Regarding our EMR (again).

When we started this thing 3 years ago, there were several layers of experts, trainers and learners. I took a week of training, and became a "Super-User", because I have a bit of computer aptitude. But the guru's of training were called "Red Shirts". Most of them were cool, professionally sharing their expertise, but there was/is a rare bird, that has the obnoxious, "red-shirt egotism", that persists even to this day, now 3+ year in practice. I bumped into one of those birds today, and quite frankly, after her little bit of "teaching", my feathers were ruffled.

O.C.* Agent Three

A dressing down
By Agent Three,
She said, “I’m a red-shirt
So, do like me,
You must chart exactly
The way that I teach,
Because this is is my ocean
And I own the beach.

OK, there’s your way to teach
But seven ways to record,
All of your obsessive details
That eventually get stored,
Into this medical record
In our digital age,
But I won’t guarantee
That it’s on your favorite page.

You want Stepford nurses
Charting perfectly, O.C.?
Go looking somewhere else
Because that surely isn’t me

*O.C. = Obsessive Compulsive

Fibril_ate;
9/30/11

Back in July I wrote about a friend who had a back surgery, and 48 hours of dismal nursing care. Today, I think I wrote the last poem about the debacle. Check it out.

Condolences

They sent me condolences
Addressed to a different name,
So, was the letter truly for me?
Oh, it's such a guessing game.

After all, I was owed an apology
For some two-month old transgression,
A mismatched name to my address
Doesn't leave a good impression.

But perhaps, it's an appropriate ending
Case closed; such a messy ordeal,
I'll never step foot in that place again
And I'll tell all my friends how I feel.

Fibril_late;
9/29/11

Most of us working at big hospitals are now using some sort of EMR (electronic medical record). I am only familiar with one of them, a product from the company, Cerner.
The complexity, layers upon layers of charting, and often, processes that don't make a whole lot of sense to the end-users, are actually setting the stage for more medical errors. Of course, the buyers of such products, and the sellers of the same, would like the public to think, that every step we take in the digital world, somehow makes their precious lives safer. Not so, and you know it.

Let's take a look at one of the biggest boondoggles, "medication reconciliation".

Reconcile Redundancy

The greater the complexity
The number of steps in an equation,
The more likely a random chance
To make a mistake on any occasion.

It's an engineering problem
Mathematical in a sense,
The more steps it takes to accomplish a thing
A greater opportunity for an offense.

And that is our state of art
In the realm of medication reporting,
The repetitive steps to reconcile
Redundant, reiterative, resorting.

Take a look at our typical patient
Age 62, Diabetic and over-weight,
He has high cholesterol and gout
And he's here, to learn his cardiac fate.

He has three doctors on tap
Primary, secondary and another,
Fourteen medications and 32 pills
All organized by his dear old mother,
Maybe I'm lucky and open the chart
Finding a medication recording,
Although, just how reliable that might be
Nonetheless, it is somewhat rewarding.

Hopefully, the guy is carrying a list
Otherwise, we're totally screwed,
Because I am supposed to record all the details
From this stressed-out, forgetful dude,
When did you take it last, what day, what time
How many milligrams, sir?
Muddled he looks, then he points at his mother
Saying, “I think you better ask her”.

But here comes the crux of the problem
And it really doesn't make any sense,
His home meds will be merged with his hospital drugs
Then we toss them all, over the fence,
Each time he goes to a procedure
Every time he comes back to recover,
We have to perform another reconcile
Like trying to save an old lover.

His fourteen meds, and today's seven drugs
Keep shifting around in the bag,
What are the odds that I'll make a mistake
And select the improper tag,
Pretty damn likely, I'm telling you
When a system is built, in this way,
How many times will I reconcile
Three times, and that's just today.

With all of the hype about Patient Safety Goals
We're battered and bludgeoned with these themes,
If a problem is “solved” with a complex solution
I tell you these are only pipe-dreams,
More problems created, more mistakes out there waiting
Software written and then sold, as the best,
But the engineers writing this nonsense
Are not the ones putting it to test.

So if they come after me, because I made a mistake
I'll point an accusing finger at Cerner,
And ultimately, the exemption that I will claim
Excuse me, I'm just a slow learner.

Fibril_late;
9/28/11

We have all seen the “Companion” animals in the hospital; usually a cat or a dog. And it is becoming ever more common, to see people carrying or walking dogs, in almost any store in town. I suspect that business owners are afraid to speak up against it, because the next thing they know, the SPCA or PETA will be protesting outside their store, trumping animal rights. Fine! If it's all right for your cat or dog, it better be hotsy-totsy for my hamster.

