JCAH In the News again.

Where To Go

We have boxes and arrows
And flowcharts galore,
Which is a sure guarantee
It will mean a new chore,
And when two chores a month
Are introduced with regularity,
It becomes quite a challenge
To a Nurses dexterity.

I’m not pointing fingers
Nor assigning any blame,
Although I suspect there’s a connection
With that famous Jayco Game,
It’s a bit like Monopoly
Hooks-and-Ladders, and Chance,
Dress up in your Disco boots
Start the music, let’s dance.

With our arrows and boxes
Pointing sideways and down,
We can tell them where to go
When Joint Commission comes to town.

Fibril_late;
5/28/09

HNNK/DKA - Thats a mouthful, isn't it? For some reason, what used to be HHNK (Hyperglycemic Hyperosmolar Non-Ketotic : Diabetic Ketoacidosis, has been renamed HNNK) ....sounds like Mary Poppins is at work here, huh?

Anyway, at our facility, some BODY has chosen to vote in the HNNK, abbreviation, and it still means the same thing, but the initials don't really work out. Whatever!

To those of us who are shackled with doing fingerstick blood glucose tests every 30 to 60 minutes, I assure you, we recognize it as SOS.

Yes, that means:

Same Old Ship

HNNK
Used to be HHNK,
Don't ask me why
They didn't say,
It still is packaged
With DKA wrapping,
And you read about it first
Where everyone is crapping.

I can hardly wait
For the next revision,
As usual, it won't be
Our decision,
We're just the folks
Who play by the rule,
That's what they taught us
Back in school.

HNNK
It sounds like a ship,
Ready to sail
On its maiden trip,
But ask any sailor
It's the same old boat,
As ready to sink
As it is to float

HNNK
Three pages of orders,
So entirely typical
With these types of disorders,
No doubt derived
By an oversized committee,
And as slaves of the document
We beg you, have pity!

Fibril_late;
5/24/09

This topic has caused another poem!

HNNK Revisited

This HNNK thing
Is a document to admire,
Dr. M, is promoting it
So we'll save it from the fire.

As stubborn as we are
I guess we'll take it for a spin,
That previous HHNK thing?
We'd had it up to the chin!

Mutiny had previously been scheduled
To arrive, June 4th, oh-nine,
HHNK orders, were getting keel-hauled
And afterwards, pickled in brine.

Perhaps our bitching and moaning
Finally passed the deaf ears,
It overstepped many a brain
Misfiring on 10 gears;
Because................
Reversing acidosis
And tweaking the glucose,
Is not a refined science
No, that doesn't even come close,
To describing the ways
The problem has been addressed,
As if every 5 years
It's another new test,
Of our capacity to follow
Convoluted orders and a hot new plan,
When we know good a well
We're back where we began.

This HNNK treatment thing
Is a sight to behold,
By the time we understand it
Most of us will be too old,
To prepare for the next version
Due in seven years,
Retired by then, anyways
We'll reminisce over a few beers.

Fibril_late;
5/27/09

This poem dates back to about 1980, and it's a real classic.

Ode To Gomer

What do you see, Nurses
What do you see?
What are you thinking
When I take a pee?

Did you notice my bladder
Distended and firm?
And that thing in my stool
It looked just like a worm.

Did you observe that my sputum
Was crawling and green,
Can't you see I need treatments
On my breathing machine?

I'm nauseous and nasty
Whoops, up comes my brunch,
Please save it for me
I'll have it for lunch.

That IV solution
Is really poison, you know
And you're trying to kill me
But I won't let go.

I'm calling my lawyer
To represent me,
I'll have you all jailed
And I'll be set free.

Oh my God, my heart's pounding
Like it's hitting my rib,
And I hear a loud voice announce
"Look, it's V-fib"!

Someone's thumping my chest
As ribs crack, one by one,
Why is everyone smiling
Like this is all fun.

Now I'm just an old body
Lying limp on this bed,
The crowd sighs with relief
'Cause this old gomer is dead.

Fibril_late;
1980?

Now, from the not so good ideas department. In this day and age of "names that catch the attention", why would Sister Euphemia allow her Pharmacy to name a new directive, "Pharmacy Profiling"? I immediately thought of "racial profiling". Duh!
So, what in the heck is Pharmacy up to, with their brand of profiling?!? I sure don't know, but I have at least one idea.

Pharmacy Profiling

Pharmacy profiling
Is the latest aberration,
Delivered by a department
Famous for obfuscation,
After numerous MERP alerts
And countless Pharm-a-grams,
They are pulling out the stops
And kicking out the jams.

