The Franny Feed
March 2014
Department Update ~ T. Edison, RN, MSN, CEN Nursing Director
Thanks everyone!
Theresa
MD update ~ J. Sun MD Medical Director
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ZB, came in code 3 at 1850. He was intubated at 1858. Dr. Melnick was amazingly proactive and helpful. RN report was given to the ICU at 2022 (and accepted on the first try!) Patient left the ED at 2051. That's 121 minutes for an ICU admission! I believe Janet was the ICU nurse (but don't quote me on that.) It was a rockstar crew in the ED, and everything went smoothly.
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Thank you to everyone that evening: Nathan, Jeremy, Holli, Meagan, Lana, Alex, Kajuana, Janet, Ryan and Megan and Chris Cheng! However, I know this is just one example of MANY that occurs on a daily basis! Thank you, everyone, in the ED for your hard work!
Joanne
EDUCATION CORNER ~ A. Shuttleworth, MSN, RN, CEN
-Restraints: don't forget to get the correct order, do the initial assessment form and 2 hour monitoring.
-Conscious Sedation: make sure you are completing the paperwork and putting it in Amy's folder where the the unit clerk sits.
-New CENs!: Megan Morrow , Alex Lipinski, Hannah Berns &, Shaina Onnagan, Kate Rider. Congrats!!
-We will be hosting four new paramedic interns in our department in April, two from City College and two from California Regional Fire Academy. Please give them a warm welcome and share your knowledge and expertise with them during their tenure with us.
-We have a new ultrasound machine for the department for ultrasound guided IV insertion on patients with difficult IV access, stay tuned for information on upcoming training classes.
Palliative Care Corner ~ M. McKigney, RN & H. Miller, RN
Recently, one of our well-known patients was admitted to the ICU for a very extended stay. She spent weeks and weeks intubated while hospital staff attempted to find someone who knew her well enough to say what her final wishes for care would have been. She had no immediate family. The staff was finally able to locate someone who knew her well and said that she would not have wanted aggressive treatment. She was eventually extubated, placed on comfort care, and passed away. Of note, this patient had ninety-two visits to the ED over a period of a few years. No one had ever noted any family, friends, or anything about wishes for end of life treatment.
Of course we are not in the habit of asking those questions, but for some of our patients, maybe we should be. We all know patients who we see over and over again, and we often see them in declining states of health. We are sometimes the very last people these patients will speak to. Patients can name anyone they chose as a Surrogate Decision Maker, they need not be family or a relative. It can be anyone they want to make decisions for them should they become unable to do so. There is a spot for nurses to document Surrogate Decision Makers in the Advance Directive Screen in AdHoc.
Quality Corner
Restraints: don't forget to get an order, do the initial assessment form and 2 hour monitoring. Conscious Sedation: make sure you are completing the paperwork and putting it in Amy's folder where the the unit clerk sits.
Compartment Syndrome: please review the PowerPoint attached. Please increase your level of suspicion for compartment syndrome. Any extremity injury with disporportionate amount of pain and tenderness, you should suspect compartment syndrome.