Posts Tagged ‘Nurse’

Good Nurses

November 10, 2010

NOTE TO READERS: We’re off on a Secret Mission tomorrow, so there may not be a post on Thursday. You’ll hear all about it later, though!

I was looking through my 1967 Johns Hopkins records and especially looking over the nurse reports. The nurse reports make up over half of my total file – neat sheets with handwritten measurements gathered at certain times. This was long before electronic records and most monitoring equipment. Nursing was really a hands on profession, not that it isn’t now. I’ve been cared for by some awesome people over the years, and a lot of them are nurses. You see and interact with the nurse a lot more than you do with the doctor, so when you are assigned a really good nurse it is a Great Thing and a Big Deal.

A big part of the job is observation and reporting, and in the ’60’s you were doing this constantly. There weren’t many automatic alarms that would go off when something was wrong; it was the nurse’s job to almost see problems coming. You were looking, observing, and making notes on every patient, so a good nurse had her head on a swivel. The nurses reports in my file I’ve nicknamed my “pee and poop sheets” because that was a major part of what was recorded: My temperature, amount taken in (input), amount expelled (output), and what I was doing at the time. Remember I was five months old; at any time of day I might be “playing”, “sleeping”, or more than likely, “crying”. Hey, I was a baby, and you people had just cut my chest open and tinkered around in there. You’d cry, too!

The order of the day was “Observe the patient.” You can almost hear the nursing department answer OK… what are we looking for? Trouble is, Cardiac Surgery was only about 25 years old then – they knew they had to prevent Pneumonia but after that, no one was really sure what to expect. So the Surgical Department just told them to observe the patient closely.

I had a fever on my 3rd day post-op. Hopkins called in a doctor who specialized in combating fever. “We see this a lot,” he told my parents. “Many patients spike a fever on the third day after their surgery, we don’t know why. If this is a 3 day fever, it will last about 24 hours and then it will disappear. We don’t know why that happens, either.” And he was correct – it was a 3 day fever, and it was gone 24 hours later. But he also told the nurses to keep a close eye on me, just in case it wasn’t a 3 day fever.

How do I know? The nurses report for that 24 hour period is crammed with notes. The best I can figure, they were checking on me every fifteen minutes for almost 30 hours.

Good nurses are lifesavers – literally!

 

 

 

A different way to take your pills

January 29, 2010

“Hey! Let’s be careful out there!” – Sgt. Phil Esterhaus, Hill Street Blues

You always, always, always need someone looking out for you while you are in the hospital. A trusted friend, someone who will look out for you. If you are under the influence of any kind of antistetic and not thinking straight, they can be your “second brain.” Later, when you have your higher thinking skills back, you can be your own advocate by keeping a notebook within reach and writing down the names of staff, the information they give you, your diagnosis, and any medications you receive.

The prescription process is complicated – it is designed to be, to prevent both fraud and medical errors – but mistakes can still happen. And they happen more often than you think. The experts say that on average, there is one prescription drug error, per patient, per day in US hospitals.

Let that thought rattle around in your head for a while.

But there is a simple step that you can take to lower the chances of receiving the wrong drug. Can you guess what it is?

Before I give the answer, let’s think about how you usually receive medication while in the hospital. It takes less than 30 seconds and you probably don’t even think about it – the nurse come into your room with a plastic cup containing your pills and a glass of water. You dutifully swallow the pills and follow it with the water. And you never get to see the original pill containers.

Your nurse prepares the medication at the Nurse’s Station desk, and it has been done that way for as long as I can remember. But to increase your safety, why not do it a little differently. Politely ask the nurse to bring your medication into your room in the original containers. And this is one of those time when you have to measure your words and ask politely, because if you don’t, most people automatically become defensive. I know I don’t like to be accused of doing something incorrectly. And I certainly don’t like to be told “You’re doing it wrong!” before I even get started! So this is when you need your best negotiation skills… and a little persuasion.

But you don’t have to accept a negative answer. Be polite – but firm. After all, those medications are going in your body!

Elementary!

November 23, 2009

My Primary Care Physician retired a while back, and I’ve been examined by the doctor who replaced him, a Dr. Holmes. Dr. Holmes seems to be a nice enough person, and fairly familiar with Congenital Heart Defects.

The nurse that worked with the retired doctor is now working for Dr. Holmes – that makes sense, as she would already know the patients. But I found out today that her surname is Watson!

I feel much better knowing that Holmes and Watson are on the case!

The Guardian Angels

September 4, 2009

They were scared to death.

The nurses of the new heart surgery team at Dayton, Ohio’s Good Samaritan Hospital had practiced, studied, and thought they were ready. But still they doubted – they were walking into uncertain waters, and one mistake could cost a a child her life.

