Hey, I’m back after an unexplained absence. Did you know that May 15-21 is Dog Bite Prevention Week? We do see a lot of dog bites in our ED, as I’m sure every ED does. I heard a speaker at the last Emergency Nurse meeting in Long Beach and she explained how dog bites can be avoided if we just learn to read a dog’s body language. It turns out that most of us don’t know how to interpret our dog’s body language. This leads to over 1000 dog bites a day across the USA, most from our own pets. Children are most at risk and bites are most commonly to the face, head and neck. Children often have difficulty interpreting adult directions and should not be expected to understand messages from their dog. For this reason, children should always be supervised when with the family pet, or any dog. Do not use the dog as a babysitter. Any dog, not just a pit bull, has a limited tolerance for a very playful child and will quickly snap at vulnerable areas if pushed too far.
Here are a few things I learned about how dogs communicate. A dog with flattened ears, closed mouth and half-moon eyes is uncomfortable and is trying to say, “Leave me alone”. Dogs don’t like to be hugged unless they initiate it, so don’t push yourself on a dog that is not receptive, with mouth open, ears up and tail wagging.
For more detail on this interesting topic, go to www.doggonesafe.com and pay special attention to the Bite Prevention and How to Speak Dog sections.
I was at the chiropractor the other day for my back and he had left this interesting info out for all to see. Did you know that the United States and New Zealand are the only two countries in the world that allow direct consumer advertising of pharmaceutical drugs? We have been doing this for the past ten years and it means that you can be watching your TV or listening to your radio and be bombarded with drug commercials telling you about the latest drugs and pills that you NEED. The question is, is it actually helping us with our health? There seems to be more obesity, diabetes, hypertension and our life expectancy is actually decreasing! We do not allow cigarette advertising on TV because smoking is dangerous to our health. Ironically, we even have a War on Drugs, that, by the way, is failing. As a nation we account for only 5% of the world’s population, yet we take over 70% of the world’s drugs. If drugs really made us healthy, as they claim, wouldn’t we be the healthiest country in the world instead of 37th?
Drugs such as antibiotics and vaccines have saved many lives. But to maintain good health requires an active participation on the part of everyone. Diet, exercise and positive thinking (or meditation) can do a lot more for our well-being than we give them credit for. So get active, take care of yourself and don’t expect drugs to passively give you good health.
Hi, I’m back. I have been working on a hot topic at my hospital, sharing medical records. President Obama promised that one of his goals was to give doctors and medical professionals the ability to easily get medical health information on patients they are treating. This has been done in the past, but it has always been difficult. When records were needed from another hospital, a phone call had to be made to the Medical Records department, then a release of info signed by the patient had to be faxed to the other institution. That had to be received and approved, then, when the clerk had time, the records were faxed page by page to the requesting facility. You can imagine that this could take up to an hour or more. Part of the problem was that HIPPA laws guarded the privacy of patient records. Yet they contained vital info about the patient’s health.
To give good care, we must share. Now, with the advent of the electronic medical record in many facilities, it is at last becoming easier for this to happen. Currently, hospitals that use the same electronic health record system are able to share records after the necessary patient consent is obtained. But this can now be done electronically, scanned rather than faxed. There is no need to wait on hold for the records department to answer the phone. There is no need to add to the mass of the paper chart with more faxed pages. Everything can be viewed on the computer very quickly. This is working very well at my facility. In the near future, it is hoped that even facilities with different record-keeping software will be able to communicate in this way.
When I was a nursing student, I was taught that one of the primary roles of the nurse was to be a Patient Advocate, to look out for the safety of the patient. While other practitioners had their own respective piece of the patient’s care to look out for (medicine, physical and/or occupational therapy, nutrition, etc.), the RN was the one who truly had an overview of the patient’s care and was in the best position to ensure patient safety. This is still true today. It is one of the reasons that having an adequate number of RNs on staff ensures patient safety.
But today, patient safety has become a buzz word for many “professional” hospital organizations. It is considered to be as important as “customer satisfaction” and courses and degrees are offered in how to provide for patient safety. (See link to article on the left.) The goal is to prevent injury and harm to the patient. But it seems they are still overlooking the all-important measure of success: patient outcome. The patient can be safe and happy customer, but still have a bad outcome if they do not have adequate care. Instead of trying to set up a new profession of patient safety experts, why not concentrate on hiring enough RNs to properly provide patient care? I’m talking about the layoffs and cutbacks that have a real effect on patient safety. Don’t just study the problem and hire new experts to fix it, use the resources already in place – the RN patient safety advocates!
As we are in the middle of the Martin Luther King weekend, my thoughts turn to diversity in all the areas of my life. As an ED RN, one of my first thoughts is to how diverse we are in the ED. It is just true that sickness and injury are the great equalizers. Having been in the hospital myself recently, I know the truth of this. No matter what your race or creed or lifestyle, when something bad happens to you, you hurt. Pain affects all positions in life and all types of people. The way the staff in the ED chooses to deal with every patient shows the extent to which we have accepted the diversity that exists in the world around us. In this day and age, we do not refuse to treat someone because we do not like their background, color or lifestyle. We are professionals and we deal with each patient based on the nature of their injury or sickness. We are not perfect and some comments may be made from time to time. But I like to think such thoughts do not prevent us from giving the best care possible. Now if only the legislature and insurance companies would take inspiration from this and pay us equally for services rendered without regard to the patient’s insurance or lack thereof. In other words, we see patients as in need of care no matter what their race, creed, disability or lifestyle. We do not see them as customers who can or cannot pay us for our services (though our bosses certainly do!).
