Politcal Correctedness

The other night I asked a question of a friend of mine regarding a new employee who he knew.  I wanted to make sure my intuition was correct and that knowledge would hopefully help to prevent a possible unintended gaffe.  I have the infamous “foot-in-mouth” disease frequently, although if I know about things in advance the incidence of flare-ups is relatively rare.  So the conversation went like this:

“So,” I started off rather sheepishly, “Bob, he plays for the other team right?”

“Oh yeah,” my friend said with a grin, “He’s an MVP for the other team!”

Case closed.

disclaimer: it matters not to me.  If anything I just wanted confirmation of a hunch.

Flatulence

I was reading some posts over at allnurses.com the other day when there happened to be one about farting that brought back a rather unpleasant memory.  But it’s funny. Kind of.

I was taking care of this gentleman who was in with respiratory issues.  He had failed his first sleep study horribly and the docs were talking about putting a trach in him to prevent him from dying in his sleep.  As you could guess, he was not exactly svelte.  He was on our unit getting diuresised and working to deal with his heart failure.  The first couple of nights started out cold, but we developed a good relationship and were able to talk about the things that he didn’t even want to consider, like the trach.

After being in bed for sometime he had begun to developing breakdown on his buttocks and we were the lucky ones to clean and dress them.  This was a near Sisyphean task.  Basically he had to get out of bed, drop his drawers and lean against the bed with his butt in the air for us to do our thing.  Turing side to side wouldn’t work as it was supremely uncomfortable for him and the bed wasn’t nearly big enough to do so.  There was no other way to do this.

So I get him to the side of the bed, pants around his ankles, big, white ass up in the air.  If anyone would have come in at the at moment it could have looked really bad.  Just not right.  So I pull the first dressing off and he mutters something.

“What was that?” I asked.

“I have to fart.” he replied.

“Can you hold off…”  brrraaaappp, he farted, cutting me off.

Eyes watering I asked him, “Can you hold off while I clean the wounds?”  He agreed.

I’m finishing up and getting ready to put the dressing on, with my face closer than it should be as I’m measuing for tape.  brrraappppp, pop, pop, pop.

Yup, again.  In my face.

“Oh my God, oh my God, I am so sorry!” he said with a mortified look on his face.

All I could do was say, “Man, what did you have for dinner?!”

He apologized profusely through the rest of the night and I told him that “shit happens” and we ended up both getting a good laugh out of it.  Now every time I do a dressing change on someone’s rear, I keep a gooooood distance.  Not going to get caught like that again!

Fitness Fail!

In appreciation of the sheer amount of turkey I am about to eat…

see more pwn and owned pictures

I too choose cake.  Soon to be basking in a tryptophan haze…yummm….*drooling* turkey.

Giving Thanks

Sure it’s cliche to do a Thanksgiving post, but hey, I live in cliches.  So here we go.

I’m most thankful for my wife.  She is my rock.  I would not be where I am today without her encouragement, support and love.  I love her like nothing else.  And even though we’ve been through a lot, I wouldn’t change who I went through it with.  Even when we’ve had nothing, we’ve at least had each other.  She’s truly The One.

I’m thankful for my family.  They’ve always been there for me/us.

I’m thankful for having a good job in a career I love.  Even though it may sound like I loathe work, I wouldn’t trade it.  I have found my place.  Along with that I’m thankful to have great colleagues who push me to be a better nurse, supervisor and person.  I’m thankful that my manager and the crew have enough faith and belief in me to ask me to be a primary charge nurse.  It’s still an adventure.

I’m also thankful for my patients.  Somehow they manage to teach me something new every day I work.  They also give me moments of laughter, sadness, frustration and pride.

I’m thankful that I live in a great country.  Again, I wouldn’t change a thing.  Even though we went through one of the most contentious elections I’ve seen, it still proves that democracy is alive.  We’re in for a new day in America and I’m excited that I get to opportunity to see it happen.

