6/16
The Super Nurse went back to her Mother’s hospital for another care conference. Her favorite nurse told her that her Mom’s doctor doesn’t like to be told what to do- he’ll often do the opposite. But he tends to move slowly, so if you want things to happen you need to push anyway and see if he’ll at least meet you half-way.
The Super Nurse had told him yesterday that she didn’t see the need to check the heparin level every six hours. Per her, once a therapeutic level is reached checking it once a day should be fine. That would reduce the amount of testing needing to be done. The reason her levels seemed to fluctuate before was because they weren’t drawing off the PICC line correctly. He agreed that the sloppy procedure was the problem before, but maintained that testing it every six hours is proper procedure. She checked today, and he changed the order to testing once per day. She trains doctors too. You gotta love her.
The doc told her that he’d talked to hospital administrators about her, now their, concerns. So he did join the crusade. He's an easy-going guy, but the nurses on the unit told her that he'd been the maddest they've ever seen him. Consequently, while she was there a hospital mover and shaker wanted to talk to her. She’s probably caused a fair amount of fear that what she’s seen could result in a law suit. But she just wants her Mom to have good care. If fear motivates them to improve the quality of care it would be okay with her.
The doctor did tell her that a couple of the nurses that had performed poorly were no longer working on the floor, and for all he knew they no longer work in the hospital. She really wasn’t trying to get anybody fired; she’d just like everybody to do their jobs correctly. But she doesn’t feel guilty about it. If they were too lazy to do their jobs correctly when a life was at stake as far as she’s concerned they should be working in a nursing home.
Her Mom continues to improve. She’s talking in a normal tone of voice and is becoming more lucid. But since her chest still hasn’t been wired together she has pain when she coughs. Since her heart is so enlarged they may never get it wired together. It may have to heal on its own, if at all. At least she has Super Nurse for a daughter and advocate; she’ll get the best care possible. And hopefully, so will everybody else.
Thursday, June 16, 2005
Wednesday, June 15, 2005
6/15
Train Boy’s birthday!
The Super Wife asked him what kind of cake he’d like. He said chocolate with white frosting. Chocolate cake? No problem. She made frosting from scratch with Mexican vanilla, but it wasn’t going to be enough. She added whipped cream. It has to be kept refrigerated now, but it IS yummy.
I have this nasty habit of picking things up I see if I think someone will like them. So I had a bit of a stock built up for Train Boy. He got about a half-dozen LEGO kits, including the Star Wars X-Wing fighter. He got a LEGO electric train that he’s always wanted- picked that up on E-Bay, and some computer games. He seemed happy with his loot. He’s a wonderful boy, and I’m happy to over-indulge him.
Train Boy’s birthday!
The Super Wife asked him what kind of cake he’d like. He said chocolate with white frosting. Chocolate cake? No problem. She made frosting from scratch with Mexican vanilla, but it wasn’t going to be enough. She added whipped cream. It has to be kept refrigerated now, but it IS yummy.
I have this nasty habit of picking things up I see if I think someone will like them. So I had a bit of a stock built up for Train Boy. He got about a half-dozen LEGO kits, including the Star Wars X-Wing fighter. He got a LEGO electric train that he’s always wanted- picked that up on E-Bay, and some computer games. He seemed happy with his loot. He’s a wonderful boy, and I’m happy to over-indulge him.
Tuesday, June 14, 2005
Super Nurse had an interesting day. She started with the doctor. She recounted the blood sugar mistake. He was not happy either. The good doctor doesn’t seem to think that his patients need killin’.
She mentioned that a nurse had administered morphine and versed at the same time, apparently thinking that doing so was a good job. Super Nurse opined, ‘She’d already had Tylenol III not even an hour before. Normally you only give versed and morphine right before a painful procedure anyway. Are they practicing chemical restraint here?” She pushed a hot button. Chemical restraint is a big no-no. The help doesn’t get to sedate patients to make them easier to manage. The doctor turned to the nurse in the room with him and said, “You call that nurse and get an explanation of this RIGHT NOW!” The Super Nurse knows what buttons to push.
