Tuesday, January 25, 2011

Molly & Me

I'm still in the breaking-in phase of work at Li'l Old County General.  For me, that has included finding efficient ways to do patient care and chart it without running behind.  I've solved most of the task tracking and equipment issues by developing my own version of a flow sheet and carrying a basket with med administration items.  There is (almost always) a roll of my favorite adhesive tape in there.  I couldn't do nights without my trusty penlight.  People chuckle at my blue basket, but it works.  

Now I have the latest improvement; Molly the COW.  Our unit has numerous portable laptops on Stinger bases.  These allow you to wheel the computer wherever it's needed, raise it to stand and lower it to sit while typing, it has wireless computer interface, and some have an on-board barcode scanner.  It's bulky, but the Stinger has  grown on me, because I can take it with me and chart wherever I am throughout the shift.  I can look at the patient while I chart his assessment.  I don't have to log into a new computer every time I want to chart a note or pass a med.  I don't have to go back to the desk and hope my memory will recall which arm his IV was in, or what time he developed SOB.

So I've been using the Stinger and trying to work it into my nightly routine.  The offgoing nurse frequently offers me a stationary computer "so you won't have to use a laptop," an accommodation I've taken to declining.  The nurses find my behavior mystifying.  My night colleagues get a charge out of seeing me push this thing up & down the halls, while they are tied to the desk.  

One drawback developed the other night when I brought the Stinger into a patient room, and the patient said in obvious irritation, "What the hell is that thing?"  "This," I said in my most winning tone, "is Molly the COW.  She's a Computer On Wheels."  (I made up the name on the spot.)  The patient, an alert 80-something, was singularly unimpressed but the explanation seemed to settle him down, and he allowed Molly to scan his ID band for a morning med.  I'm thinking of decking her with seasonal flowers or big stickers, to see how patients respond.  Valentine hearts coming up soon?

I especially like bringing Molly into the room for admission assessments because I can face the patient while asking 1,000 personal health questions, and chart it on the spot.  Done!  I imagine that one day we'll have the same capability in a computer the size of a Blackberry, but for now I consider Molly my best girlfriend.

Monday, January 24, 2011

Wild Ride Weekend

There was no warning, really, that this weekend was going to be wild, unless you count the number of shifts that had gone smoothly and were *almost* boring of late.  Naturally, something had to give.  

It gave an hour into the shift when the patient threw me out of their room and called for a hospital administrator.   It's the first time I've been accused of giving anyone a snippy answer.  Guess they didn't like my looks.  Their behavior became so outlandish that I had no idea what they might do next.  It turned out to be nothing but a fit of pique.  So that was a ridiculous episode; a tempest in a teapot.  After half a dozen phone calls and a supervisor visit, we traded patients and things settled down.

The second night started out with a pair of undertakers wheeling out the shrouded body of a patient who had passed at the end of the previous shift.  The patient's nurse had come on at 7, so she caught the squeal* on that one, and was looking a bit subdued.  

The night was going well, despite my several ill patients.  One was comatose, with a lot of loose chest congestion and an intermittent cough.  Another's vitals deteriorated every time they dozed off.  A third, with distention and edema, had just finished 2 units PRBC's.  I rounded often and made sure equipment was at the bedside just in case.  Then I gave a few meds and talked with the nurse whose patient had died.  

"Didn't you hear?" she said.  "I must be the angel of death.  That's the second patient that's gone out on me in a week."  "Well, you know how these things run in cycles," I said.  

We haven't had any deaths, or even very sick patients,  since New Years.  Just now we have a preponderance of very ill patients.   One of the many charms of a medical unit.  

It was now near morning.  The floor was quiet, and at that hour you can hear every sound on the floor from anywhere on the unit.  Which is how I was able to clearly hear someone call out my name, in the kind of voice that tells you something is wrong.   It wasn't a medical emergency; death is not an emergency for those who anticipate it.  The patient was simply gone from this life.  

Believe it or not, as many dying patients as I've had, I had never had one die abruptly.  This was a shock to the system.  Another visit from the supervisor.  God bless my co-workers, who prepared the patient to be seen by family, and did it before I could get off the phone with everyone who needed to be called.  The ride that night went on until a second pair of undertakers, this time wearing dark suits and overcoats, wheeled the shrouded patient away.  

We consoled one another, and stories were recounted.   The oncoming nurse, one with long experience on the unit, said she had seen seen many cases of abrupt death.  Even the float nurse had a story to tell.  I came home and had a stiff drink, and slept fitfully.

I just knew the third night was going to be either a bloody bore or something else bizarre.  I put in a foley, assessed four patients, gave two meds and two prn's for pain and then we had a minor staffing crisis.  The patient we had been told was coming from the ER did not materialize, and now we were overstaffed.  You know what that does to the budget.

So I was floated to the telemetry unit, where I had never been before.  I don't do telemetry, but after meeting Frick & Frack, the Stepdown Boys, I'm ready to learn.  I took report, did a bed check, ate some lunch sitting down, and later had time for a cup of coffee before doing a nurse lab draw and am meds.  I was actually able to sit down and eat without having a chart in my lap and a keyboard in my face!  What a great night!

*British slang meaning to take the call for an emergency.

Monday, January 17, 2011

Post-Holiday Slump

I hate the Grey Days of January & February.  We've been slow at work, too; people have been placed on-call and called off every day for the past two weeks, as if the patients themselves wanted to avoid going out.  Then it began to snow and suddenly the ER filled up and we admitted three patients overnight.  I'll never understand human behavior when it comes to hospitals and snow.  Did everyone wait to have the PNA/UTI/pancreatitis so they could be in hospital while it snowed?

The last snowstorm dumped 10-12 inches on us and the county authority is complaining bitterly about the cost of scraping and sanding the roads.  It's sleeting again so here comes more road mess.

The one bright spot has been floating to Ortho, where I was welcomed.  I found someone had created a full set of patient care protocols, which made the night go more smoothly than expected.  I actually enjoyed myself, pushing a Stinger portable computer into patient rooms to pass meds and chart assessments.  Even though it got busy at 0500, it was still a manageable shift.  I gathered some ideas I will use when back on my own unit.  Comparing my Ortho experience to the other unit, I observed how much more random detail is required on medical.   It's a wonder we ever get anything done.  When I see how far medical has to go before patient care will proceed smoothly, I am daunted.