Monday, May 18, 2009

"Too many indians, no chief..."

This was said by someone on my unit today, describing our management, and their poor leadership and communication skills.

I had an odd day today.

I get on the unit, see that I have 3 pts. Two are slated for DC, one is staying and is generally stable.

I am told that when I am down to one patient, I will take 3 pts from M so she can work on the computer training stuff for when we go electronic in a month. This makes little sense to me, as we all need to practice, so why not give my 1 to her, and then the next day she can do computer training. But whatever.

Pt 54 has had all his paperwork done and signed off, I just have to write the DC note and get him gone. He is getting picked up by Notoriously Late Transport Service. They give me a window from 1548-1618 that he will be picked up. He's anxiously waiting in his wheelchair in the hallway. I can tell he wants to GTFO. Around 4 I call the runner, and she comes to get him. She needs the CNA's help to bring his stuff, which includes a full prosthetic leg. Apparently the CNA also needs to hang out with 54 until his ride comes. But he's off my unit and I'm down to 2.

Pt 70 is waiting on his son to come get him. He is forgetful, and keeps asking about when he's coming and when he's getting his IV out. I've been told the pt can stand on his own long enough to pivot into a wheelchair. His son will be bringing his powerchair from home. Son finally comes around 1605 so we can go over the DC paperwork. I find out that he forgot to charge the powerchair enough to get it up to the unit, back down to the car, and back into his house. I assure him we can get a normal wheelchair to get him down to the lobby. We go over paperwork. Everything's all signed off, and I tell the son he should drop by the pharmacy on his way to the car to get his dad's meds. The son doesn't seem to believe me, though I tell him it'd be the best in terms of efficiency. I call the runner to come get the patient, and am told that since it's early enough, I can call the volunteers to wheel him down.

Volunteer comes up and I ask the patient how much help he needs in standing. He tells me he can't stand. I hate it when people misinform me in report. Argh. Frustrating. The volunteer tells me to call Lift team, and she'll come back when he's in the chair. So I call Lift for some stat help, and he shows up pretty darn quickly. Nice. I <3 Lift team. I should make a button for it. Anyhoo

We try to stand him up and get him in the chair, and Lift Guy notices that, sometime in the 15 min since I last saw the pt, he has had a lovely loose C-Diff stool. So out come the full gowns and I get to do a last-minute cleanup. To all you non-medical-professionals out there, pray you never have to deal with C-Diff smell. It's bad. Very bad.

Finally we get 70 into the wheelchair and call the volunteers again to get him gone. I think he left my floor at 1650. And then there was 1.

Going back in time slightly, I was hanging ABx for 71 at 1630, and overheard the MD talking about a small bowel obstruction, and possible surgery "tonight". So I file that into my head and go about my business. Not an hour later I'm getting a call from OR asking if I'm ready to give report on her. Ooookay.

I give report, and get going on the pre-op paperwork. Her daughter wants to be there before she leaves for surgery, but, in common fashion on my unit, she is whisked away before I have a chance to get things fully in order. And her daughter shows up about 3 minutes after the pt is wheeled down. I try to direct her to where the pt has gone. I have to assume she made it. I apologized profusely.

So now I'm zero. I'm seriously wondering at this point if I'm getting M's patients or not. it's about 1800 at this point. I ask J and he says I'll switch with M at 1900 so I should go eat dinner. I start getting cleaned up, and he changes his mind. I'll go on computer training instead. So I start on that. Something b0rks so I pop out to ask J about it, and Resource M says "You're getting patients! One admit, one transfer"

"Uh, bwah? J said I was on computer duty. Can you talk to him and figure it out?"

I hate having conflicting info from various sources. Kills me.

So we finally figure it all out, I'm on computer duty. Wheeee. As is M, whose patients are being taking by the 7-7 crowd. Mostly we complain about how dumb the system is.

I'm dreading the day we switch over to electronic charting. It's going to be disastrous.

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