Wednesday, January 25, 2006

A Plethora of Paperwork

I am an addict.

It is true.

My drug has been available to the general public for five years now. I discovered it a year ago.

Most people can take it without becoming emotionally affected. I, however, am drawn to it as a moth to a flame.

I suffer emotional withdrawal symptoms when it is taken from me, as it invariably is.

I swore I would not become involved again, but my family is co-dependent and encourage my participation. I am often forced against my will to relapse.

At work, I have to sneak into the back room to get my fix. Some of my co-workers know. Others have never discovered my secret.

I'm so ashamed.

It's cruel. It's encouraging. Sometimes, it puts people in the "dawg pound".

I am addicted.....to American Idol.

Please help me.

hhhhhhhhhhhhhh


Life used to be so simple in the ER.

If a patient needed to stay in the hospital, you obtained a room number from Admitting.

You then would take a final set of vital signs to verify that the patient was indeed stable for transport, bring your nursing notes up to date and double check the lab work to make sure that no one missed the potassium level of 9 or the hemoglobin of 1.

A call to the receiving nurse was then placed to give "report", a verbal narrative of the history of the present illness and emergency department course, adding significant historical medical information as necessary: allergies, previous surgeries, etc.

After receiving a litany of 15 reasons why the receiving nurse can't take the patient right then, a negotiation ensues. A time for transport is agreed upon and the patient goes up with his chart.

Oh, how I long for the good old days.

Approximately one year ago, some agency (JACHO?) decides that things must change for the good of the patient! Here is what now must be done before the patient goes up:

  • Report must be faxed.
    • This entails writing the entire report. So, everything that you have just spent hours writing on the nursing notes must be summarized and rewritten on the fax report form. Even I, with my passion for charting, think this is asinine. It is also mandatory.
    • It takes longer to fill out the fax report than it does to verbally report.
    • The only advantage is the nurse can't give you 15 reasons for not taking the patient any longer.
      • In my facility, the policy is the patient comes up 30 minutes after the fax. Oh, and we call to confirm that the fax is on the way. In the beginning they mysteriously weren't received.
        • Okay, in the interest of fairness, sometimes faxes are sent to the wrong floor or a bed number is changed after report has been faxed.
        • And the floor/unit nurses get a 30 minute "heads-up" after the fax and before the patient arrives so they can prioritize prior to getting the patient. Which I know I would greatly appreciate if I worked up on the floors.
    • We tried faxing the nursing notes instead for a brief period, thinking that would cover all the bases, but how shall I put this, not all nurses are thorough "charters" and/or it was difficult to read through to get the pertinent information.
  • We need to practice "medication reconciliation".
    • This means that, when a patient is going to be admitted, an exact list of what medications the patient is taking, including vitamins and herbal supplements must be listed, along with the dosage, frequency and the last time the patient took the medicine. Allergies and adverse reactions are also noted for a second time (first on the nursing notes).
    • The goal is a noble one: to make sure the patient is discharged with the medications "matching" the ones they came in taking, with or without changes.
    • This is all done on a new form that acts as a physician's order sheet for meds (ie they can check to order the drug as written or to not order it.
    • Guess who gets to get all this information ready for admission - yep, the ER nurse. They say the family can fill out the form and sometimes the patients come in with beautiful computerized lists that bring tears of joy to my eyes. But usually the family is anxious about doing that so it falls to the nurse to complete.
      • Oh, and by the way, those beautiful computerized lists? We can't copy them. They must be re-copied, by hand, on the form.
  • Signature recognition
    • On a separate form, in addition to signing your name twice on the nursing notes, you must print your name, sign your name, and designate your work station.
    • Apparently illegible handwriting is making signature reading a lost art.
    • To my blessed delight, my facility no longer requires this form. But for many months this was also mandatory.
So, in one year, three new pieces of paperwork were added to the already hectic activity that accompanies a patient admission. Two of which require the nurse to sit, undisturbed, for a minimum of 20 minutes to complete in addition to all the regular paperwork. We have no recourse but to do as we are told.

I wish someone would tell these agencies off.

Where is Simon Cowell when you need him?



13 Comments:

At 1/25/2006 07:59:00 PM, Blogger 2 Joshua said...

Don't worry. I'll be praying for your swift deliverance from American Idol.

 
At 1/25/2006 08:35:00 PM, Blogger kenju said...

Speaking of Simon, did you see the San Francisco show tonight? He had a hair hung crosswise, didn't he?
I'm addicted to it too, Kim, just like Survivor and Big Brother.....Lol

 
At 1/25/2006 11:47:00 PM, Blogger Unimum209 said...

I love all your vintage nursing pictures, where do you find them all?

We aren't getting Americal Idol this year by the looks of things. Our Australian Idol finished a couple of months ago but it just doesn't have the funk that your show does. Typical of Australian television - just doesn't compare.

 
At 1/26/2006 04:42:00 AM, Blogger Rita Schwab - MSSPNexus said...

