(Another) maladjusted, non-working, non-contributing, suck-the-life-right-out-of-me repeat offender for various complaints of pain and anxiety was "rushed" to the ER by an apparent new friend, breathless with concern. This was apparently her first performance for the new friend; we had seen this same one dozens of times, the very familiar "unresponsive" in the car act, followed by miraculous consciousness and hyperventilation. And pain. Yawn.
After demanding a wheelchair, assistance, a Go Directly to a Treatment Room hall pass, and yelling for "somebody to fu*king do something" for his new friend's chronic and life threatening panic attack and narcotic-needing pain condition he said:
"This is an emergency! She can't breath! She needs.....Spazepam!"
No shit. Let me just pull the pin on that Ativan grenade and let it fly, then everyone will feel allllllllll better.
Tuesday, May 29, 2012
Monday, May 21, 2012
RIP, Paper ER Records....We Will Miss You
After months of hype, our ER will join the rest of the world in the 21st century and initiate electronic health records. Let the spinning begin.
It is an already out-dated program, cumbersome, not user-friendly, and fits awkwardly with our existing systems...when it works. The roll-out date is soon. Very soon. I agreed to be the super-user for our building, mainly because it is my 4th ER to have worked at when the electronic records have been the new thing....it is better not to rely on anyone else's wits but my own when it comes to computers.
I would say we are probably the last health care facility in the free world to finally put this into practice. As with any New Thing, the first thing people want to know is: how will this affect me, personally?
Well, the simple answer is that electronic health records in my universe will not do two things: it will not lessen my work load or decrease my current responsibilities and it will not mean I have lots and lots of free time to spend with patients. Triage, which I can normally accomplish in under 3 or 4 minutes, will now take about 20 minutes. There goes your door-to-doc time. Of course the new plan is to put patients immediately into a treatment rooms, fill 'em up with unregistered patients, add lots of confusion about who is where and then have no place to put a cardiac patient. But hey, overall that should really help those all-important patient satisfaction scores. Naturally, electronic records should mean a lot less paper work, right? Wrong. We will have approximately 1/2 metric fu*k ton more when all is said and done.
There is much fear and loathing, wailing, and gnashing of teeth. Ellen is beside herself. New Cathy is ready to go work at Burger World.
I took another stupid phone call from one of the Suits about an aspect of my job that she could never, ever do.
Suit: "Are you excited? Go live will be here before you know it!"
Me: (dead pan) "Beside myself. What a joyous occasion".
Suit: " I know, right? Hey, we have something for you! It's a t-shirt that says SUPER-USER! Isn't that awesome? I got you a large, is that OK? You can wear it the first day so everyone knows who you are!"
Me: "Oh. Cool."
Really? A t-shirt that says super-user? That is so....wrong. On several levels.
1. I don't wear t-shirts.
2. I would never wear one to work even if I did wear them.
3. There are about 6 people who work here on the evening shift. They all know who I am
4. Think very carefully about the connotations of labeling anyone a super-user. That would also apply to 2/3 of our frequent fliers seeking narcotics.
It is an already out-dated program, cumbersome, not user-friendly, and fits awkwardly with our existing systems...when it works. The roll-out date is soon. Very soon. I agreed to be the super-user for our building, mainly because it is my 4th ER to have worked at when the electronic records have been the new thing....it is better not to rely on anyone else's wits but my own when it comes to computers.
I would say we are probably the last health care facility in the free world to finally put this into practice. As with any New Thing, the first thing people want to know is: how will this affect me, personally?
Well, the simple answer is that electronic health records in my universe will not do two things: it will not lessen my work load or decrease my current responsibilities and it will not mean I have lots and lots of free time to spend with patients. Triage, which I can normally accomplish in under 3 or 4 minutes, will now take about 20 minutes. There goes your door-to-doc time. Of course the new plan is to put patients immediately into a treatment rooms, fill 'em up with unregistered patients, add lots of confusion about who is where and then have no place to put a cardiac patient. But hey, overall that should really help those all-important patient satisfaction scores. Naturally, electronic records should mean a lot less paper work, right? Wrong. We will have approximately 1/2 metric fu*k ton more when all is said and done.
There is much fear and loathing, wailing, and gnashing of teeth. Ellen is beside herself. New Cathy is ready to go work at Burger World.
I took another stupid phone call from one of the Suits about an aspect of my job that she could never, ever do.
Suit: "Are you excited? Go live will be here before you know it!"
Me: (dead pan) "Beside myself. What a joyous occasion".
Suit: " I know, right? Hey, we have something for you! It's a t-shirt that says SUPER-USER! Isn't that awesome? I got you a large, is that OK? You can wear it the first day so everyone knows who you are!"
Me: "Oh. Cool."
Really? A t-shirt that says super-user? That is so....wrong. On several levels.
1. I don't wear t-shirts.
2. I would never wear one to work even if I did wear them.
3. There are about 6 people who work here on the evening shift. They all know who I am
4. Think very carefully about the connotations of labeling anyone a super-user. That would also apply to 2/3 of our frequent fliers seeking narcotics.