Three Bites

Too many frickin' dogs
Wherever I go,
I've seen them at the pharmacy
And the motion-picture show,
Teacup-poodles at Costco
Handbag-bassets at Taco-Bell,
To, us cat aficionado’s
It feels like canine hell.

I plan to protest
I propose to fight back,
We cat and rat-lovers
Have to take up the slack,
And each and every one of us
Who prefer rabbits and hares,
Need to get out in public
And show that somebody cares.

If I'm ever in the hospital
I'll send my wife
To “Rent-a-Rabbit”,
Because too many dogs
Have become society's bad habit,
I'll need my helper-hare
And I want my comfort-cat,
And he wants his ever playful
Laboratory rat.

I want equality
For the animals that visit,
No more chance for discrimination
When people say, “what is it?”,
A biped, a quadruped
A uniped, who cares?
Because there once was a time
When even dogs, would bring stares,
So the future is bright
And those dogs will take a lickin',
Because after my rabbit
I'm bringing a chicken.

Canine-companion
Ain't got nothing on me,
Just wait till they see
My helper-wasp and my bee,
The Cockatoo speaks Spanish
And my Coyotes that howl,
Whenever the nurse
Brings some soap and a towel.

Some say I'm like Doolittle
But in fact, I do a lot,
Equality of animals
Is hotter than snot,
And according to the Baboons
From Animal rights,
They fully support my stance
And give it, “Three Bites”.

Fibril_late;
9/26/11

People are patients and just like all the rest of us. Sure, going to the hospital is stressful, and maybe you really are totally fubar..........but why treat your doctors, nurses and everyone who want to help you, like crap.........why cuss and swear at us? Because you are evil. It's that simple. Inside hiding, is your nasty little self.

Foul Air

I see the wholeness of people
In their most vulnerable position,
No matter how they arrived
They have a medical condition,
They are stressed, they're in pain
And sometimes angry, to boot,
Some of them will abuse their caregivers
Like hunting animals to shoot.

And the real nature of who they are
Will be revealed without blindness,
Most rise above their afflictions
With beauty and kindness,
But if they are petty and nasty inside
And lived life with a bad attitude,
No amount of pain-killer
Can make you feel better, dude.

Why take it out on us
Those persons assigned to give you care,
Why disturb the atmosphere
With your cussing, cursing air,
Why address me with foul language
Essentially I'm there, at your behest;
Your evil Karma
Is just my daily test.

The sordid nature of your soul
Beneath your beat-up bod,
The true nature of your personality
Like dirty, worn out sod,
Striking out at your caregivers
And calling them foul names,
If this is your idea of control
It is the stupidest of games.

Perhaps you always felt inferior
And now you're the superior witch,
Perhaps you always felt downtrodden
And now, you're just an angry bitch,
Perhaps you might think my language
To be foul and uncouth,
Yet, you use those same names
Toward your caregivers
Those fresh young angels of youth.

No one wants to see you
And no one wants to talk,
No one wants to hear
Your foul, angry squawk,
No one wants to care for you
But we do, because that's our job,
And really all I can say is
I feel sorry for your husband Bob.

Fibril_late;
9/22/11

Ok, so maybe I need to proceed cautiously, now that I'm in new territory; at least until they understand that I am super-nurse..............

Good Advice

Sometimes the trouble
With so much experience and knowledge,
When one feels like a post-graduate
From the autonomy college,
Perhaps I was acting too loose
When the blood pressure was dropping,
“You should have called me”, said Doctor
After all, I wasn't out shopping.

I'll take that good advice
And be more careful next time,
To avoid future antagonism
And perform a little more sublime.

But ultimately
No harm was done,
The patient went home
Feeling, the happy one,
She thought that her care
Was exemplary and super,
Looking as fit as a fiddle
For a low-ejection-fraction trooper.

One might ask, were my actions
Too happenstance and loose,
Was some evil done
Or some kind of abuse?
No, none of those things
In fact, all ended well,
But I'll call the doctor in the future
So I won't catch hell.

Fibril_late;
9/16/11

Last Night

Here's what happened on the last night of work, over at the previous job.

My patient had undergone a VAT (video assisted thoracotomy), and had previously been using Oxycontin frequently at home. Post-op she had a Q-pump with a local anesthetic infusing into the rib area, she was on a basal-rate Dilaudid PCA, and popping an Oxycontin every four hours.