She elaborated on the poor procedure she’d seen with the PICC lines. Her Mother has a blood infection she just can’t seem to kick. ‘Does it not seem likely the PICC line is contaminated?’ ‘A hospital induced infection?’ (She used the technical term) Another hot button pushed. The doctor agreed and said he’d have it replaced.
She told him she’d written up a list of care problems she’d observed. He said he’d like a copy of the list. He was not aware of any of the problems. Then he said, this is who you need to talk to, if you don’t get any satisfaction then go talk to… right up the line. He was helpful. He almost sounded like he was ready to mount up for the Crusade himself.
Then she went to talk to the floor supervisor. ‘Uh-huh you have concerns.’ “I have a list.” ‘Can I have a copy of the list?’ She went back to check on her Mom. Management started showing up in the room. ‘You have concerns?’ “I have a list.” ‘Can I have a copy of the list?’ It went on that way with a couple other people. She was pleasant, she was helpful, she was their worst nightmare- she knew what she was talking about, and had seen bad things up close and personal. Hell, she was educating their nurses.
It would be interesting to check in on the hospital in a few months and see if any changes have occurred as a result of her free, intense performance review. You have to wonder how many copies of her list are floating around there now.
I’ve told her that she’d be an outstanding nurse manager. She really knows her stuff and has a heart for patient care. She could get a staff to competence and then some. She says she couldn’t do it. She couldn’t bear to give someone a bad evaluation. Even though she just did it for free.
God bless her. She probably saved a lot of lives today.
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She mentioned that a nurse had administered morphine and versed at the same time, apparently thinking that doing so was a good job. Super Nurse opined, ‘She’d already had Tylenol III not even an hour before. Normally you only give versed and morphine right before a painful procedure anyway. Are they practicing chemical restraint here?” She pushed a hot button. Chemical restraint is a big no-no. The help doesn’t get to sedate patients to make them easier to manage. The doctor turned to the nurse in the room with him and said, “You call that nurse and get an explanation of this RIGHT NOW!” The Super Nurse knows what buttons to push.
She elaborated on the poor procedure she’d seen with the PICC lines. Her Mother has a blood infection she just can’t seem to kick. ‘Does it not seem likely the PICC line is contaminated?’ ‘A hospital induced infection?’ (She used the technical term) Another hot button pushed. The doctor agreed and said he’d have it replaced.
She told him she’d written up a list of care problems she’d observed. He said he’d like a copy of the list. He was not aware of any of the problems. Then he said, this is who you need to talk to, if you don’t get any satisfaction then go talk to… right up the line. He was helpful. He almost sounded like he was ready to mount up for the Crusade himself.
Then she went to talk to the floor supervisor. ‘Uh-huh you have concerns.’ “I have a list.” ‘Can I have a copy of the list?’ She went back to check on her Mom. Management started showing up in the room. ‘You have concerns?’ “I have a list.” ‘Can I have a copy of the list?’ It went on that way with a couple other people. She was pleasant, she was helpful, she was their worst nightmare- she knew what she was talking about, and had seen bad things up close and personal. Hell, she was educating their nurses.
It would be interesting to check in on the hospital in a few months and see if any changes have occurred as a result of her free, intense performance review. You have to wonder how many copies of her list are floating around there now.
I’ve told her that she’d be an outstanding nurse manager. She really knows her stuff and has a heart for patient care. She could get a staff to competence and then some. She says she couldn’t do it. She couldn’t bear to give someone a bad evaluation. Even though she just did it for free.
God bless her. She probably saved a lot of lives today.
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6/14
Super Nurse wanted to stay home today but felt like she couldn't after yesterday's incident. A nurse at the hospital nearly killed Clare by shear incompetence. If She hadn't been there they'd be planning Clare's funeral. That's no dramatic exaggeration, the mistake was that big. She was UPSET.
Anyway, Super Nurse had wanted to stay home today for a rest, but after yesterday she doesn't think she has that option. She went back today to watch out for her Mom, and to go head-to-head with the hospital administration over the quality of care that almost cost Clare her life. She is still upset, it was a bonehead error and the nurse insisted it was their hospital's standard procedure. We shall see.
