Tuesday, 12 January 2010

Good Things are Happening. I think.

So the first thing that I learned today is that starting tomorrow my ward will be using signs and tabards to protect the staff nurse from interruptions when she is trying to do a complicated and time consuming drug round for a ward full of medical, surgical,elderly, and neuro patients.

 It cannot come soon enough.  Time to try this idea again.

 I hope to god that the visitors take note of it.  Interruptions during drug rounds are one of the major causes of errors that hurt hospital patients.  When the nurse is with that drug trolley she is concentrating on about 100 different things.  She also has to move quickly and medicate/assess a large number of often uncooperative and confused patients with lots of prescribed drugs in a short amount of time.  Every patient on the ward is going to be due their drugs at the same time.  It can take 2 hours to get through 12 patients for their 8 AM medications.Then 4 hours later they are all due again.  Leave her alone unless it is an emergency.  Twice I have seen fatal drug errors as a result of the nurse being got at by  other patients' visitors (with minor issues/questions and then abuse when they didn't get the answer that they wanted) during drug rounds.  It wasn't pretty. 

I know it is hard for people to accept but when you are sharing your nurse with lots of other people she cannot be there when you think that she should.  I have had many visitors interrupt during drug rounds.  If it is an emergency than fine.  But they interrupt to ask when Aunt Lola's nursing home will assess her.  Then they rationalise it by saying "It's not convienant for me to talk to the nurse later because I have a nail appointment."  Um. No.  What is not conveniant is the nurse making an error that hurts or kills a patient because you are in her face. 

This is even more important to get across to social workers and other health care professionals who do this to the nurses.  And these people should know better.  I understand the visitors not realising but there is no excuse for any hospital employee to behave like this. Social workers will walk past 3 health care assistants making a bed and tell a nurse who is concentrating on pulling drugs that someone needs a pillow.  I am just as happy to fetch a pillow as anyone else but if you stop me during a drug round to request it and I go on a hunt for it and lose my focus, someone might get hurt.   Yes, it is so intense that simple requests for pillows could screw it up and do harm, even if you don't want to accept or believe that. Not so with the healthcare assistant however. Not ever.

I have also heard a rumour that we are going to be getting 1 (possibly 2) new staff nurses to replace the 5 we have lost.  Real staff nurses.  I have heard this before.  Let's hope they give them a job this time. 

So we have some good news.  Nothing major but a step in the direction.  It's always good when management does positive things, even if they are small steps.

Should I start a poll to see how many of you think that visitors and allied professionals are going to ignore the tabards and then cry out for the nurses' blood when a drug error occurs?


The Dobbing Doctor said...

At my hospital we have introduced this red tabard saying "dont disturb me, I'm on drug round" for the nurse whilst she is going around.

I don't have any objective figures for drug error reduction, but from talking to the nurses who wear them, they don't like it.

Apparently it just serves as a big red sign that says "I'm a nurse who looks like I know what am doing, please come and harrass me". They report subjectively that drug rounds suffer the same amount of interruptions as before. Not least from the likes of me "Please nurse, I need to prescribe this this and this for Mr Jones and this IV antibiotic for this lady".

Don't want to burst your bubble too soon.

Keep up the blog, tis a good read! :-)

Nurse Anne said...

Well then anyone who interrupts should be held accountable for errors and delays, including visitors.

Matt said...

" Nurse Anne said...
Well then anyone who interrupts should be held accountable for errors and delays, including visitors.

12 January 2010 11:48"

Anyone who interrupts the nurse during drug rounds should be shot. Lets go all Daily Mail on their asses :)

Nurse Anne said...

No if we were the daily hail we would be saying "shoot them for interrupting a drug round if they are immigrants, gay, non white or single mothers"

Hayley said...

I wonder if it's as much a lack of education as anything else; I don't think your average Joe Public really understands the nature of pharmaceuticals. It sort of ties in with my brother's biggest bugbear (he is a community Pharmacist) that people don't realise what the role of a Pharmacist is. In terms of media representation (and I include written as well as visual and audio media), there is a very unbalanced accounting, with the majority of the limelight focused on doctors.

And then, there's the fact that people don't note negatives. They see 'Don't disturb me' and read DISTURB ME, DISTURB ME!!!

Of course, as the RN on the drug round, you're stuck between a rock and a hard place. By rights you should be able to ignore people who attempt to interrupt you, but you can guarantee that if you did PALS would be on you like stink on cheese, and as for a formal complaint...

Good luck with the new initiative. I look forward to hearing how it works out!

Nurse Anne said...

Hi Dobbing Doctor,

I know what you mean. I can certainly understand that doctors need to find the right person to give their orders too and needing to grab the first nurse that they see. I do wish that they would be more aware of the fact that I am focused on team A of patients. And am not current on what is happening with team B. This isn't because I don't care about team B but I am responsible for team A and can barely keep track of their info or stay on top of things. Please go directly to the team B nurse for orders about team B.

What I would like to know is why doctors walk onto a ward with one nurse who is on her knees, and 4 care assistants who are messing about and then do this: Grab the nurse away from a drug round to hold the arm of the patient you are trying to cannulate. Certainly they could get a care assistant to help with that rather than the nurse who is already struggling to get the drugs out safely and on time?

Hayley, You are so right. People see nurses on TV throwing a few pills into a few pots and handing them out on a tray to all the patients. They think that this represents reality. They think that there isn't all that much to think about on a drug round. It is total ignorance.

Nikki said...

Our aprons saying the same thing have not arrived yet. I will comment back when they do and let you know how they are working.

The problem I have is specifically on the evening drug round a patient will ask for a commode. I know at that time my HCA will be trying to get all the blood sugars done, the 4 hourly obs and start feeding the patients, all these tasks come at once. I know if I take the HCA away from their jobs to get the commode the blood sugars won't have been done and when i arrive I can't give the insulin yet because of it. So I usually end up getting the commode.

As for getting interruptions from other professionals, it's usually started by "sorry to interrupt you whilst you are doing your drugs but....."

I hope you get your new staff nurses

OrganisedPauper said...

Last time I was in hospital as I was mentally alert I was able to arrange to do my own drugs. I had no idea it was possible to do this until a nurse told me. I had to record doses etc myself, but it suited me as I was used to doing my own meds and could take pain relief when I needed it rather than having to bother a nurse. I figure it saved someone work as well because my drugs were complicated.
My mother's a theatre nurse, she believes her hospital is top heavy with managers. It's a medium sized town's hospital. Where there used to be 1 bed manager there are now 5. No money has made it to the people at the sharp end.

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