Wednesday, November 28, 2012

So we have this new computer system.

The whole damn thing's been reworked, top to bottom, and it's rumored to be the best, most efficient, most amazing computer system in the history of EVAH. Lab tests and MD notes and medication administration and tiny bits of lint from the dryer are all linked together; all that's linked to some magical whoozit that records when a nurse enters a room, what equipment s/he uses while there, and when s/he leaves. It's rumored, in short, to be the best. damn. thing. since SLICED FUCKING BREAD, MAAAN.

Except, well, it doesn't work.

And I mean, all joking and superlatives aside, it doesn't work.

For instance: let's say you have a patient who wants only one Lortab, rather than the two that were ordered. Instead of pulling two out and wasting one, or just doing an RN override on the Diebold that holds the meds, you have to now call the doctor and get an order for only one Lortab. And then wait for that to be entered and linked and so on.


Let's say you have to waste a partial dose of a medication, like when a patient gets two milligrams of morphine but the morphine comes in four-milligram ampules. The old way to do it was pull, waste at the machine, chart. The new way is pull, have two people scan the med at the bedside, waste at the bedside, do an override to administer 2mg of an ordered medication, then go back and enter the waste at the machine.

And, because everything is now coordinated, Les Machines keep track of how long it takes you to get *back* to the Diebold and waste. If it's more than about a half hour, your administration will get flagged for investigation, because you might be huffing morphine. Which is fine and dandy unless you have five (or six, or eight) patients to deal with. Nurses with huge patient loads often waste everything at the end of the shift.

Let's say you have a person on a heparin drip. Even if you only want to enter the same drip rate hour after hour after hour, you still have to scan the person's armband, scan the bag, and get a witness. This is the new rule for every titrate-able drip in the system. For us, it's not a big deal: we might have one or two drips running in the NCCU on a person. In the med-surg CCU or in the neurosurgical CCU, though, it's a big deal: imagine having to scan-scan-witness-verify for eight drips on each of two patients. Every hour. On the hour.

And, finally, let's say you go into a room that holds a person who's been admitted for a TIA. They're neurologically intact, fine and dandy, and on only aspirin and an antacid. If you leave the room before a certain number of minutes have elapsed when you're giving those meds, you get flagged for not doing sufficient patient teaching on the Tums and Bayer you just administered. If you take too long--that is, if your patient is on six different meds, five of which are new, and the person has questions--you get flagged for inefficiency.

THIS IS WHERE I GET ALL CAPSLOCKY. The trouble with setting up difficult failsafes in a time-crunch-prone profession like nursing is this: once the new checks are set up, all the older ones get scrapped. We no longer have the pop-up windows on our med records that alert us to possible double-dosing. Instead, we have a huge, long, convoluted process to go through that guarantees nothing, as most of our peers are too time-crunched to double-check us.

We learned, less than four hours after the system was implemented, how to get around it. By the end of day shift on Monday, most nurses had copied the scan-codes from med labels and stuck them to the back of their ID cards. We'd also figured out how to copy the med-admin codes from the patients' armbands and stick them to the charts. We worked around the new, cumbersome failsafes. . . .

. . .but we didn't have any other checks or warnings to alert us when we'd fucked up. In other words, our system now has only one point of warning for each patient, and that point has already been sabotaged in the name of saving time.

So we have this new computer system. It reminds me a lot of a story I heard from one of my colleagues. He and his wife bought a gorgeous, brand-new house where everything, from the computer to the thermostat to the hot-water heater, was controlled through the Internet. Their online service provider suffered an outage that lasted three days (he's in the boondocks). During that time, they had no heat. Or hot water. Or air-conditioning. Or TV, phone, Internet, or burglar alarm service. Reprogramming things manually wasn't an option. Why should it be, with this shiny new system?

No system should ever have only one point of failure. Even muskrats and beavers have a back door out of their homes. Manglement's reduced a perfectly workable checks-and-balances system to something with one point of failure, in the name of Patient Safety, and we've already figured out workarounds.

In other news, the hospital-wide campaign to leave our badges in the bathrooms for extended periods of time seems to be working. Manglement might be monitoring our pee-breaks, but we'll work around that, too. (I wonder what they'll say when they see that four of us were in the public men's restroom on the ground floor for six hours on Tuesday?)

Wednesday, November 14, 2012

Tips for Everybody:

There's nothing like coming in to work, feelin' all efficient and enthusiastic, to find that you're two nurses short in a three-nurse unit. Unless it's finding out that a different department expects your unit to staff theirs for some undetermined amount of time in the morning and again in the afternoon.

Dear Doctors: Please don't wear your ID tags on your belts. Especially please don't do this if you're an observant Muslim, a conservative Coptic Christian, or a member of some other staunchly upright religious group. See, if you've got both a name with eighteen syllables and a strong moral sense, it's gonna be embarassing for both of us if it looks like I'm starin' at your junk while trying to read your ID.

Tip for myself: Next time it seems like a patient is globally aphasic, shaking her head and smiling gently whenever you try to get her to do something, make sure it's not because she speaks only Romanian.

A gentle note to Manglement: top-down initiatives, like locator chips in ID cards, timers in employee bathrooms, and noise-and-motion sensors in nurses' stations and common areas, can and will be hacked.

Many, many thanks to the elevator inspector who sang loudly in the elevator shaft as he was doing a routine inspection of that elevator's braking system.

Also many thanks to whoever it was that joked up a pile of mattresses sitting in a storage room by sticking a can of peas in there, so it peeked out one side.