If anyone can shake up a whole hospital to raise it's standard of care it would have to be the Super Nurse. She's knowledgeable, and she can't be bluffed. I'm expecting an interesting report tonight.
I'd say that her family should be grateful for keeping Clare alive yesterday, but she didn't tell them. She didn't want to upset the rest of her family. But she did conduct a free seminar with the nurse on safe and proper procedure. The nurses at the hospital actually like her, several have told her they could use her and she could certainly get a job there if she wanted one. That's not much comfort though.
Super Nurse wanted to stay home today but felt like she couldn't after yesterday's incident. A nurse at the hospital nearly killed Clare by shear incompetence. If She hadn't been there they'd be planning Clare's funeral. That's no dramatic exaggeration, the mistake was that big. She was UPSET.
Anyway, Super Nurse had wanted to stay home today for a rest, but after yesterday she doesn't think she has that option. She went back today to watch out for her Mom, and to go head-to-head with the hospital administration over the quality of care that almost cost Clare her life. She is still upset, it was a bonehead error and the nurse insisted it was their hospital's standard procedure. We shall see.
If anyone can shake up a whole hospital to raise it's standard of care it would have to be the Super Nurse. She's knowledgeable, and she can't be bluffed. I'm expecting an interesting report tonight.
I'd say that her family should be grateful for keeping Clare alive yesterday, but she didn't tell them. She didn't want to upset the rest of her family. But she did conduct a free seminar with the nurse on safe and proper procedure. The nurses at the hospital actually like her, several have told her they could use her and she could certainly get a job there if she wanted one. That's not much comfort though.
Monday, June 13, 2005
6/13
The Super Nurse was back in Davenport, watching her Mom. She took a break, and when she came back she noticed that the insulin had been turned up. That may sound like she’s diabetic, but she’s not. It’s apparently a standard thing to do to patients in an ICU. Blood sugar level has a significant effect on healing, ask any diabetic, so it’s controlled closely.
So the Super Nurse asked the nurse why the insulin was turned up. ‘Because she has a blood sugar level over 400.’ Super Nurse was appalled. ‘She’s not a brittle diabetic. She’s been on tube feedings for weeks. Think. A blood sugar that high is impossible.’ The nurse was sure that no mistake had been made. Super Nurse knew it was wrong. She demanded a retest.
The nurse stuck a needle in the end of the PICC line, made a draw, and said, ‘There, that’s done.’ Super Nurse was even more appalled. She was pushing the appalled envelope. Super Nurse informed the nurse that she couldn’t use that sample- that blood had been stagnant in the line. To get a good sample enough blood has to be pulled through to be fresh, that would take at least 5 cc’s. After discarding that old blood, THEN you take the sample.
Super Nurse told the nurse she wanted the blood sugar test by doing a stick on her Mom’s ear. Her Mom consented. The sample was taken and her blood sugar was…. 43. If a person is fasting their blood sugar might get as low as 80. Clare was well down the road to diabetic coma and death.
Super Nurse was not happy. But knowing mistakes can be made she did not scream or yell. Nope. In the spirit of Christian love the Super Nurse put on a PICC line care clinic. Ya gotta love her. By time time Super Nurse was done the nurse was well-schooled. Unfortunately, the nurse was a poor student. Every time the nurse came in and disconnected the PICC line Super Nurse had to remind her to swab it with alcohol for at least 30 seconds before putting it back together. Every time.
Super Nurse is upset. Some of the nurses have been outstanding, but when you have one that doesn’t know how to safely do the job you fear for the safety of the patient. Super Nurse will go toe to toe with the Administration tomorrow. This could be interesting.
The Super Nurse was back in Davenport, watching her Mom. She took a break, and when she came back she noticed that the insulin had been turned up. That may sound like she’s diabetic, but she’s not. It’s apparently a standard thing to do to patients in an ICU. Blood sugar level has a significant effect on healing, ask any diabetic, so it’s controlled closely.