Apparently she was on Klonopin for an anxiety disorder; and quite obviously, this woman was on a lot of drugs at home. So I'm thinking, that when I told her she was getting her Klonopin, but really it was a Pepcid, the placebo effect was fully operational. She went right to sleep; later telling her daughter that the Klonopin really helped. Go figure!

Last Night

My last night at work
Was kind of funny,
But I'll wait a year
Before I tell you, sonny,
About the little mistake
I made with one med,
It caused no harm
And no one is dead.

In fact, I might have actually
Saved a life,
Someone's mother
Someone's wife,
When I administered Pepcid
And not Klonopin,
Was anyone hurt
By this omission, this sin?

In retrospect,
I think it was better
II didn't follow the med-profile
Exactly to the letter,
What with frequent Oxycontin
And the Q-pump for pain,
That Klonopin might have
Gone straight to her brain.

Respiratory depression
When that breathing stops,
The rhythms get whacky
And everybody hops,
To the tune of the wild rabbit
Can you think of a better name?
If she ends up on the ventilator
Tongues will wag and fingers blame.

So a Klonopin omitted
I have no sense of guilt,
She got a Pepcid swap instead
And her comfy, hand-made quilt.

8/26/11

When I interviewed, I said that I had probably seen or experienced, every possible Heart-cath disaster/dilemma that one could imagine. Although some of those events were truly scary, they were all learning experiences. I've just returned from my 7th day of new job, and here was the dreaded retro-peritoneal bleed crisis. Sure that happens now and then, but 'tis all the more dreadful when the patient is completely disoriented, suffering from severe dementia and fighting like a trapped wild animal.

Just another terrifying, true story.

Shouldn't Be Done

It wasn't criminal or negligent
But it shouldn't have been done,
Although diagnostically wonderful
Heart-caths aren't for everyone.

Fairly youngish, only sixty
But fate had struck her, many blows,
A brain tumor and severe dementia
There is nothing that she knows.

Pre-cath she wandered frequently
Amidst our busy staging scene,
Frequent searches, where did she go?
She was the rambling queen.

After her cath and clean coronaries
It was our job to pull sheaths fast,
With the application of heavy pressure
On her groin, like a bomb-blast,
She started screaming and writhing
Fighting, kicking and trying to sit,
I'm telling you, it wasn't pretty
And all hell broke loose, I admit.

Two nurses pinning her down
One giving drugs to relax,
Blood pressure dropping to sixty
Pale and diaphoretic, those are the facts,
I saw the hallmarks of bleeding
Internally, that was my thinking,
Because I've taken this boat down the river
And I know the signs when they're sinking.

IV fluids wide open for volume
A little drug to quiet this poor lady,
Tachycardia was soon our companion
Her skin was so pale and too shady,
A Rapid Response was called overhead
What the heck, have some friends drop in too,
Get a couple of other, hot opinions
We better do something, before she's blue.

An emergency call to the Cath-Lab
Where her doctor is working on some other guy,
Ya, sure, take her down for a CAT-scan
That sounds like a good thing to try,
With the nurses running out the door
Racing that gurney down the hall,
Sure enough, she was sure bleeding
She won the ICU bed after all.

It wasn't criminal or negligent
But it shouldn't have been done,
Heart-caths are clearly, quite dangerous
Not frivolous exercises for fun.

Fibril_late;
9/9/11

There's nothing wrong with busy...........it keeps nurses off their phones, off Facebook, and makes the time fly. But sometimes if you look in on it, chaos will be your impression. The new job is a bit of all that

The Wild Magician

It's a dance, it's the rhumba
It's some crazy samba, my friend,
In the middle of the day
It's seems like there is no end,
At five in the morning
You might think you know these folks,
But they're just passing through
With all of their nervous jokes.

Let's take a moment to examine
To summarize the outpatient condition,
They are told to arrive two hours early
So we can prepare their admission,
Hopefully, they arrive promptly
To give us time to do their prep,
In theory, we're a well oiled machine
With everything going step-by-step.

Unfortunately, in real time
We dance to the tune of the wild magician,
From the doorway, it looks more like chaos
Combustible and approaching ignition,
Patients are waiting beyond the time
There were informed regarding appointment,
Because of an emergency with Billy Bob Borko
Extreme Unction, consecration and anointment.

But eventually this day shall pass
The most that need be done is achieved,
And as long as they continue to pay us
No one shall be aggrieved.

Fibril_late;
9/4/11