So after a sleepless night, most of them stopped by the hospital chapel before reporting to duty. And on Wednesday morning, July 16, 1959, they all assisted in Dayton’s first open heart surgery – a seven hour operation to repair a hole in a 9 year old girl’s heart.

The operation required the services of six doctors, six nurses, and three technicians. The technicians were probably in charge of the new heart-lung machine. The machine was funded, in part, through an unusual source: the proceeds from “High Fever Follies”, a talent show!

The operation was a success, and that original nursing team recently attended a ceremony to mark the 50th anniversary of that first operation. Age has caught up with everyone – the young patient passed away in the year 2000 – and Good Samaritan has changed. The hospital just opened a $31 million dollar facility dedicated to heart care. A heart attack victim being brought into the hospital can be in the Catherization lab having a life saving angioplasty within 90 minutes of arrival.

And Guardian Angels still patrol the halls of “Good Sam” – the decendants of that original group who stopped by the chapel that July morning fifty years ago.

Wanted: Primary Care Physicians

August 10, 2009

Let’s talk Healthcare Reform.

Don’t get discouraged, and please don’t leave. We’re going to stay away from the Red vs. Blue rhetoric, and (hopefully) neither side will be called a bunch of loons. Since we’re friends, you and I, we’re just going to take a look at something we really need. If we don’t fix this problem, any healthcare system could come crashing down like a house of cards.

Most of the plans being discussed formally establish a “Medical Home” for patients. We can go see any doctor we choose, but the Medical Home system would establish a Primary Care doctor as our automatic first stop – we see him/her first. If we need specialized care, they’ll refer us to a specialist. Chronically ill patients need a primary care doctor anyway; I write often about finding a good Cardiologist, and that is important, but life happens. CHDers turn ankles and slice our fingers while chopping onions just like everyone else. We need a Primary Care doctor for those times when the problem isn’t heart related.

Problem is, for the Medical Home plan to work, we need more Primary Care doctors. We’ve got a shortage on our hands now, so much so that older doctors can’t retire. They aren’t paid as much, so more doctors choose to be specialists. The Primary Care docs we have are already being asked to work harder and harder; some of them are choosing to relocate to facilities where the pace isn’t so frantic. One of the reasons the Universal Healthcare system introduced in Massachusetts is in such trouble is the shortage of Primary Care doctors. The system is simply being overwhelmed.

Even if we could somehow make Primary Care the most attractive job in the world, we’d still need six years or more before the number of new doctors would begin to climb. One way to deal with the problem now is to expand the role of Nurse Practitioners. NP’s are nurses, but they have had extra training and often have Masters degrees. Some states already allow a Nurse Practicioner to diagnose and treat patients; they can even prescribe medication. Some states don’t.

We need Federal legislation to get all the states on the same page, with a national standard of care. Then we can talk about Universal Coverage, insurance, coverage, and who pays. But let’s fix the doctor shortage problem first.

How I became the Funky Heart

June 8, 2009

It’s a pretty interesting story. You see, I was born on another planet. Right before the planet self destructed, my father placed me in a spaceship and sent me towards Earth –

No, wait a minute, that’s someone else’s story. Sorry about that! This is more of a Dragnet type of story… the names have been changed to protect the innocent.

I had gone to The University of Alabama at Birmingham (UAB) Hospital to have the Fontan procedure, and it had gone wrong. Scar tissue normally forms over your heart after you have open heart surgery, and surgical teams know that and expect it. I had had two previous heart surgeries, so I am sure they felt like there was a good chance that I could have more than usual. But what they didn’t know was that there was a lot more scar tissue than normal, and that it had formed adhesions with the back of my breastbone.

So when they split my ribcage that scar tissue tore, and blood went everywhere. The surgery was canceled and I needed 20+ units of blood to survive the operation. So even though I never had the Fontan, I got all the pain associated with having heart surgery.

*Sigh* The fun was just beginning. I got better and was sent home. I was recovering but the incision wasn’t healing, and finally began to leak pus. Back to the local hospital, where I was quickly transferred to a larger hospital. There the Cardiological team studied me, and finally said “Yep! It’s infected!”

OK, doc, what do we do?

Debridement!

Wikipedia says that debridement is “the medical removal of a patients dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.” How that works in the real world is they sedate you, haul you down to the Operating Room, and scrape out the infected tissue. It’s not fun.

So I was debrided. They re-opened my incision, scraped the dead tissue out, packed the incision with gauze and covered me with a large bandage, sent me for a short stay in Recovery and then back to my room. And not knowing any better, I went along with this.

