Monday, February 27, 2006

Back to the Cath Lab

This is a little bit technical for most, but not all of the readers. In this community, it is an issue of huge import. How many people have had, or know someone that has had a cardiac cath?

With the poor diet (when told they have to cut fried foods from their diet, the comment is "What can I cook?"), combined with the decreased physical activity levels, obesity, and smoking, this area is heart attack central.

Apparently, the entire staff of the Cath Lab threatened to walk out last week. I don't know their issues (besides staffing, call, and flexing), but I would certainly entertain them in this forum.

I don't know if the person that commented on this topic is a current employee, or former, just that he/she appears knowledgeable and is timely. Some of the earlier comments can be found here.

Ok, back to the 9fr holes. During any intervention in the cath lab, the pt. receives blood thinners, heparin etc... The sheath can't be pulled until the blood is thick enough to pull the sheath, as determined by the ACT. This is several hours after the intervention. Therefore, the sheaths are pulled by trained nurses. They are pulled in the cath lab by a nurse or a tech, if an intervention was not done.

Other variables come into play here as well. The patient has been given versed and fentanyl during the cath, to ease the pain and anxiety during this procedure.

They are told to lie flat for x amount of time, to hold pressure on the site if they cough, and other instructions to help prevent re-bleed from this site.

But wait a min. They have been given versed and fentanyl. It makes you forget and not care. They are forgetting to hold their head down, coughing, and not holding pressure on the site.

This is where it is so important to have good staffing. They are told to get on the call light if they the site starts bleeding, or if it starts swelling or hurting. The site is supposed to be checked on every 15 min.

So, if someone is not answering call lights, if the nurse is giving blood, or in a code etc... and there isn't another to check it, yes some one could bleed to death very easily. That is a big artery, with a big hole.

Staffing is so important. It is the most important issue related to the heart program, and if Essent is not going to take that seriously, then we should not have it.

I "think but don't know" for sure that the nurses and tech's pull sheaths pretty much everywhere. I think this is common practice.

Another problem along the lines of this same issue, is floating (staff). If you float a knowledgable ER nurse to the stepdown unit, or ICU, and they have a patient with a sheath, or a post cath. Do you think they are gonna have a clue what to do in case of a problem?

If things are so bad that they have to float ER staff to these areas, do you think that there is going to be someone with time to help that ER nurse deal with a sheath problem?

It spells death. It spells law suit. It spells eternal guilt for someone.

I'm telling you guys, staffing, and appropriate staffing, and acuity is a huge problem.


Anonymous said...

In some countries, family is the answer to the disconnect created by staffing. Patients might not eat, unless family is there for them.

How many times have you gone by a room and seen a patient laying in bed, obviously unable to feed himself, with an untouched meal tray in front of him? It was probably charted as "no appetite." The staff may have good intentions, but with understaffing(yes, I said it, so fire me!) and time constraints, they don't get the help they need.

I would not leave a member of my family to their own resourses in this hospital!

Anonymous said...

Well there is the problem. How many patients HAVE families to take care of them in the hospital? And if you're paying $1000+/day why should you have your family do your nursing care?! You're paying for a service!

Anonymous said...

Just remember that when the issue of socialized medicine comes up. The places that holds true seemed to be, with the profit motive satisfied by bribes.

Anonymous said...

Your right about the problem. You are paying 1000/+ dollars a day, and there is no one to feed your loved one.

Here is where the staffing issues comes in. Paying a regular RN on the staff is somewhere about 20 dollars an hour. Paying an agency nurse is about 95 dollars an hour. The nurse gets about 30-40 dollars of this, the agency gets the rest.

It cost more to run staff on agency, therefore less nurses, especially when the money is the bottom line.

Anonymous said...

There is a distinct problem with PRMC. I have had my grandfather and my father-in-law in this facility in the past 2 1/2 years. My grandfather was almost given the wrong medication because the nurse supposedly couldn't read the writing on the chart. Luckily my mom was in the room at the time and strongly questioned why he was getting a "new" medicine. He had a stroke and was on a soft diet... his tray had a hamburger on it. My father-in-law was admitted there on a Monday a.m. He was dismissed on Wednesday at lunch. He didn't get a tray until they were filling out his discharge forms. We had to bring him the rest of his meals. I 'm sorry that some of the nurses get really mad at us for asking questions and verifying things on our own as family members, but we have seen many mistakes happen. They'll just have to get over it where my family is concerned when one of us has to be admitted. I do worry about folks being admitted that don't have anyone looking out for them. I cannot even begin to tell you what great service we received with my father-in-law at Baylor for 5 bypasses. We had excellent care in Tyler at ETMC when he suffered a hymorraghic stroke and we finally got him transferred from the e.r. here after finding out that we didn't have a neurologist at this hospital. Our family motto has become "stop off at PRMC to stop the immediate bleeding then get me to Dallas ASAP"