Monday, May 14, 2012
Smoke Signals
This man walks into the ER (classic start of a bad joke, why should today be any different). He noticed that some thick, black smoke was pouring out of one the the chimneys in our very old building as he was passing by a couple of hours ago. He was on his way to an appointment and just didn't have time to stop but, hey, nice of you to check in with us on your way home to make sure we were not burned to a crisp in the interim. He suggested we might want to have our maintenance guy check it out.
Ellen gets nervous about these things and wondered if we should call maintenance now, on the off-shift and also off-site, or if I thought it could wait until the following day. Or if she should call the fire department. I'm the nurse in charge which I guess also makes me in charge of everything else. Besides, six months earlier there was a back-up of thick smoke that cleared out the building and left an odor for days.
Me: Yeah, put a call in. What the heck is a little overtime when we might be fully engulfed in flames in a little while?
Ellen: Wouldn't we have a lot of black smoke if there was a problem in the boiler room?
Me: Well it's a catholic hospital so white smoke means that a new pope has been elected. Black smoke would mean they haven't made a decision. Although I'm pretty sure the old pope has to be dead first but I don't really keep up with that type of thing.
Ellen: I don't understand.
Me: I'll go check the boiler room; you call maintenance.
Ya gotta love Ellen. She is so earnest; she always means well and would do anything for anybody. She has at least 10 "get well" or "Happy Birthday", cards going around. New people are powerless to escape the Spanish Inquisition when it comes to Ellen's Vital Records: Life Events, Spouse's name, Children, Pets (and their names), and especially Birthdays. Everybody gets something; a cake, brownies, raspberry bars, or our favorite, Whoopie Pies. And hers are goooooooooooood. But I digress.
On another night I had a problem with a strong odor of smoke. Cigarette smoke. It was coming from somewhere......close. REEEally close. From inside the building. From....Holy Shit! That asshat was smoking.... in the bathroom?
Old Drunk: "Nope, I wasn't smoking"
Riiiiiiight. "Sir, you cannot smoke in here. If you do it again, I will call the police and have you escorted out"
I had to open up the ambulance bay doors to get the smell out. It is bad enough that people reek of cigarettes in triage while they claim to smoke "2 or 3 cigs a day"; sometimes at the end of the day all I can smell is stale cigarette smoke. It is so disgusting.
I am a reformed smoker. I last smoked 33 years ago, my final pack of cigs hitting the trash bucket at the same time as my first positive home pregnancy test. It was tough to do, no doubt about it. I just don't get that people with kids think that they are not exposing them to the dangers of third-hand smoke by merely smoking outside. The chemical residue clings to clothing, skin, hair, furniture, and builds up in the car. If you are "only smoking outside", you are exposing your family unnecessarily to harmful toxins.
OK. Off my soap box.
Ellen gets nervous about these things and wondered if we should call maintenance now, on the off-shift and also off-site, or if I thought it could wait until the following day. Or if she should call the fire department. I'm the nurse in charge which I guess also makes me in charge of everything else. Besides, six months earlier there was a back-up of thick smoke that cleared out the building and left an odor for days.
Me: Yeah, put a call in. What the heck is a little overtime when we might be fully engulfed in flames in a little while?
Ellen: Wouldn't we have a lot of black smoke if there was a problem in the boiler room?
Me: Well it's a catholic hospital so white smoke means that a new pope has been elected. Black smoke would mean they haven't made a decision. Although I'm pretty sure the old pope has to be dead first but I don't really keep up with that type of thing.
Ellen: I don't understand.
Me: I'll go check the boiler room; you call maintenance.
Ya gotta love Ellen. She is so earnest; she always means well and would do anything for anybody. She has at least 10 "get well" or "Happy Birthday", cards going around. New people are powerless to escape the Spanish Inquisition when it comes to Ellen's Vital Records: Life Events, Spouse's name, Children, Pets (and their names), and especially Birthdays. Everybody gets something; a cake, brownies, raspberry bars, or our favorite, Whoopie Pies. And hers are goooooooooooood. But I digress.
On another night I had a problem with a strong odor of smoke. Cigarette smoke. It was coming from somewhere......close. REEEally close. From inside the building. From....Holy Shit! That asshat was smoking.... in the bathroom?
Old Drunk: "Nope, I wasn't smoking"
Riiiiiiight. "Sir, you cannot smoke in here. If you do it again, I will call the police and have you escorted out"
I had to open up the ambulance bay doors to get the smell out. It is bad enough that people reek of cigarettes in triage while they claim to smoke "2 or 3 cigs a day"; sometimes at the end of the day all I can smell is stale cigarette smoke. It is so disgusting.
I am a reformed smoker. I last smoked 33 years ago, my final pack of cigs hitting the trash bucket at the same time as my first positive home pregnancy test. It was tough to do, no doubt about it. I just don't get that people with kids think that they are not exposing them to the dangers of third-hand smoke by merely smoking outside. The chemical residue clings to clothing, skin, hair, furniture, and builds up in the car. If you are "only smoking outside", you are exposing your family unnecessarily to harmful toxins.
OK. Off my soap box.
