Paging Doctor Obvious

I know that your residents have told you in great detail that you must be careful around the nurses. They must be led to the right decisions and when you are not available, be given adequate, concise and precise instructions for the successful administration of medications and interventions to heal you patient. But really? Did you really need to write this order?

Hold lorazepam for respiratory depression or oversedation.

It’s not like we’re going to say, "Hmmm…Mrs. Smith is only breathing 11 times a minute and won’t stay awake for more than a brief moment, but she seems anxious. Maybe I she just needs a little more lorazepam…" Maybe some might though. But the vast majority of us do have the common sense not to do something as boneheaded as that, we don’t need it spelled out for us.

And also, taking 4 hours to write admit orders is just not kosher. Learn to speed it up a bit buddy.

No, we need it now.

Somedays our hospital staff just baffles me.  Somedays they are über-ready to get something done, like the CT tech who calls 30 seconds after you put the order for a CT in.  Other days you call phlebotomy and three hours later they show up to draw a “now” lab.  There’s no consistency.  And when you need something like blood, it’s usually not just something that you can be “meh” about.  Case in point happened a couple of weeks ago.

We had a patient who needed blood.  Badly.  Unfortunately due to their specific disease and numerous antibodies, they needed special blood.  The Red Cross had to fly it in.  Yes, fly it to us and we’re fairly good-sized city.  It’s not like we’re in the middle of podunk backwoods-land.  The blood bank calls us at 1am and says the blood has arrived and we figure we’ll be getting a call soon that it will be ready.  2am, nothing.  3am, nothing.  The house doc comes up asking if the blood has started, he wants it done now.

So we call blood bank.

“Calling about the blood for us up here on 5.  Is it ready yet?”  asks the nurse.

“No, we’re having a problem with the computer and can’t get it ready.” replies blood bank.

“No, we really need it soon.  It’s kind of important.”  replies the nurse.

“Well, you see there’s a probelm with the computer generated tag and I can’t do anything about it.  Only my supervisor can has the right access…”  says blood bank.

“And when are they coming?”  angrily asks the nurse.

“Uh, I haven’t called them yet.  Don’t really want to wake them up, it’s 3am.”  they say.

“Maybe you don’t get it.”  says the nurse.  “My patient’s H/H has dropped to 5.0/16.3 in the last 4 hours that you’ve been stalling on getting the blood to us.  You need to call them.”

“Let me make a call.”  they reply.

30 minutes go by.  The house doc comes by again, still wondering if we’ve started, which we haven’t.  And then comes the cool part.  He calls them.

“Look, I don’t care if the supervisor has to override this or that.  My patient needs blood.  If they haven’t arrived in 10 minutes, I’ll come down there and sign the blood out myself, to hell with your computers.”

Guess  what?  The blood was ready in 7 minutes.  Sometimes having an MD to throw their weight around is a good thing!

Too True, Too Funny

Shoe expedition, part II « Cranky Epistles

I didn’t even know you could get Papagallos, Esquivals and Swarovski-encrusted Converse sneakers for kids. Moreover, why would you want to get crystal-encrusted-sneakers for your kid? What the fuck? What kid can go out and actually play in such ridiculousness?

*snerk* was the sound I made as I blew soda out my nose when I read that.  What?  You actually let kids go outside?  OK, I’m reporting to CPS…not.  Every summer day at 9am it was “go outside and do something, you’re not allowed back in until dinner.”

And the hipster shoe clerk?  We have a legion of those people in PDX, thankfully they confine themselves to dive bars, dive coffee houses, fixie bike meet-ups and indie rock shows.  They would not be working at *gasp* a mall…

We’ve decided that most people have more money than sense.

I hear ya’.  More money than brains.  Isn’t that the American way?

BikePortland.org » Blog Archive » National organization finds that bike-to-school bans are on the rise

BikePortland.org » Blog Archive » National organization finds that bike-to-school bans are on the rise.

Robert Ping, the State Network Coordinator for the Safe Routes to School National Partnership shared a startling bit of information during his presentation at the Safe Routes to School Conference today.

In communities throughout America, students are being told they are not allowed to bike to school.

“It’s pervasive throughout the country and we’re hearing about it more and more,” he said. The problem, according to Ping, is that many school principals and administrators feel that biking and walking to school is simply unsafe. They are concerned about being held liable for anything that happens during the trip to and/or from school.

Used to be I could sit in my paretn’s living room and watch a steady stream of kids walking to the school at the end of the block.  Not any more.  Instead it is a steady stream of cars lining up to drop children off at the school.  I go past a small private school on my way home from work in the morning and during the school year I play a frequent game of “dodge the soccer-mom minivans” as I run the gauntlet past the school.  And walking is unsafe?

An interesting side note is that while the schools are worried about walking and biking to school and the liability it “entails”, it says nothing about the over-active hormone machines known as high school students behind the wheel.

Me, I plan on living near the school where my kids will go so that they can walk or ride their bike to school.  It just makes sense, unless some dipshit decides there is “too much liability.”

Idiots in Charge

I’ve come to the conclusion that the people in charge of things like regulations and billing are some of the biggest morons in our industry.  Worse though, is that they just don’t get it.  They are so far removed from the bedside that they have no clue that adding an extra check box in itself spawns that many more things to click and chart under and then you multiply that by the number of patients you have and the number of times you have to do it. The single click quickly spirals into more than just one click.  That and the rules so often do not reflect the true nature of what we do.

Today while going over charge capture methodology for our Epic transition, one of the billing people said the following, “My clinical experienced is pretty limited, so let me see if I understand this correctly…”  So what’s wrong with that you ask?  She’s in charge of auditing charts for billing/regulatory compliance.  One would think that some degree of clinical expertise/understanding would be required to accurately understand the charts.

And the folks making the BIG rules, CMS, is suffering from such a case of rectal-crainio inversion it’s not even funny.  A perfect example we went over today was blood transfusion.  Simple right?  Drop a charge every time you enter a unit of blood into the computer.  But no, that would be too easy.  For CMS (and thusly everyone else) beleives that you should only get paid per instance.  In other words, per MD order, not number of units.  So if the order is for 1 or 6 units, we get the same thing, even though we do the exact same amount of nursing care for each unit.  Every time we have to double verify, take vitals, stay with the patient for the first 15…each time.  So if it is 6 units, you’re doing the same work 6 times, but really only getting reimbursed for the first.  Makes sense to me!

I still believe that every billing person, CMS regulator, TJC auditor and anyone who writes rules and regulations be required to spend at least a week a year, if not more in the trenches.  No cushy units, but units where they would have to work and be subject to the rules they have enacted.  Then they might not be so regulation happy.

One can dream can’t they?