Tuesday, June 26, 2007

New Doctor on the Block

Well we have a new psych doctor to our hospital. There was promises that things would get better because this doc unlike the last was really dedicated. In the last several months we have had a lot of problems on our psych ward, as you can tell by my posts. The nurses were pulling their hair out and we have been having to restrain a lot more patients and administration frowns on that. The old psych doctor has decided to practice elsewhere (trust me he needs to) and they brought in a very popular doc.

Upon the new doctors arrival we had a patient starting to act out. The nurse immediately recognized this acting out to be sun downers syndrome. As the day wore on the patient was growing more and more agitated and psychotic. The counselor started talking to the patient while the RN paged the doctor. The counselor and I were able to talk the patient down, at least we thought.

After 8 hours of paging the Doctor and no response things went down hill. I was patrolling when the RN called over the radio for help. My partner and I took off in a sprint and hit the door like a ton of bricks. When we got down the hallway we found the counselor and RN pinning the patient to the ground. The RN stated that the patient had hit her in the mouth. I called over the radio for a code green (emergency response team needed). What we didn't know was that our operators handling the radio were idiots.

The operator asked if we were going to go to the scene. I told her I was already there. She called no one for help. The RN had to get to the phone to call the clinical coordinator (house supervisor) and he called for assistance. We got the patient into the "quite room" and put her in 3 point restraints. The clinical coordinator checked out the RN and we started documenting. After the incident the clinical coordinator got a hold of the doctor and the new doc got his ass chewed.

The doctor has not been returning pages for the last couple weeks. He claimed that the RN was incompetent and mixed up the last two numbers on the pager. I checked into it and the numbers were indeed correct and the doctor was lying. Now he is saying that the pager the hospital gave him is junk, so he is using his own personal pager. Well now he not answering that one either. I have made a complaint to administration because we are being tied up on the psych unit. The nurses are not aloud to do really anything without doc's permission. The guy is going to get someone killed.
Flashlight 1

Wednesday, June 6, 2007

He Has What???

I had a very stressful yet educational day that involved diseases. In the middle of my shift we were called to report to one of the floors because of an agitated patient. Upon arrival the nurse was standing far away from the room which is normal when a patient is scarring staff. The nurse gave me the patient’s name and room number and asked me to talk to the patient about leaving the room. As my partner entered the room I noticed a yellow cart that holds all the PPE (personal protective equipment). The seal had been broken and a box of masks was on the floor and that’s when it hit me.

Right before we entered the nurse ran like hell away and I yelled, “Is all this stuff for him or for another room?” The nurse stopped and yelled back, “Oh yea I would definitely wear a gown, gloves, mask and shoe covers.” As she turned the corner she shouted what he had, but all I could make out were these few letters “MRVECDIF.” Not knowing what that was I stopped my partner and we got all the gear on, but we were not prepared for what was next.

When we walked in the entire room was covered in urine, feces, and some sticky stuff and no way can this stuff come from a human. The odor would have been an efficient wallpaper remover. Now I know why I had to wear the shoe coverings. Now in the middle of this mess was a 60 year old that had to weigh 90 pounds. On his stomach were a bandage with a tube an
d that weird sticky stuff was oozing out the sides. There was no way this guy could have been terrorizing the floor. I was coming to the conclusion the reason they did not want to deal with him was because of this “MRVECDIF.”

My partner started to discuss with the old man about staying in the room while I went to find his nurse. After searching the entire floor I had the secretary contact her on her companion phone. The nurse was hiding in an empty room, or in her words looking for supplies (room was not the supply room). I asked her why she wanted us to the floor since the guy posed no threat. She stated he was wondering the floor and what he had was highly contagious and it was visiting hours. I asked her to put the guy in seclusion, soft restraints, or at least a posey vest. The nurse said the doctor refused to do any of the above because the doctor would have to come in on his day off.

I went back to the room and the old guy was just sitting in his bed rubbing feces on the bed. Since there was no threat to others we left and I informed his nurse of what was happening. I also let housekeeping know what room to go to because no one should have to sit in a room like that especially with what ever “MRVECDIFF” is.

10 minutes later we were called back to his room, the nurse stated, “The patient was gearing up for something.” She was crying wolf, but I take all reports of threats seriously. Upon arrival the patient was just sitting there playing with his feces again. I called the nurse and told her she needed to order a sitter because I can not legally do anything to him. The nurse asked if I could stand by until they moved the patient next door to a new room. After 40 minutes of standing around and the patient playing in his feces I went to talk to the other nurse tending to the patient that was supposed to be moved. I asked her when she was moving her patient. She told me that her patient was not the problem patient so she was not moving her patient. I said that’s fine and we left the floor. I found the patient’s nurse and asked again what the patient had and she stopped and said lightening fast what sounded like, “MRVECDIFF.” It was almost like she was trying to hide the illness from us.