I’m thankful for my health and that of most of my family.  I’m more than grateful for the nurses and doctor in the ED the other night who took care of my wife in such a efficient and caring fashion.  While I may lash ot a the ED, it is born of frustration, y’all really do rock.  I’m also glad that it wasn’t what we worried it was, but it does add one more worry to the list.

Big thanks to those who read my drivel (all 4 of you…).  Seeing that counter go above 20,000 the other day made me realize that I am reaching out and that I may have something valuable to say.

Thanks again to everyone who touched my life this year.  Now, go get off the interwebs and spend time with your family!  Regular posting will resume over the weekend.  Maybe.

A “Here’s Your Sign Moment”

Was out shpopping with the wife the other night.  During the madness I realized that the holiday season is truly with us.  It was madness.  Crazy busy.  And to help with the increase in shoppers are the ubiquitous temporary seasonal help.  We joked at an old job that the job application for seasonal workers was the “mirror test”.  You hold a mirror up to the applicant’s mouth and if it fogs over, they’re hired.

Gross mis-generalization?  Yes, very much so.  But some of the temps were really that bad at that particluar job.  It didn’t help that brains weren’t needed, just a strong back.

We finished up our adventure and headed for the check-out lanes.  A pierced gent rang us up, not that I have any issue with piercings, but do believe they have a time and a place, and when you’re at work, representing your employer is not one of those.

So the total came up to $13.42.  My wife hands him a twenty dollar bill and 42 cents.  He looks at her completely dumbfounded and says, “But the total is $13.42. You gave me $20.42.”  Totally baffled.

“Right,” my wife responds in her best teacher voice, “I give you $20.42 so you can give me and even $7 back and not have to deal with all the change.”

“Huh?” he mulls it over for a long second, “Oh, right, uh…” as he punches the amount into the till and gives us our change, “Here’s your change. Thanks for shopping with us.”

I wanted to say, “Here’s your sign.” but refrained from doing so.  We laughed all the way to the car.  Such fun.  So much fun.  And we wonder what’s wrong with education in this country when a cashier can’t make simple change on the fly?

Meme me baby!

Keep Breathing just posted on a new meme circulating around the blogosphere.  The rules say thus:

Pass it on to five other bloggers, and tell them to open the nearest book to page 56. Write out the fifth sentence on that page, and also the next two to five sentences. The CLOSEST BOOK, NOT YOUR FAVORITE, OR MOST INTELLECTUAL!

I have an issue with this.  First, I’m on the couch and the closest “book” is a video game booklet.  Second, since nursing school, my relationship with books has been tenuous at best.  Somedays I can read voraciously, other days I have the attention span of a gnat.  Third, I tend to read more magazines than books right now. I get into heavy books so I can only do a couple a year.  Since I don’t have a book handy, I’ll do the next best.  An excerpt from Wired, November 2008:

“From a decommissioned bomb shelter four stories beneath Los Angeles City Hall, this 23-year veteran is singlehandedly hauling the city’s fire department into the Web 2.0 era.  He has about 80 projects in the works – involving everything from Twitter to BlogTalkRadio – that will not only help broadcast urgent information to the public but also gather crucial intel to assist first responders on the ground.”

From, “Smoke Detector: The LAFD’s one-man geek squad.”

Yes, I’m a geek.  That said, I’m not going to nominate anyone else.  But if you want to play along, go right ahead!

Sensational MRSA Headline

How our hospitals unleashed a MRSA epidemic | Seattle Times Newspaper

It says it right there:  MRSA is the fault of hospitals.  If it wasn’t for hospitals, MRSA wouldn’t be so prevalent, wouldn’t be so deadly or such a large issue.  Right.  What a crock of shit.

It mentions nothing abot the over-prescribing of antibiotics.  Nothing of the emergence of the USA300 clone of MRSA in community-acquired infections.  Nothing of the reality that this is based on environmental pressure on the bugs that cause them to acquire resistance in the first place.  No, it’s the hospitals’ fault.

Now I will give due.  We suck when it comes to handling these issues.  And we can do better.  Unfortunately this is a multi-factorial issue and difficult to address whitout pointing fingers.  Wahing hands?  We don’t do it nearly enough.  And nurses aren’t the only culprits.

