I work at a level 3 ER, striving to be a level 2 someday. At one point we had emergency meds on shelves in the trauma room, so we could just grab and treat as the doctor gave orders. A few months ago the pharmacy said we couldn't have any meds stored outside the Pyxis, and now we have just a crash cart with code drugs, nothing else.
When we get a patient in now the nurse has to run back and forth to the med room, and misses the thread of action on her patient. The doc even adds to what he needs or changes his mind, and she's in the med room, not even in sight, she comes back, and has to run out all over again. It's impossible to chart, give care and be a runner, and when you give report you realize how much information you missed out on.
What does everyone else do? Are your meds in the trauma rooms? Do you have an extra nurse assigned as a runner? Does anyone know of standards that say meds need to be within a certain distance relative to the trauma bay? How do you manage to get meds given, and maintain continuity? I'd like to get back to my boss with some suggestions.
Level II facility - We have a pyxis in each trauma bay, it doesn't have everything, but its cuts a few trips out. Doesn't have the life saving Tetorifice shots because there's no fridge, heaven forbid!
We also have STEMI and RSI kits in the pyxis with all the meds you might give
Common meds: Zofran, Fentanyl, Mannitol, Tetorifice, that's really the essentials?
They need to get you at least a small pyxis
On the side conversation....level 1 trauma is SUPPOSED to have dedicated staff because in reality you can get slammed constantly with patients. I worked at one, it was crazy most of the time
level 2, you have days where you get a bunch, and days you get NOTHING. We have one dedicated trauma nurse, which is probably better than most level 2's. When we get a call for a critical trauma patient, a couple nurses usually leave their assigned areas and hopefully there is a float to go help the trauma nurse. Someone needs to man the Belmont, someone needs to type and usually another nurse to get IV access and be the runner. Reality is even on the sickest trauma patient, there isn't enough space for more than 4 nurses between the doc and techs.
The minor traumas that barely meet criteria, two nurses is usually enough. This depends on facility.
Ironically, the level 2 I work in now is FAR better staffed than the level 1 I worked at. I would frequently get 2 to 3 traumas in the bay over at the level 1, and have no one to help me. I frequently had to tell the docs who said they need a nurse, "well I'm all that's in here and I have to start with the sickest one." Unsafe...
If you don't have a dedicated trauma team per shift, that soubds like a real dangerous place to work.
There should always be at least 2-3 nurses, and another 2-3 medics all trauma/tncc certified
If its your patient your only job is to scribe. You stand in the room at all times and record every assessment finding and every med ordered. You dont leave to do anything else. The doc calls out orders and other members of the team follow them, and calls to you when its completed should you beed to ascribe a time to wheb certain actions took place
At least thats how ive seen them run
Unfortunately outside of level 1 & 2 trauma centers, that is probably not very realistic. Especially not in rural areas. I work nights in a small ED in a very remote (but heavy on tourist travel) area. 2 RNs after 1am, some nights after 11 (or even at shift change). Unit secretary goes home at midnight or earlier. Some nights are slow, sometimes we get major traumas in the wee hours. Sometimes a bus load of Chinese tourists rolls at high speed, and we get a dozen patients, and no one there to translate. Sometimes we go all night without seeing a patient (happens a couple times a year). Cant really staff a dedicated trauma team (particularly one that is more staff than our high point during the day) for those kind of swings. There's life outside the major medical center.
We have "kits" in the pyxis controlled refrigerator that we can grab ahead of time (or if someone is deteriorating) ie RSI kit. Pressors and such have to come from the main pyxsis. We just hope we have someone free to run (house super, borrowed ICU nurse or even PCU/OB nurses). Perfect? Not even close, but coming up with what works for your facility is the key.
KLAW
1 Post
Level 2.
We have Pyxis in the trauma bays. We also have a pharmacist in the ED who pulls the meds for us and helps with mixing and titrating.