10 minutes later I get another call from the nurse yelling at me, she said this patient can not be left alone. I told her to order a sitter because the security department did not have the man power to watch patients, patrol several buildings, watch the parking lot, lock up doors, and respond to emergency calls. I returned to the floor to try and find a solution, but they did not want a solution, they wanted us to baby sit the non threatening guy. This went on for hours and finally they decided to move him into a private room and they wanted us to do it. We are not supposed to, but at this point we were both so mad we did the move ourselves. We just had to wait for our psych doctor to check the guy out.

Now earlier I had asked the guy if he knew where he was, what the date was, and asked him where he hurt. The old guy had all the answers; he was acting that way because he was just a jerk. So the doctor walked in and he was done in less than 5 minutes. The doctor came to the same conclusion I did. Now it was time to move the jerk to his new feces, urine, & sticky stuff free room. We covered a wheel chair with sheets wheeled him into his room. As we did that his nurse appeared out of the wood work and said, “Now grab some soap, a wash cloth and wash him. I told her hell no and walked off, that pushed me over the edge.

Basically the whole day the nurse was trying to dump this sick jerk off on us and the psych ward. When I went down stairs to write my report I wanted to know what the hell my partner and I have been exposed to. When I called back I spoke with the secretary because I was so damn mad at the nurse. The secretary finally deciphered the code after trying to figure out what was scaring the staff. What the nurse was yelling was, “He has “MRSA VRE a
nd C DIFF.” I did not know what it was so I jumped on WEB MD.com and after I finished my reading I was slightly upset. It turns out that those things are in the sputum and he defecated and urinated everywhere.

I called our employee heath nurse at home and she said we would be fine as long as we didn’t rub it into any cuts or open sores. Also if we did get infected we would just be under observation and not given antibiotics. I went back to Web MD and it says if you have a drug resistant strain then no antibiotics would work. I called back to the floor and guess what it was a drug resistant strain. Both my partner and I are fine, but not very happy about the fast one the nurse pulled.

Flashlight 1

Friday, June 1, 2007

A Break Down in Communications

Our emergency room had calmed for the night and my partners and I had settled in the office to take a much earned break. No more than a minute passes and our switchboard operators call over our radio stating, “Why aren’t you at the code blue on level 2”? We told them because they never called us. So we jumped up and ran to the second floor. Upon arrival staff was still arriving to this 35 year old crashing fast. There had been almost 10 minutes of down time for this patient who was coding for mysterious causes.

The security department responds to code blues for several reasons because we are all trained in basic life support, we move equipment out of the way to move the patient, lock down elevators, and crowd control. People visiting love to stand in the middle of hallways and door ways to watch the circus. They actually will argue with us stating they have a right to watch (still can’t find that one in the constitution). It seems when people code all the hospitals junk is parked in or around the room. We also get a set of all keys (weighs a ton) so we can also lock elevators and make them go directly to the floors we want. The last hospital I worked in the never wanted us jumping in and starting compressions, but this one realizes if we are the only ones there then we need to know what to do.

So after everything calmed down and the patient returned to us, damage unknown, and we got the patient into the ICU I went to our switchboard operators. I asked why the big break down in communications and the explanation dumfounded me. Our hospital has came up with so many acronyms and short terms that when level 2 wanted to call a code blue they ended up calling for the wrong team. L
evel 2 called down for a quick response team which also means code green for a combative patient. So instead of doctors; pharmacist, RNs, techs, and security you instead get plant operations, housekeeping, security, and the police get put on hold. Well when no one showed because our operators assumed everyone in the hospital had special pagers, we don’t only radios, the level 2 staff had to leave all patients to help this one.

I went to do a debrief session with our switchboard and nurses and figured a way to fix the problem. I understand the hospital wants to be cute with all these special names to hide codes, but now it could cause people to loose their life. They should stick with a basic code system that has worked for years and cut down on confusion. I know calling a code blue will attract crowds, but that’s why we show up. Medical staff needs to worry about patient care and let security worry about our job. I am glad to say the patient is doing alright and it turns out the patient had a hidden infection that did not show up in any tests. It was the first times in years where it felt like we in a medical television show like House or something.

Flashlight 1