Important Safety Tip: For a Debridement to work, you’ve got to get all of the dead and infected tissue out. The best way to do this is to 1) Scrape like a maniac while in the Operating Room; and 2) give the patient antibiotics. The problem is, my crack team of local cardiologists didn’t think the antibiotics were necessary. So what could have taken one trip to the Operating Room turned into three.

I was not happy. They opened up my bandages and peeled back the gauze every day, and when they said “Looks like we have to debride again” I literally cried. What in the world was going on here? Why couldn’t I get any better?

And this time, there was no safety in numbers – I had a Cardiological Service, with several doctors who rotated. I saw a different doctor every day, and every one of them had a different opinion:

“I think we can get you out of here by the end of the week.”

“Two weeks, tops.”

“At least two more weeks.”

“I don’t feel comfortable making a prediction yet.”

After that third debridment we had a late night visitor. A nurse came in, made small talk with Daddy and I, and finally said, “Most of the nurses think you need to seriously think about going somewhere else.”

Now THAT is a sign – saying such a thing can get a nurse fired, so when they get to the point that they are advising the patient to grab his stuff and go, listen carefully. So Daddy called the Cardiologists at UAB the next day. They took care of all the arrangements to return and have me admitted.

The first UAB doctor I saw was not a Cardiologist, but a Plastic Surgeon. “Here’s the plan,” he said after he examined me. “We’re going to start you some antibiotics and run them around the clock. I want you to drink a serving of Ensure at each meal and before bed to promote tissue growth. And then I am going to take a long weekend.”

Huh?

“My daughter is graduating college, so I’ll be out of town. And it’ll take some time to see if the antibiotics and the Ensure are working. I’ll examine you when I return and we’ll plan what to do then.”

So the time passed, and Tuesday morning, as promised, he was back and examined me again. “It’s going to take a while to heal, but we’re on our way. I don’t see the need to do any more debridements.”

In two days I was on the way home. I spent six days in Alabama, while my “adventure” at the other hospital had cost me seven weeks. And I came out knowing that the only one looking out for me all the time was – me! So I needed to stop being passive and start taking an active part of my health care.

And that’s where the Funky Heart was born.

Funky Heart on Change of Shift!

May 28, 2009

“Top Ten Reasons to Date a Congenital Heart Defect Survivor” was chosen for publication by Change of Shift! Change of Shift is the premier Blog Carnival for the nursing profession, hosted this week over at Code Blog!

Welcome, Code Blog readers! Makes yourselves at home!

What do you think you are doing?!?!

January 15, 2009

You know it had to happen. Especially right after I had written about volunteering at a training school.

I was scheduled for a Prothrombin test today, so I dutifully appeared at the doctor’s office, filled out the form, and waited my turn. It wasn’t long before my name was called and I went into the examining area.

The first unusual thing to happen was when we reach the cubbyhole they have set aside for bloodwork, and the nurse grabs my left wrist, searching for my pulse.

“You aren’t going to be able to find it there,” I tell her. “Use my other arm.”

“Oh, I usually don’t have any problems,” the nurse says. Ut-oh. Attitude alert!

After a few moments she admits, my pulse is hard to find. “I have a shunt on that side of my body,” I said. “The pulse isn’t readable on my left side.”

My answer earned me a Why didn’t you tell me that? glare. The next thing was the blood pressure – that was also new – and then she pulled out the lancet for a Prothrombin test via finger stick.

By now I have already rolled up my sleeve. “The finger stick test doesn’t work on me,” I tell the nurse, but I’ve got a feeling about what will  happen next.

“Why?”

I’ve tried to use one of the home test machines, but my Hemocrit is so high that the machine just reads error code number 5. So they have to do the blood draw from my elbow joint.”

“Let’s try it anyway,” she says, and snaps my finger with the lancet. In a few moments my blood is transferred to the reader; it whirrs and clicks and reports ERROR CODE 5.

Another glare for me. And to make it even better, my sleeve is still rolled up. Yes ma’m, I’ve done this test before!

While it’s true that you have the medical knowledge, I’ve been fighting this illness all my life. I know my body. And I’m familiar with most of the diagnostic tests that I may have to have. Just take a moment to slow down and listen to what your patient (in this case, me!) is saying. We’re not just another sample, another form to be filled out, another person to get a medical history from.

We’ve figured out a lot about how to live with whatever we are fighting. And we’ll usually share what we know… if you just take a moment and ask.

Do a good deed!

January 14, 2009

First of all, I have to admit to “thinking in the box”, so to speak. Here I am trying to promote Congenital Heart Defect research, and I had never thought of this idea before yesterday.