Physicians can be the most lackadaisical about infection control.

In April 2006, doctors at the UW Medical Center carried personal items from home into sterile operating rooms and dropped them on the floor. These items included backpacks and satchels, made of porous materials friendly to germs. Hospital administrators told inspectors this was “common practice.”

In November 2006, a physician at St. Joseph Medical Center in Tacoma removed his surgical mask during an operation. He had complained it was uncomfortable. Hospital officials told inspectors the physician was a “repeat” violator and had been warned before to keep his mouth and nose covered.

In hospitals, the most common violation is the failure to wash hands upon entering or leaving a patient’s room.

In the worst cases, as few as 40 percent of staff members comply with hand-washing standards. Doctors are the worst offenders, according to confidential hospital records reviewed by The Times.

I’ve lost track of times I’ve seen docs walk into isolation rooms and not don any PPE.  VRE?  MRSA?  C.DIff?  Not a problem, it seems their white coats magically protect them from the all but the worst offenders.  Not to mention becoming a vector in their own right.

While measures like presumptive isolation, isolating anyone who has ever had MRSA, screening everyone on admit my help to slow the rise of the germ in hospitals, it does nothing to prevent it coming from the outside.  All of the MRSA patients I have taken care of, have had it on admit.   It’s why they were there.  In a perfect world, we would have private rooms or all patients.  There would be a fast bedside screening tool for MRSA and other community-acquired resistant germs.  Rooms would be cleaned appropriately and thoroughly.  We would all wash our hands or use foams/gels every single time.  But it’s not a perfect world.  Even in our new unit we have double rooms.  Even though our housekeepers do a pretty good job, there is still the risk of acquiring MRSA from a previous occupant just on odds alone.  It is going to happen.

One problem the article doesn’t address is the rise of the USA300 clone that is present in nearly 97% of community-acquired MRSA infections, most notably in skin and soft tissue infections.  This virulent and nasty strain, with its included Panton-Valentin Leukocidin exotoxin can cause necrotizing fascitis, sepsis and pneumonia.  It’s nasty. But again, like any MRSA, good hand hygeine and terminal room cleaning can help to prevent its transmission inside hospital walls.

While hospitals may have covered up cases and mortality due to MRSA, as shown pretty damningly in the Times article, this not just a focused problem.  It is a multi-systemic issue that reaches across disciplines.  Therefore its going to take a multi-system effort to combat it.

Sick Day

I don’t usually take sick time, but am being knocked out by a nsaty cold.  Sinus congestion, swollen glands, sore throat, cough, just pure misery.  I gutted it out for two days this week, but when they called this evening to say I was in line to be called off, I jumped at the opportunity.  Besides the day charge nurse had seen me this morning and knew I was feeling like shit.

So I’m going to sit back, watch TV, drink some green tea and OJ and generally relax.  Best thing?  I don’t have to go back until next week!

Decent non-pity posts to follow, soon, I promise.

EMR Woes

I said in a previous post that I am part of a team working on a new EMR for our hospital system.  I haven’t yet put down my thoughts on the process except briefly.  Writing about situations and changes makes it easier to digest, it gives me time to mull over what I’m taking in and really process what’s at hand.  I haven’t done that so much, mostly because of the sheer volume of information we’re being exposed to.  Imagine learning a whole new charting system from scratch, in near-minute detail in a matter of hours.  Then imagine you have to make decisions for workflow and behaviors based on a brief overview.  It’s a bit overwhelming to say the least.

Right now I’m guardedly optimistic about it all.  There a great many things in this new EMR that will be incredible.  There’s a lot of things that we’re going to have to change in our current processes to work around the new system as well.  Additionally, there is going to be a radical paradigm shift required for our system to implement it.