Pharmacy profiling
Am I on their list?
Are they hunting down perps
Regarding meds that were missed,
Planning pointless punishments
For punks such as me,
Pharmacy profiling
Will be a catastrophe, you'll see.

Pharmacy profiling
I'm worried a bit,
Big Brother is watching
They're profiling my shit,
Luckily, I'm devious
Sneaky and sly,
Profiles be damned
Will be our battle cry!

Fibril_late;
5/15/09

A Poem Inside

When there's a poem inside
And it's sneaking out,
It might make a little squeak
Or exclaim with a shout,
Sometimes with a holler
At other times a whisper,
At times with a crunch
Like lettuce in a crisper.

It's very spontaneous
With a little assistance,
Words chosen at first
Take the path of least resistance,
With quite a few readings
The words sort themselves out,
I'm happy with the result
Or knock it over with a clout.

It might land in a trash-heap
With potato peels and rice,
Or find the desk of a publisher
Who turns out to be nice,
And in most cases the writing
Will find a way to be fun,
Just one page or two
And then it's all done

Fibril_late;
5/12/09

Loose stools.........certainly a problem!

Loose Stools vs. Loose Schools
Part 1

I think I’ve discovered
The answer for the ages,
After studying diligently
Well over 5000 pages,
A query frequently posed
Regarding loose stools,
It originated I’ve discovered
From those days of loose schools.

All sorts of problems
Can be traced to those times,
And I assure you, it's difficult
Making all of these rhymes,
Regarding a topic like this
But I shall prevail,
Loose stools need a solution
There is no room to fail.

Fibril_late;
5/12/09

Dementia: out in left field, scrambled, discontinued, broken neuronal connections in the brain, and currently irreversible.

Into This Moment

Happily demented
You don’t know what you’ve missed,
Live the moment right now
Forget who you kissed,
You don’t know your daughter
Your husband or son,
You live the moment right now
And it all seems like fun.

Happily demented
You won’t realize that you’re lost,
You could shop every day
And never know what it cost,
So just sit on the porch
Reminiscing the past,
Time condensed into this moment
Until death, shall it last.

Fibril_late;
5/12/09

SNF - We pronounce it like the word "sniff". The abbreviation translates to "Skilled Nursing Facility". Sad to say, but long-term care facilities are commonly colonized, along with their patient population, by a vast variety of infectious, communicable cooties.

The C-diff Song

She came from the Sniff
With a case of C-diff
We weren't surprised
By that occurrence, not a bit,
Oh, but that smell, it did offend
Forever, without end
Just imagine 12 hours of that shit;

Any Nurse worth their salt
Would surely, ponder the gestalt
As if some evil apparition, dogged their trail,
Just by walking in the door
At eighteen-hundred, forty-four
They'd be dealt, the shit assignment, without fail;

They realize, it all depends
On humble beginnings and horrid ends
Who's in charge, the night they both will work together,
Because crappy assignments, seem to follow
With smiley platitudes that all ring hollow
It's just another night to bear the cross and leather;

Gown and mask, booties and glove
There's nothing better, when you're in love
Enjoy it, over and over, all night long,
When you get home, and notice the booties
You will feel like you're covered in cooties,
That's the way it goes, when you dance the C-diff song.

Fibril-late;
5/5/09

It has been a quiet stretch. Work has overwhelmed me with writable dilemma's; however, it took a walk through academia to spark my muse.

*Look, I don't make up sentences like the following.........I leave it to my peers - read within the brackets: (I only respond in rhyme)

["In consideration of our current shortage of nurses and consequent heavy workloads, we cannot afford to adopt new practices, unless they are evidence based"]
and furthermore,
["Evidence-based guidelines can serve as a catalyst for knowledge translation to the clinical arena"].

Come-on, what the FUBAR, are these bumps talking about regarding "knowledge translation", huh? Just think a while on it......

Evidenced Based

Evidenced based
HooRah, HooRay,
Do what the experts say
Tomorrow, today,
They are the ones
Who decide what we do,
But I don't really know them
Any better than you.

Quality control
Based on the best,
They said, they did more than
One thousand plus test,
Who am I to question
I'm just the nurse,
If it screws up, what then?
Of course, I bear the curse!

Evidenced based?
They didn't ask me, not ever,
Perhaps, 25 years
Was not enough to say I'm clever,
After all, I'm not a researcher
I don't have the degrees,
I'm just an AA, RN
Gesundheit! Did you sneeze?

Evidenced based?
It carries some meaning,
Although, I am not sure
Just exactly who they're screening,
The Nurse, or the patient
It's not terribly clear,
I guess, I will know
If I'm fired some year.

Fibril_late;
5/4/09