So the Super Nurse asked the nurse why the insulin was turned up. ‘Because she has a blood sugar level over 400.’ Super Nurse was appalled. ‘She’s not a brittle diabetic. She’s been on tube feedings for weeks. Think. A blood sugar that high is impossible.’ The nurse was sure that no mistake had been made. Super Nurse knew it was wrong. She demanded a retest.
The nurse stuck a needle in the end of the PICC line, made a draw, and said, ‘There, that’s done.’ Super Nurse was even more appalled. She was pushing the appalled envelope. Super Nurse informed the nurse that she couldn’t use that sample- that blood had been stagnant in the line. To get a good sample enough blood has to be pulled through to be fresh, that would take at least 5 cc’s. After discarding that old blood, THEN you take the sample.
Super Nurse told the nurse she wanted the blood sugar test by doing a stick on her Mom’s ear. Her Mom consented. The sample was taken and her blood sugar was…. 43. If a person is fasting their blood sugar might get as low as 80. Clare was well down the road to diabetic coma and death.
Super Nurse was not happy. But knowing mistakes can be made she did not scream or yell. Nope. In the spirit of Christian love the Super Nurse put on a PICC line care clinic. Ya gotta love her. By time time Super Nurse was done the nurse was well-schooled. Unfortunately, the nurse was a poor student. Every time the nurse came in and disconnected the PICC line Super Nurse had to remind her to swab it with alcohol for at least 30 seconds before putting it back together. Every time.
Super Nurse is upset. Some of the nurses have been outstanding, but when you have one that doesn’t know how to safely do the job you fear for the safety of the patient. Super Nurse will go toe to toe with the Administration tomorrow. This could be interesting.
Sunday, June 12, 2005
Whine at me: publicserf@yahoo.com
I had a nice moment today, Sunday. Super Wife showed me a questionaire that Ms. Pikachu had done at school. One of the things was "Most Admired Person." Yup, she wrote, "My dad." Apparently that's what I get for giving her chocolate when she craves it. Everybody has their price, you just need to know the currency.
This evening I told Super Wife that we should do something for Train Boy's birthday. With Ms. Pikachu it was always a big 'something.' I told her that maybe on his birthday we could take him and his friend Benjamin to Chuck E Cheese. She thought that wouldn't work- his birthday is on Wednesday, and Ms. Pikachu has Youth Group on Wednesday nights. I said that's ok, she doesn't want to go to Chuck E Cheese anymore anyway. Just taking the boys would be fine, and it would be a special day for Train Boy. So will you call Benjamin's mom and ask? "Not today, tomorrow." Why not? It's only nine o-clock on a Sunday evening, do you have reason to suspect they're normal? Well, at least I tried.
It wasn't much of a Sunday, almost ninety degrees and I mowed the lawn. Sweat City. The Super Wife is happy to have the lawn cut as short as the neighbor's, so it was worth it. Admittedly, a rancher asked about grazing rights, so maybe it did need a cutting. So she was happy about the lawn, but not for long.
She talked to her sister to find out how their Mom is doing and was told that now Clare has a bacterial blood infection. As if enough hasn't happened already. Super Nurse is just sure the infection was caused by sloppy procedure on the part of Clare's nurses. They routinely disconnect the PICC line to make their work easier. The problem is that every time they disconnect the line it's another risk of infection. Do it a lot, and infection almost becomes a certainty. Super Nurse says that where she works PICC lines are only disconnected if absolutely necessary, and then they're swabbed with disinfectant for at least thirty seconds. At the hospital the nurses just give it a quick wipe and slap it together. Super Nurse is REALLY NOT HAPPY. Tomorrow she's going to drive back and talk to the nurse manager about their lack of sterile procedure and unacceptable PICC line protocol. Oh, to be a fly on the wall.
I have a feeling that by the time Clare is out of there Super Nurse will have made her impact felt on the whole hospital. She told me she was considering calling JCAHO and explaining the situation to them. Conceivably, that would result in the American Hospital Association auditing the hospital for proper procedure protocols. While I understand her anger over this happening, calling JCAHO is like retaliating with the nuclear option. Are you sure you want to do that FIRST?