Sunday, May 13, 2012
No Filters
I have had people call 911 from the waiting room on many occasions, usually by disgruntled individuals with relatively non-urgent complaints who felt that their problem deserved attention ahead of minor complaints such as chest pain. Mostly by people who were not as sick as they thought they were. Some who thought, erroneously, that they would be magically whisked into the back door and immediately ensconsed in a comfy bed, or taken to another hospital. Never, ever have I had an 11 year old female do it for attention.
(Heard on police scanner): "Got a 911 hang up from XXX st., the ER. Came from a phone in the waiting room".
Me: "WTF"??
(Heard on police scanner): "Got a 911 hang up from XXX st., the ER. Came from a phone in the waiting room".
Me: "WTF"??
Saturday, May 12, 2012
Lady, Lady, Lady
Lady is still up to her old tricks; frequent visits (mostly during the day), speed-dialing the patient services rep to complain about some imaginary slight, or for perhaps calling attention to her obesity, poor eating habits and lack of diabetic control cause-effect.
She had some abdominal surgery a while back, but at Ginormous University Hospital in another state. Naturally, because she is a poor healer she had some wound dehiscence. Said hole in her belly has been plugged up on a daily basis by the home care nurse.
The thing about home care is that the patient must, oddly, be at home to receive a service. Lady's home care nurse, understanding what a deep personal relationship we have with Lady, gave us a heads up that we might hear from her. She didn't happen to be home at the time of his visit and she would only be able to stop back at her house late in the afternoon. It depended on his other scheduled visits.
Of course she called to inquire if she should come right down for us to handle her emergent wet-dry dressing change. She didn't know about the call from the home care nurse.
Lady: "Yeah, I'm having some issues with my home care nurse. She's beginning to be a real pain in my ass. She said that just because I missed her visit by 7 minutes she couldn't come back because she had to go way out to Booneysville and it would take her out of her way. That is unacceptable, I was out buying groceries so I could have healthy food for my diabetes, and groceries don't buy themselves. Should I come in and have you change it?"
Me: "No, Lady, your home care nurse is the one you see every day who knows about your wound and how best to do the dressing. What exactly did she say? Maybe that she would TRY to come by and that she would call you?"
Lady: "Uh, um.....well, she's really beginning to bother me. She might be able to come back but she didn't say when"
Me: "It is the weekend, any issues you are having with her will have to be dealt with on Monday. In the meantime, she is your nurse. I suggest you wait until you hear from her. She did say she would try to get back to you, but to be fair, you were not home when you agreed to be there. That's not her fault, is it? And if she had to go to Booneysville waiting around for you when she didn't know when you would be there isn't fair to her or her other patients"
Lady: "Well, so you're saying I shouldn't come in?"
Me: "No, I said wait to hear from her. If she can't reschedule your visit, have her call ME"
Lady: "Oh. So she can tell you how to do the dressing"
Me : "Yes" (actually because I know she will not be calling me which means you will not come in by that big white taxi with the flashing red lights for a dressing change that doesn't need to be done)
Come Monday, two things happened; Lady fired the home care nurse, and the home care nurse stopped by to thank me.
She had some abdominal surgery a while back, but at Ginormous University Hospital in another state. Naturally, because she is a poor healer she had some wound dehiscence. Said hole in her belly has been plugged up on a daily basis by the home care nurse.
The thing about home care is that the patient must, oddly, be at home to receive a service. Lady's home care nurse, understanding what a deep personal relationship we have with Lady, gave us a heads up that we might hear from her. She didn't happen to be home at the time of his visit and she would only be able to stop back at her house late in the afternoon. It depended on his other scheduled visits.
Of course she called to inquire if she should come right down for us to handle her emergent wet-dry dressing change. She didn't know about the call from the home care nurse.
Lady: "Yeah, I'm having some issues with my home care nurse. She's beginning to be a real pain in my ass. She said that just because I missed her visit by 7 minutes she couldn't come back because she had to go way out to Booneysville and it would take her out of her way. That is unacceptable, I was out buying groceries so I could have healthy food for my diabetes, and groceries don't buy themselves. Should I come in and have you change it?"
Me: "No, Lady, your home care nurse is the one you see every day who knows about your wound and how best to do the dressing. What exactly did she say? Maybe that she would TRY to come by and that she would call you?"
Lady: "Uh, um.....well, she's really beginning to bother me. She might be able to come back but she didn't say when"
Me: "It is the weekend, any issues you are having with her will have to be dealt with on Monday. In the meantime, she is your nurse. I suggest you wait until you hear from her. She did say she would try to get back to you, but to be fair, you were not home when you agreed to be there. That's not her fault, is it? And if she had to go to Booneysville waiting around for you when she didn't know when you would be there isn't fair to her or her other patients"
Lady: "Well, so you're saying I shouldn't come in?"
Me: "No, I said wait to hear from her. If she can't reschedule your visit, have her call ME"
Lady: "Oh. So she can tell you how to do the dressing"
Me : "Yes" (actually because I know she will not be calling me which means you will not come in by that big white taxi with the flashing red lights for a dressing change that doesn't need to be done)
Come Monday, two things happened; Lady fired the home care nurse, and the home care nurse stopped by to thank me.
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