Having JCAHO surveyors in your hospital is kind of like American Idol, although certainly less entertaining. There is always a Simon in the group.

Want to tell off JCAHO? They actually allow that (sort of). Keep your eye on this link:
http://www.jcaho.org/accredited+organizations/field_reviews.htm

It's where JCAHO lists open field reviews, i.e. - 'this is what we plan to do, speak now or forever hold your peace.'

Here's your chance to sing for Simon Ms. Kim!

And now ladies and gentlemen - the 2006 American Idol - Cherry Ames!

Rita

 
At 1/26/2006 07:46:00 AM, Blogger Tracy Lynn said...

Hey, Kim, I just wanted to thank you. After I read this post, I went straight into MS Word and printed up a list of my meds, along with dosage and time of ingestion. I'm sure my neighborhood ER nurse will send up a prayer to you as well.
And while I can't think of any off the top of my head, I'm pretty sure there are worse things to be addicted to than American Idol.

 
At 1/26/2006 08:55:00 AM, Anonymous Susan said...

Those medication reconciliation forms send me up the wall! Talk about redundant charting and a big waste of time.

I too have to do negotiations with the floor with every single admit. What kills me the most is when the nurse can't take report, but neither can the charge nurse or any other nurse on the floor. What's that about?

Thanks for once again letting me vent.

 
At 1/26/2006 09:11:00 AM, Blogger Jo said...

Hi, My name is Jodi and I too am an AI addict.

I live viacariously through those girls. I wanted to be a singer too. (They've come to Austin a few times, I was always just over the age limit, but I'm not quite what they are looking for anyway)

In my hospital, I often work the unit desk which includes the responsibility of signing off admit orders. (charge nurse re-checks them after) We have the signature sheet and The MAR reconciliation. The ER doesn't fax though (sorry, I wish they did, it would give me a headstart on ordering diet, labs, etc) They carry the entire chart with orders up with the patient.

The process is:
The ER "bed aheads" a patient (a tenative reservation)

If patient does indeed get admitted, then the ER (usually a couple hours later, which is fine) calls to get a room assignment and tell us they are calling report to our voice mail system.

The charge takes the bed ahead and gives the room, I usually get the notice that they are calling report. I notify the Nurse getting the patient and the ER has to wait 20 minutes after calling report to bring the patient.

If we are in "Code Max" mode, meaning the hospital as a whole is getting slammed and the ER is diverting, then the ER is allowed to bring up patients at will with one quick phone call of warning. That leaves the units and the house supervisor to figure out what to do with them. (usually means more patients transferring to other floors, patients who can be discharged are done so in a hurry, etc).

Crazy huh? Our ER is coveted amoung Nurses in the area, a lot of my classmates and associates want to work there.
Not me, Trauma centers are just not my forte'

 
At 1/26/2006 09:50:00 AM, Blogger Fat Doctor said...

"Hi, my name is bigmamadoc, and I am addicted to several reality shows."

I hear ya, sister!

 
At 1/27/2006 05:31:00 AM, Blogger MommaK said...

HA!! I'm an Idol addict too. Nice to know the affliction doesn't skip those in the health care profession. Thanks for stopping by. I used to live in the SF area. Oh how I miss it!

 
At 1/27/2006 09:50:00 AM, Blogger Jillene said...

Sorry about your disgust with Medication reconcilation but it is a necessary evil...we (pharmacy and I am sure you) want to keep people alive and drug interactions and misadventures kill them. A solution to your problem and something that we are working towards at our hospital is having a pharmacy staffer do med. reconcilations. Specifically we have pharmacy interns do this...we really like and know alot about drugs and talking to patients. This works pretty well. Do you have clinical pharmacists floating around your hospital or possibly in your ER?

 
At 1/27/2006 04:02:00 PM, Blogger may said...

and for the life of me, i will never understand why we need to lock the saline flushes...

 
At 1/27/2006 07:25:00 PM, Anonymous nephronurse said...

I, too, am an AI junkie. Did you see this week's show from San Francisco? I saw a trailer for a movie starring Hugh Grant as a Simon Cowell-like character and a show called American Dreams. Wish I could remember the title now. It looked pretty good.

The paperwork explosion continues unabated. A patient has to sign their name on 17 separate documents to be admitted into my dialysis program.

 
At 1/28/2006 08:43:00 AM, Anonymous donorcycle said...

HA, HA! I always said that it takes 3 calls to get a patient upstairs-the first one so they can tell you the nurse taking report is busy, but will call you back. Which never happens. The second, where they put you on hold until you lose the will to live. And finally, the third where the nurse reluctantly gets on the phone after threats to call the nursing supervisor. Ahhhh, the thrill of it all. I agree, faxing report stinks for all the above reasons. And why does the ER do the med reconciliation. In our hospital, the floor nurse does it.

p.s. my addiction is Project Runway. Hang in there sister!

 

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