Monday, September 12, 2011

violins in ER

I took a class today on violence in the ER, a subject near and dear to all of us. Over the years I have seen people get hurt. A nurse was punched in the mouth in triage out of the blue. She had to get dental work. A patient jumped on the back of a co-worker. We had a guy who was so big, and apparently strong, that despite being restrained, was able to tip his cart over a couple of times.

This class was about techniques to employ if someone grabs you in different ways. They were good ideas, but am I going to remember them if someone grabs me? Probably not. We learned how to take somebody down with this beautiful scenario in which everybody has a different role and there is somebody to direct the whole thing. In ER, its usually a free for all and whoever is there helps hold them down and get them restrained.

The most interesting part was a new rule about restraints, every ER nurses favorite subject when it comes to charting. You now when you have to hold someone down to give them an injection so they will calm the hell down? Well now that action of holding someone down is considered a restraint and therefore, the doctor has to have a face to face with the patient, then
put an order in the computer. So unfortunately for docs, they can't sit at the desk and just listen while the rest of the ER staff is struggling with these people and trying not to get hurt.

That also means more charting for guess who? The nurse. Restraint charting has become a nightmare. It is long and complicated and requires assessments ever 15 minutes and the charting that goes with it. Another JCAHO piece of brilliance.

The next JCAHO inspection, whadaya say we restrain the clipboard carrier and then after 4 hours have them do all the charting for that four hour period? Of course while they are charting, they have 3 other patients (a chest pain, a drunk and a fibromyalgeur). The fibromyalgeur has her light on, the chest pains BP just dropped and the drunk just peed himself. Yeah..I like it....

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