She's really not happy though. She said some of the nurses don't belong in an ICU. The ICU should be the nursing cream and she thinks some of the nurses would hardly be acceptable in a skilled unit, and marginally tolerable in a general medical unit. She's slow to say anything bad about anybody, so it says something about how she perceives things there. Some of the nurses have been outstanding, the quality has just been maddeningly uneven. Why yes, Super Nurse SHOULD be a nurse manager.
Earlier today Ms. Pikachu was demanding that we take her out and let her drive something. Super Mom has done this in the past- she'd go a business that was closed and let Ms. Pikachu drive around the parking lot. She's getting antsy, she wants to drive NOW.
Super Mom is still having wrist and shoulder pain. She was discussing that with someone she knows and the other woman suggested that cherry juice can be helpful in reducing inflammation. So, tired enough of the pain to try anything, she bought some. When I got home that evening Ms. Pikachu asked me if I’d bought it, “That’s nasty stuff Dad.” Okay, I’ve been warned.
When Super Mom got home later she recounted her conversation of how it was recommended, and said I should have some. Do I look inflamed to you? Whatever I need, cherry juice probably isn’t the answer. I drank some anyway, because it was my husbandly duty. Duty, Honor, Super Wife.
The stuff is as thick as syrup and it’s like drinking cherry pie filling- we’re talking Verry Cherry, quite tart, intense. It’s not the kind of stuff where you say, “Barkeep, I’ll have another, and make it a double.” No, this is sippin’ juice, or lickin’, because it IS that thick. But it would probably be good to cook with. Putting it in a chocolate cake might be wonderful.
Anyway, when we had lunch today I poured the kids a Sprite. I thought a little cherry juice might make it “punchy” so I got it out. Ms. Pikachu saw it and yelled, yes yelled, “Not in mine, that stuff is evil!” I put some in mine, tried it, and thought it quite tasty.
I asked her if she’d just like to have a sip to try it, “Uh uh, get that stuff away from me.” I offered it to Super Wife, she liked it. I said, “See, I like it, and your Mom likes it.” That got an adamant “You two are freaks.” “Well, then that would explain YOU.” My but we have fun.
Where was Train Boy in all this? Supplying background sound effects. He seemed to spend every available moment putting both wrists together, then blowing against them to make farting noises. Apparently he was sound editor on a reality show where flatulence was the punch line to everything. On the way home from church? Farting noises. Sitting at the table to eat? Farting noises. Oddly enough, the only time he didn’t make farting noises was when he was in the bathroom.
My Dad probably would have known what to do, but I didn’t. All the noise had my nerves on edge, I was stressed. Don’t explode, don’t say something to regret. So, what to do? In desperation I put on my best Wise Father Knows Best demeanor and said, “You know, if you keep doing that, some day you’re really going to fart like that, and nobody is going to believe you.” That got a laugh, and that was the last of the day’s farting effects. Being a parent often isn’t what you expected at all.
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I had a nice moment today, Sunday. Super Wife showed me a questionaire that Ms. Pikachu had done at school. One of the things was "Most Admired Person." Yup, she wrote, "My dad." Apparently that's what I get for giving her chocolate when she craves it. Everybody has their price, you just need to know the currency.
This evening I told Super Wife that we should do something for Train Boy's birthday. With Ms. Pikachu it was always a big 'something.' I told her that maybe on his birthday we could take him and his friend Benjamin to Chuck E Cheese. She thought that wouldn't work- his birthday is on Wednesday, and Ms. Pikachu has Youth Group on Wednesday nights. I said that's ok, she doesn't want to go to Chuck E Cheese anymore anyway. Just taking the boys would be fine, and it would be a special day for Train Boy. So will you call Benjamin's mom and ask? "Not today, tomorrow." Why not? It's only nine o-clock on a Sunday evening, do you have reason to suspect they're normal? Well, at least I tried.
It wasn't much of a Sunday, almost ninety degrees and I mowed the lawn. Sweat City. The Super Wife is happy to have the lawn cut as short as the neighbor's, so it was worth it. Admittedly, a rancher asked about grazing rights, so maybe it did need a cutting. So she was happy about the lawn, but not for long.
