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.

[htrn]

I see alot of waste in my department. We have delivery packs with oodles of paper drapes that never get used and each instrument pack contains 13 instruments that need to be resterilized and packaged - we only use two or three hemostats and one or two pairs of scissors - maybe a needle driver - but that's it.

Another thing that makes me crazy is that we do normals on glucometers every night, whether we have patients or not. That's 60 strips a month, not incuding what we have to do when we change bottles. Why can't we run normals at the time we run a bedside glucose if it hasn't been done in a few days.

We go through so much IV tubing, especially if we have a labor patient go to c-section. Anesthesia will pitch all of our tubing and hang their own. They don't even bother to try to keep any of the tubing sterile so we can use it post-op. Very wasteful.

But, they will tell us we can't have all the linen we need because it is too expensive.:trout:

[Cattitude]

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.

yes, wasteful at times and at certain places. my prior hospital usually had ample supplies of everything but linen. i'm probably guilty of using more chux, wipes, gauze, etc, than i should. but again, who has time to count?

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[color=#483d8b]resources are very wasteful. like another poster said, the 80 and 90 year olds really don't need aggressive treatment, daily labs, etc. but this is a whole other issue that's not going to change anytime soon.

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.

!

i just had a pt. discharged from a ltc tell me that they would not give her new foley bags but switch back and forth between a bedside bag and a leg bag. ok, this is actually what we do at home also but we teach home aides to rinse the bags out with a solution of vinegar and water.

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[color=#483d8b]did they do that in the ltc? nope. she said they didn't and told her they couldn't possibly change to a brand new bag, there just weren't enough. they took the old bag off and hung it to dry in a shared bathroom. ughhhhh. can we say uti???

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[color=#483d8b]i understand being thrifty, but not at the expense of pt. care. that's what this is becoming:trout: . shame on the owners of these facilities!

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[MS._Jen_RN, ASN, 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.

I work in a hospital setting and I have to agree. I see a lot of waste. Examples: 3-4 partially used rolls of tape, 2 open Depends packs, 3 partly used chux packs, 2x2 and 4x4 packs all scattered around a pt's room. You know one on the night stand, a couples in a drawer. All because someone was too lazy to look to see if there was already one of something there and too lazy to put it in one spot when they were done. Not to mention all the lab tests etc that are done that don't need to be.

If I were in an LTC as those described, especially if I were an agency person, i would be tempted to put a call in to the state. It's stupid to not have the stuff to provide safe care to you patients. I bet you are expected to be an "excellent" facility and provide "excellent" care too.

~Jen

[indigo girl]

yes, wasteful at times and at certain places. my prior hospital usually had ample supplies of everything but linen. i'm probably guilty of using more chux, wipes, gauze, etc, than i should. but again, who has time to count?

[color=#483d8b]

[color=#483d8b]resources are very wasteful. like another poster said, the 80 and 90 year olds really don't need aggressive treatment, daily labs, etc. but this is a whole other issue that's not going to change anytime soon.

i just had a pt. discharged from a ltc tell me that they would not give her new foley bags but switch back and forth between a bedside bag and a leg bag. ok, this is actually what we do at home also but we teach home aides to rinse the bags out with a solution of vinegar and water.

[color=#483d8b]

[color=#483d8b]did they do that in the ltc? nope. she said they didn't and told her they couldn't possibly change to a brand new bag, there just weren't enough. they took the old bag off and hung it to dry in a shared bathroom. ughhhhh. can we say uti???

[color=#483d8b]

[color=#483d8b]i understand being thrifty, but not at the expense of pt. care. that's what this is becoming:trout: . shame on the owners of these facilities!

[color=#483d8b]

i have seen this switching back and forth between bags frequently in ltc. the more enlightened facilities use the vinegar and water approach. i do not know why some places just do not understand this. it certainly cuts down odor as anyone with a feline that misses the litter box would know. of course, in home care, nurses seem to be more creative and do what works.

[weirdRN, RN]

1000's of dollars down the toilet. Or how about reams of redundant paper charting?

HEHEHEHE....I am right there with you sister! :roll

[NurseyTee]

Wasteful?????? At the facility where I work, we have NO chux, no wipes, no kleenex and the administrater just d/c'd extra large breifs because they are too expensive. WHAT? Is he not thinking of the money in man-hours and supplies needed to clear up the excoriation and skin breakdown from briefs that are too small? I just don't understand some of these decisions. The toilet paper is like sand paper and the supplies are always short. Lately, as other's have stated we don't have adequate linens for bed changes or any draw sheets. It gets very exhausting, trying to figure out how to keep up with it all.

[SuesquatchRN, BSN, RN]

Wasteful?????? At the facility where I work, we have NO chux, no wipes, no kleenex and the administrater just d/c'd extra large breifs because they are too expensive.

We were always short the large briefs, no pun intended. Housekeeping would actually ask us how many each resident would need through the night. What, like we have pee clairvoyance?

What a time wasting PITA. But God forbid someone stays wet or a pressure ulcer begins. And don't chart that because then the state will see!

[RosesAreBlue]

At our facility, we have to let our residents sit in piss all night, by our DON's orders. She says the new 'nighttime' diapers are 'extra absorbent'. Absorbent my butt. Every morning on my last round, my partner and I have to change everyone's bed from top to bottom because we weren't allowed to put fresh diapers on these people. If that isn't sad, I don't know what is. We have a full census, too, which is infuriating. And they gripe at us when the patients start to develop sores on their rumps!

[not now, RN]

I actually wrote the DON a note one night. I work 3-11 and I get complaints frequently about NOC's not having enough linen to last through the night. Since I used to be a CNA at my facility before becoming an LVN the CNA's tend to turn to me to solve problems. I counted all the pads left over after last rounds for the PM shift. I then opened the "NOC shift" closet (long story) and counted those. There was no possible way for NOC's to do rounds every two hours and I let my DON know.

Sadly, nothing changed and it won't until state shows up. We always get tons of new linen when state shows up. :angryfire

[RosesAreBlue]

What I wish state would do is send someone to be hired at a facility that seems to have a lot of complaints and let the 'undercover' nurse see if everything is alright. I think it'd be much more effective than everone hollaring down the hall that state's coming, clean up your act.

[Jolie, BSN]

Another thing that makes me crazy is that we do normals on glucometers every night, whether we have patients or not. That's 60 strips a month, not incuding what we have to do when we change bottles. Why can't we run normals at the time we run a bedside glucose if it hasn't been done in a few days. (quote from obrnheather)

You can thank JCAHO for this requirement.

[Jolie, BSN]

At our facility, we have to let our residents sit in piss all night, by our DON's orders. She says the new 'nighttime' diapers are 'extra absorbent'. Absorbent my butt. Every morning on my last round, my partner and I have to change everyone's bed from top to bottom because we weren't allowed to put fresh diapers on these people. If that isn't sad, I don't know what is. We have a full census, too, which is infuriating. And they gripe at us when the patients start to develop sores on their rumps!

Please contact your state ombudsman (anonymously). This is absolutely unacceptable, and amounts to neglect. If the DON thinks briefs are expensive, wait until the facility has a fine to pay. May your DON spend her golden years in wet briefs.