In my moment of clarity, I picked up the phone and called the Dean of Nursing at my alma mater and volunteered to be a “guinea pig” if any of the classes were studying CHDs. They don’t even have to be studying Heart Defects; perhaps there is a class teaching proper diagnostic procedures. If that’s whet I’m asked to do, I’ll probably throw the students for a loop! As Jack Nicholson said in the movie Batman, “Wait until they get a load of me!”

I know what you’re thinking – I just want to meet nurses! Trust me, I already know many nurses, and most of them count me as a friend. To be serious, if you live near a medical school or nursing school and have any kind of chronic illness, give them a call and see if you can volunteer to participate in one of their classes.

One thing that could be done – you may have to suggest it – is a simple Question and Answer session with the students. Let them ask you what your life is like, and answer honestly. How else are they supposed to learn?

Whenever I go to see my Adult Congenital Cardiologist he always brings a medical student or a younger associate into the examining room. My doctor does the primary examination and then the other person examines me.

“Can you hear the shunt?” my doctor will usually ask, and the student finally admits that no, it can’t be heard. I try not to chuckle, because it is a trick question. If you can hear my shunt, trouble’s brewing.

I don’t mind a poking and prodding a bit. In fact, most CHD Survivors don’t have a problem with it. We aren’t standing on every street corner, and if the younger doctor can learn something – anything – from me, that’s wonderful. He may not know enough to help me, but one day in the future a case may come into his ER that no one can figure out.  When he puts his stethoscope on the patient’s chest and hears a strange beat, hopefully he’ll remember that guy with that weird heart defect that he examined back in medical school.

Not on MY life!!!

October 9, 2008

This is unreal.

My hospital is not going to be doing the prothrombin test anymore: That’s the test of the Warfarin level in my blood that gives me my INR number. And it isn’t really their fault — their accreditation agency told them to stop offering the test. Apparently, if your Hemocrit is above 55%, they have to hand-calculate the results to determine the correct INR. The hand calculation means they can not guarantee the accuracy of the results, and so they ordered the hospital lab not to offer that test anymore.

I’m not mad at the lab techs. They are some of the nicest people I’ve met, and always bend over backwards to help me out or to hurry up the process if I ever need a test rushed. And they can still do the CBC test for me. But I’d really like to talk to someone from the accreditation agency. if you aren’t offering this test to people with a Hemocrit over 55%, what about the patients in the hospital? And if you suddenly can’t speak for the accuracy of the results, then what about all my previous results? I’ve had that test done once a month for SIX YEARS; are those results suddenly no good?

But like I said, I’m not mad at the hospital lab. I’m not mad at the accreditation agency, though if I sat down and asked them some questions, I’d probably be steaming before we were through. You are about to meet the people I am really mad at.

Before I even knew there was a problem, my doctors and nurses in Atlanta learned about it and were trying to work out the problem. One of my Nurses Googled my area and found this group of doctors, who have an office about half a mile from the hospital. She called them, explained the situation, and asked if they would be willing to do the prothrombin test for me.

Now don’t let the fancy name fool you. They aren’t a state agency, what they are is a group of 24 cardiologists who, along with their Nurses and Nurse Practitioners, work at five offices spread throughout the middle part of the state.  So my Nurse asks if they are set up to do a prothrombin test on a patient with a Hemocrit above 55%.

Certainly! came the answer.

Can you do it for a local patient of ours, and forward the results?

Absolutely not.

Before they will do a lab test for me, I would have to transfer all of my cardiac care to them. Look down their list of doctors — there is not a Pediatric Cardiologist in the entire group, much less an Adult Congenital Heart Specialist. But they are arrogant enough to demand that I leave the doctors and nurses that I trust, and who specialize in care for my heart, before they would stick a needle in my arm.

I’ll answer them with the same answer they gave my nurse: Absolutely not.

South Carolina has the highest death rate from heart disease in the country. Heart disease – the problems you have when you age, nasty stuff builds up in your arteries, and you have heart problems because of that. If you have a heart attack followed by a bypass, these are the guys for you. Congenital Heart Defects are pretty consistent throughout the population: 1 in every 125 people have a CHD; slightly more in some areas; slightly less in others. The composition of their staff shows that they are not interested in dealing with Congenital Heart Defects; I guess it just isn’t a “growth industry.”

And that is why I am miffed. They have offices in the larger cities, but they also have some offices in smaller areas. It would be the perfect situation for them to hire a Pediatric Cardiologist and move him/her between these smaller offices, providing good health care to sick kids (and adults) in the rural parts of the state. But it seems that they are chasing the dollar bill. Maybe that heart on their sign should be green, not red.