One those biggest things is CPOE, or computerized physician order entry.  While this has one of the greastest benefits, it’s also going to require the biggest amount of buy in by stakeholders (yes, I’ve been studying corporate jargo-speak).  I can pinpoint the docs who will jump on it, feet first and be the leaders.  Then I can also target the docs who will have to have their hands held all the way through who will go kicking and screaming to it.  Then there are the middle ground who will grudgingly accept it as a measure of change.  It should reduce a lot of the transcription errors we currently encounter.  No more will we pass the chart around looking for someone fluent in “dr. X’s” scribble.  The responsibilty for the right orders will no longer be on the nurses and the unit secreatary, but rather the doc themselves.  Maybe that will reduce hissy fits as our come back can be, “You entered the order, not me.”

Another cool thing is being able to see what is being charted in the ED prior to the patinet coming up.  We can even see the triage nurse notes for clues to the actual beahvior of the patient.  No more hiding the fact of drug seeking behavior, or drunkeness, or other bad behavior.  We wold be able to see the record from triage on. No more trying to figure out is the patient got ASA in the ED or not. It’s in the electronic MAR.  The lines that are palced in the ED carry over to in-patient status allowing us floor nurses to really see where that IV is (left, right, what’s the diff).

But moreso is the abilty to (in theory) seamlessly see the records from the PCP, the meds, the treaments, all the imaging done in system, all of the intangibles that sometimes get duplicated because we just don’t know if a certain study was done or not.  We can see that they’ve been to the ED 3 times in a 24 hour period, even if it is at different hospitals, or that they followed up per dischrage instruction when they present back to us on the rebound.

No doubt it’s going to be painful.  In the begining I’m sure the amount of time we spend charting will go up.  It will be that way until we (nurses and others) find the right rhythm, where what we need to chart on is located adn how to do it effeciently.  There will be growing pains, for sure.  BUt as it stands, I think it will be a good thing.  The goal is to bring all the disparate systems curently in place, insular systems that rarely talk to each other and flush them away to be replaced by this overarching canopy of a system where it is all integrated and communicating with itself.  I know that it is something we have to do.  In order to keep abreast of the variety of rules and regs that are foisted on us by folks like the Joint Commision and CMS and to be able to provide discreet data to prove that we are as good as we say we are, will be a huge step in the right direction.

I just feel lucky that I’m able to get in at the ground level.  I figured since I was a harsh critic of our current system, I had better put my money where my mouth was and take part inthe process to hopefully prevent the smae mistakes and missteps from happening again.  Besides, it’s cool.

Time Spent With Others

I’ve been spending far too much time on-line with Halo 3.  Yes, it’s nearly an addiction.  I told myself the thrill of fragging folks from around the world would wear off, but sadly it hasn’t.  Somedays I actually look forward to the time when I can sit down and play.  Honestly I haven’t felt this way about a video game for a long, long time.  Is it a bit weird that a 30-something would love to do this?

Not at all.  We grew up with this.  Sure I remember the time before video games.  We went outside to play.  But then I remember the envy of the friends who had the Atari 2600, Colecovision, or even an Apple II.  I can remember the Christmas morning when my brothers and I opened a NES from under the tree.  We spent hours in front of that thing.  To this day I still can’t beat SuperMario Brothers, try as I might, I just can’t.

In college, one guy had a N64 that we hooked up to the big-screen TV in our dorm lounge, which led to long nights of Deathmatch in Goldeneye and 4-way racing in MarioCart.  It also led to social alienation from the fairer sex.  It wasn’t just guys geeking out, it was community bonding.

For a long time, I didn’t play on-line.  It was too expensive and the Internet was too expensive and many places I lived only had access to dial-up.  But whenI bought my 360, that all changed.  There is really something incredible about being able toplay the same game as 200,000 people scattered across the world.  It’s amazing that you can play against 7 other folks in an 8-way Deathmatch.  It truly blows my mind.

It is a nice escape.  For an hour I can just sit and zone out, talk trash and concentrate on nothing but trying to survive.  It’s freeing.  The cares of the day drift away and for a moment the economy doesn’t matter, the election doesn’t matter, the price of gas doesn’t matter.  All that matters is the game and the fun we’re having.  Maybe I’m immature, stunted in my growth, but I beg to differ.  I just have different skills than some.

Here’s a couple of screenshots from games I’ve played recently.

Splat!

My Nads!

There you have it.