Waste of resources - well, it is amazing to me that someone 87 and dying is getting daily tests, but do you want to explain to the non-paying family that maybe the money would be better spent on a younger person?

[indigo girl]

Just to be the devil's advocate here, it is appalling how wasteful we are in medicine and some thriftiness would probably be a good thing.

SOME, yes of course, but I really do not think that is a big issue in LTC today. I can not speak for hospitals as I no longer work in that area. What I do see, and pretty consistently, is that some facilities are so frequently short of supplies, that you have to wonder how they even manage to function daily.

Just a few more examples, one place seldom has enough linen at night, in fact this is common in a number of facilities. If a GI bug hits, as it did a number of facilities recently, it was a hugh problem. Yet, should the state appear at the door, like magic, brand new linen (unstained) appears from the locked basement storage areas. Staff are forced to make difficult choices all the time about how to keep residents dry and clean with inadequate supplies.

I have seen them have to use wall soap dispensers because there were no

bottles or even bar soaps available to wash residents.

Or picture a facility with 4 different units having to use one glucometer between them and down to their last bottle of test strips. What time do we all have to start doing our fasting blood sugars? It is not unusual to have one pulse oximeter or thermometer device being shared by 4 or 5 different units. You are always waiting or searching for these machines. And because in many places, the nurse must do the vital signs herself, she is the one spending valuable time searching for the equipment. So, whenever there is an outbreak of noro virus or flu (like every winter) with several patients sick, it becomes very difficult, stressful, and time consuming.

I could go on and on, but I think most in LTC are seeing this. Are we wastful? How can we be? There is barely anything left to waste!

[withasmilelpn]

SOME, yes of course, but I really do not think that is a big issue in LTC today. I can not speak for hospitals as I no longer work in that area. What I do see, and pretty consistently, is that some facilities are so frequently short of supplies, that you have to wonder how they even manage to function daily.

Just a few more examples, one place seldom has enough linen at night, in fact this is common in a number of facilities. If a GI bug hits, as it did a number of facilities recently, it was a hugh problem. Yet, should the state appear at the door, like magic, brand new linen (unstained) appears from the locked basement storage areas. Staff are forced to make difficult choices all the time about how to keep residents dry and clean with inadequate supplies.

I have seen them have to use wall soap dispensers because there were no

bottles or even bar soaps available to wash residents.

Or picture a facility with 4 different units having to use one glucometer between them and down to their last bottle of test strips. What time do we all have to start doing our fasting blood sugars? It is not unusual to have one pulse oximeter or thermometer device being shared by 4 or 5 different units. You are always waiting or searching for these machines. And because in many places, the nurse must do the vital signs herself, she is the one spending valuable time searching for the equipment. So, whenever there is an outbreak of noro virus or flu (like every winter) with several patients sick, it becomes very difficult, stressful, and time consuming.

I could go on and on, but I think most in LTC are seeing this. Are we wastful? How can we be? There is barely anything left to waste!

It sounds like you work at my facility! Even worse, in my opinion is the 11-7 nurse supervisor that shrugs and says, "I guess we won't do them then", when it looked like we were running out of test strips. Excuse me?!? Much as I love my patients I'm beginning to think I don't want to work in LTC or even nursing anymore. It just seems like nobody cares.

I do get frustrated with waste though- like a patient gets d/c'd home and their meds get wasted. 1000's of dollars down the toilet. Or how about reams of redundant paper charting?

[stillpressingon]

It sounds like you work at my facility! Even worse, in my opinion is the 11-7 nurse supervisor that shrugs and says, "I guess we won't do them then", when it looked like we were running out of test strips. Excuse me?!? Much as I love my patients I'm beginning to think I don't want to work in LTC or even nursing anymore. It just seems like nobody cares.

I do get frustrated with waste though- like a patient gets d/c'd home and their meds get wasted. 1000's of dollars down the toilet. Or how about reams of redundant paper charting?

Yeah, isn't it crazy how stuff that we should be scrimping on we "can't," and things we shouldn't, are "essential for the benefit of our pt's" Huh?? Oh, Brother!

[SuesquatchRN, BSN, RN]

You said it, Indigo Girl.

But we don't waste meds, except narcs. We keep 'em to use when we need to start someone on something STAT and can't wait for the out-of-facility pharmacy to deliver. Plus, we can only order one week before running out.

[BULLYDAWGRN, RN]

suessquatch i'm tending to agree with you on the 87 yo thing. we get terminal ill full dnr pt's admitted to our icu every day. now these pt's could easily be managed on a less skilled or less exspensive floor/unit per say. but as far as being wasteful with supplies, yes i've been guilty of that. but you know when your being ran ragged like a dog, you tend not to think about only grabing 2 4x4's at a time.