She talked to her sister to find out how their Mom is doing and was told that now Clare has a bacterial blood infection. As if enough hasn't happened already. Super Nurse is just sure the infection was caused by sloppy procedure on the part of Clare's nurses. They routinely disconnect the PICC line to make their work easier. The problem is that every time they disconnect the line it's another risk of infection. Do it a lot, and infection almost becomes a certainty. Super Nurse says that where she works PICC lines are only disconnected if absolutely necessary, and then they're swabbed with disinfectant for at least thirty seconds. At the hospital the nurses just give it a quick wipe and slap it together. Super Nurse is REALLY NOT HAPPY. Tomorrow she's going to drive back and talk to the nurse manager about their lack of sterile procedure and unacceptable PICC line protocol. Oh, to be a fly on the wall.
I have a feeling that by the time Clare is out of there Super Nurse will have made her impact felt on the whole hospital. She told me she was considering calling JCAHO and explaining the situation to them. Conceivably, that would result in the American Hospital Association auditing the hospital for proper procedure protocols. While I understand her anger over this happening, calling JCAHO is like retaliating with the nuclear option. Are you sure you want to do that FIRST?
She's really not happy though. She said some of the nurses don't belong in an ICU. The ICU should be the nursing cream and she thinks some of the nurses would hardly be acceptable in a skilled unit, and marginally tolerable in a general medical unit. She's slow to say anything bad about anybody, so it says something about how she perceives things there. Some of the nurses have been outstanding, the quality has just been maddeningly uneven. Why yes, Super Nurse SHOULD be a nurse manager.
Earlier today Ms. Pikachu was demanding that we take her out and let her drive something. Super Mom has done this in the past- she'd go a business that was closed and let Ms. Pikachu drive around the parking lot. She's getting antsy, she wants to drive NOW.
Super Mom is still having wrist and shoulder pain. She was discussing that with someone she knows and the other woman suggested that cherry juice can be helpful in reducing inflammation. So, tired enough of the pain to try anything, she bought some. When I got home that evening Ms. Pikachu asked me if I’d bought it, “That’s nasty stuff Dad.” Okay, I’ve been warned.
When Super Mom got home later she recounted her conversation of how it was recommended, and said I should have some. Do I look inflamed to you? Whatever I need, cherry juice probably isn’t the answer. I drank some anyway, because it was my husbandly duty. Duty, Honor, Super Wife.
The stuff is as thick as syrup and it’s like drinking cherry pie filling- we’re talking Verry Cherry, quite tart, intense. It’s not the kind of stuff where you say, “Barkeep, I’ll have another, and make it a double.” No, this is sippin’ juice, or lickin’, because it IS that thick. But it would probably be good to cook with. Putting it in a chocolate cake might be wonderful.
Anyway, when we had lunch today I poured the kids a Sprite. I thought a little cherry juice might make it “punchy” so I got it out. Ms. Pikachu saw it and yelled, yes yelled, “Not in mine, that stuff is evil!” I put some in mine, tried it, and thought it quite tasty.
I asked her if she’d just like to have a sip to try it, “Uh uh, get that stuff away from me.” I offered it to Super Wife, she liked it. I said, “See, I like it, and your Mom likes it.” That got an adamant “You two are freaks.” “Well, then that would explain YOU.” My but we have fun.
Where was Train Boy in all this? Supplying background sound effects. He seemed to spend every available moment putting both wrists together, then blowing against them to make farting noises. Apparently he was sound editor on a reality show where flatulence was the punch line to everything. On the way home from church? Farting noises. Sitting at the table to eat? Farting noises. Oddly enough, the only time he didn’t make farting noises was when he was in the bathroom.
My Dad probably would have known what to do, but I didn’t. All the noise had my nerves on edge, I was stressed. Don’t explode, don’t say something to regret. So, what to do? In desperation I put on my best Wise Father Knows Best demeanor and said, “You know, if you keep doing that, some day you’re really going to fart like that, and nobody is going to believe you.” That got a laugh, and that was the last of the day’s farting effects. Being a parent often isn’t what you expected at all.
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