Tuesday, November 15, 2016

The cost of doing business across unit lines

Another Friday afternoon, another adolescent  psych patient who had made controversial statements in school and was promptly sent to the ER for evaluation.  Friday's are a bad time to come to the ER for a psychiatric evaluation.  It was likely that this young patient would be spending the weekend in the boring ER, eating pudding with a cardboard spoon, watching boring TV, and not allowed to use the cell phone.  I am of the opinion that school counselors should not be allowed to see students on Friday afternoons.  My independent anecdotal study points to Friday afternoon as prime time for making regrettable statements resulting in ER visits.

The ER is a bad place for kids on weekends as we are overflowing with acting out professional psych patients, intoxicated individuals who have fallen off bar stools, and plain dangerous people.  It is not all that safe for staff.  So quiet adolescents get quite an education and maybe not so much attention.

I sent the tech in to get vital signs on this kid, a skinny 15 year old.  The tech seemed unconcerned that the BP was 66/28.  She shrugged, "I took it three times, so...."

I went in search of the appropriately sized cuff.  Nothing.  Not a single correctly sized cuff in the entire department.  I trudged up to pedi to beg for one.

Anne is the night charge on pedi and is known to be territorial.  I get that she needs to keep track of pedi belongings, but sheesh.  She came within inches of requesting a criminal background check for me to "borrow" the necessary hospital equipmet to properly care for a patient would have been on her unit had they the staff to do the necessary safety 1:1 psych watch.

I returned to the ER with the BP cuff, now 15 minutes past my quitting time, and gave report to one the kids on nights.  I handed her the cuff and asked if she would please go in and take the BP that I was quite sure wasn't in the toilet.

"Anne gave this to me.  I had to fill out an application and give her one of my kidneys, my cell phone number, and promise my first born child.  She asked which nurse would be taking over care of the patient, including last name.  I am trusting that this will be returned to pedi undamaged".

Then, trusting soul that I am, I brought it back myself.  The day nurses can give up one of their kidneys.  Or kids.