What is trending on the PIN ListServ?
  
INQUIRY: ABGs
 
I am checking to see if any of your nurses do ABG (arterial blood gases) blood draws and if you know of any guidelines, policies, training, competency requirements to be able to do them.  There are some training stuff on the internet, but, didn't know if anyone already had a program in place.
 
 Responses:
  • Lab does ABGs
  • Lab or Physician does ABGs 
  • Respiratory Therapist does ABGs (24/7 RT) 
  • We do not have a program, but we do have a nurse who draws ABGs if a provider asks her to.
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INQUIRY: OR to ED for continued recovery
I am looking at a process for when a patient comes to the ED and goes to OR for outpatient surgery and back to ED for short recovery.  An example could be a foreign object in the esophagus.  Have do others handle this, ED Obs, Standard Obs or any other way?
 
  • Our patients are admitted OP surgery. Since it is usually out of Surgical OP hours, the Medsurg RNs do post op care until pt is ready to go home.  
  • We admit to OP Surgery, as well.  After hours, the patient is recovered by the floor nurses.
     
     
INQUIRY: Clinical Sitters  
Does anyone have great ideas for clinical sitters? Which group of people do you use? Is it voluntary or paid? This is a person who could sit with the confused patient occasionally to take the load off the staff RN who does not have CNA support and there  are no extra RNs.
  • On occasion we have used Hospice Volunteers for short periods.
  • Because we do not have an abundance of staff... we encourage a family member or friend to stay or at least be available by phone in case we need to call them in to sit with the patient. At times we have asked staff of course with their usual pay. Sometimes a clergy member or other church members of that patients denomination have come in (we don't pay them).. Our conditions of Registration state that we provide General Nursing Duty so this would be classified as "over and above type of thing & we would expect the family to assist.
INQUIRY: TB Testing/Screening for Volunteers  
I am curious what other facilities do as far as their Volunteer staff and TB Screening?  We use Hospice volunteers, volunteers for beauty shop, and volunteers to do the "Pink Lady" role in the CAH.
  • At Roundup, all of our volunteers and new employees are required to go through the TB process which is: If they have had a negative TB test in the past 12 months, they must provide that and then they are only required to do the "1 step" process. If no documented TB test in the past 12 months, then they are required to do the 2-step process. We then
    do an annual questionnaire to screen for s/sx. 
  • We only have Hospice volunteers who all are screened with the 2 step process
  • All of our Hospice volunteers and " pink ladies " are screened with the 2 step method. 
  • We also do the 2 step process with all volunteers. We pay all costs.
     
INQUIRY: Inpatient Certification by MD 
How is everyone handling the MD signing the inpatient order and certification when the patient is admitted by the nurse practitioner or the physician assistant when the MD is not around or it is the weekend and the MD is not on call?
  • We have a concurrence for that is faxed to the MD to be signed and returned.
  • We manage this within our EMR (Cerner). It is set up so that the orders automatically got to the supervising MD for cosignature.
  • Ours through Cerner does the same as Big Timber.