I saw a cryptic writing in church last weekend and I think I am beginning to understand it. It read, “Without the truth of their eyes, the happy folk were blind.” ED folk are blind in that they do not see distinctions based on race, religion, sexual orientation or disability. We are happy to treat all in this diverse world.
Hey, this is a New Year! Sorry to keep you in suspense, but I am still here.
A big topic for this year will be Violence in the ED. This includes assaults both verbal and physical against nurses, doctors, techs, EMTs, paramedics, secretaries and volunteers. Some people feel it is OK to take out their frustrations against the very people who are working to help them. As caregivers we understand the frustrations and have been willing to overlook the attacks against us at work. But with the escalating violence in society in general, it is time to take a stand. It is NOT OK to attack the hands that are helping you. Health care workers are not soldiers fighting in a foreign land. We are in your own communities and we are not fighting you personally, we are fighting the processes in your body that are destroying your health. Show respect for those who have worked hard to learn the skills necessary to care for you in times of crisis. You came to the ED seeking help. You may not understand our methods, but please let us do what we have trained for.
Some states are passing laws to make it a felony to attack or harm a health care worker. It is about time. Hospitals, ambulance and clinics must be seen as safe zones that are above the rage of the society.
How often have ED RNs heard this in their waiting rooms and at Triage? Sure, patients come first, but the whole idea of triage is to sort out the most needy from the less needy. We all live in our own worlds and it does seem that any time we have pain or something wrong with our body, it must be taken care of at once. Doesn’t the fact that a patient shows up at an Emergency Dept mean that they will be seen and cared for at once?
It is true that there are no appointments at the ED, so patients are not seen in the order they arrive, but by the severity of their problem. This means that some will have to wait. Actually, what I tell patients is that it is a good thing to wait. If they are seen at once, it is because they are really sick and in danger of death. Wouldn’t you rather wait, if your life is not in danger?
Many EDs now strive to get patients into an exam room as quickly as possible, so their treatment can begin quickly. The Triage Nurse who sees patients when they arrive can make the decision to “room” a patient based on the severity of their problem. Even if you are not triaged immediately, rest assured that an RN has at least seen you in the waiting room and made a determination about the severity of your illness. The only reason you may have to wait for further treatment is that someone who is having an even greater emergency is having their life saved while you safely wait.
As any ED RN knows, we have to treat anyone who presents to stabilize their condition before we can even ask about whether they have insurance or not. The EMTALA law mandates that everyone presenting to an ED has to be treated first and asked about their ability to pay later. This is good for the patient and good for the ED staff who want to just care for their patients. The problem is, the EMTALA law mandated care, but did not mandate how this care was to be paid for. The current health care crisis has left many without primary care physicians and so they inappropriately seek care in the ED. And if they can’t pay, they don’t have to. This has led to the closure of many EDs and overcrowding in those still open.
For this reason I welcome the part of Health Care Reform that mandates everyone to have insurance to pay for their care. This could finally level the playing field where care in the ED is mandated, but no means to pay for it is mandated – until the new Health Care Reform Act. People have not been responsible enough to either be independently wealthy or get an insurance plan to cover their medical expenses. Accidents and emergencies are not going away, they just need a mandate to pay for them.
I was at a hospital meeting the other day and a man spoke up to ask the speaker why he could not get an itemized bill for his care. He got a bill that just listed the total cost for all the services he received, but did not list them individually. How could he compare the price for services he got here to what another hospital charges? I myself was in the hospital recently and I only got a bill for what the insurance company paid in total. It seems to me that the billing department should list how much I was charged by the day for each service and supply received. But we are told this is too complicated! Not knowing prevents us from shopping around.
The hospitals want their customers to be satisfied. Are they worried that we would not be satisfied if we knew how our hospital charges are broken down? I know we would be dissatisfied, because then we would see that services and supplies are billed at different rates depending on what type of insurance we have (or don’t have).It is a very confusing system that few people can comprehend. It is in desperate need of reform.
For a taste of the problems that can occur, see this article on billing fraud: Hospital Billing Errors and Fraud
When I was in San Antonio in October for the ENA convention, I saw this great film, 21 and a Wakeup, about medical care in Vietnam. It is about the final days of the war at a hospital in Saigon struggling to make the difference between life and death for the last valiant soldiers in Vietnam. It really is one of the best portrayals of women in war ever put on film. Though an independent production, it includes well known actors Faye Dunaway, Tom Sizemore, Ed Begley, Jr and Ben Vereen. It is available only through the web site of the producers and directors. Five dollars of the sale price goes to your favorite military, women’s or medical charity. You can find reviews by Googling it, but I found it to be an exciting movie for an ER junky. I also promised the producer, Chris McIntyre, who was at the showing, that I would let others know about it. So check it out!
Here are a few things I learned about how dogs communicate. A dog with flattened ears, closed mouth and half-moon eyes is uncomfortable and is trying to say, “Leave me alone”. Dogs don’t like to be hugged unless they initiate it, so don’t push yourself on a dog that is not receptive, with mouth open, ears up and tail wagging.
