Leadership Meeting for the Med-Surge Staff, Essay Example

Last Monday morning, I went to the leadership meeting for the med-surge staff at banner Estrella. At the beginning of the meeting, the staff was focused on establishing the responsibilities of members of the group. They assigned different house counsels to represent different committees. Each committee has a different focus. These foci include improving employee engagement, enhancing patient experience, improving safety in the work environment, improving clinical practice, researching clinical practice, and providing evidence base practice. The goal of the meeting is for hospital employees to have a voice. The meeting addressed how preventing staff injury leads to a decrease in hospital cost through fewer treatments and additional compensation. The meeting also provided nurses with an opportunity to discuss different issues/concerns that relate to patients. For example, the quality control/patient safety committee focused on preventing falls. They talked about ways of preventing falls by following hospital protocols for fall prevention, and through assessing patients and estimating how much assistance a patient requires during their stay. Another way is to do hourly checks on patients. Another issue that came up was preventing medication errors such as double dosing.  A nurse mentioned how frightening such incidents were, and that often such incidents happen because nurses are severely under-staffed.  It was also discussed that this med error is common when patients are admitted to the floor from the emergency department. For instance, a doctor on the floor may put  an order for antibiotic when the patient already received  a dose of the same antibiotic from  the emergency department before the patient was transferred to the floor.  It was relieving to see another nurse strongly commenting that it is the nurse’s responsibility to take a minute and check the charts from the emergency department so as to see what medications the patient already had before administering any drugs! Another med error discussed was how oftentimes a doctor places an order for morphine every 6 hours and places another order for morphine every four hours and forgets to DIC or cancel the previous order. Both orders are on the pyxis system and if the nurse is not cautious enough to see the different orders under same medicine, he or she can easily double dose the patient because the pyxis system does not signal or warn the nurse if a nurse from the previous shift gave Q6 an hour ago. One of the suggestions was to invite a representative from each department (doctor, pharmacist and an IT) to the meeting so they can all tackle this med error issue more effectively rather than going back and forth with emails and phone calls which might lead them to reach no definite solutions. Another solution was to continue performing a safe practice which means nurses have the obligation to always double check orders.

On my second week of clinicals I could not help but to notice how different my preceptor has become. I don’t know what happened but one thing for sure is that he was a changed man. His approach was more encouraging and he was more willing to share information with me. He gave me multiple learning opportunities and basically let me take care of 5 out of the 6 patients we had. I provided treatments in his presence; I did patient teaching regarding chemotherapy treatments and educated the patient on what symptoms  might manifest  with neutropenia. I also taught a diabetic patient with poorly controlled glycemic index. This diabetic patient’s blood glucose levels were fluctuating and were basically out of control. At the beginning of the shift his blood sugar was 56 so we had to give him orange juice, milk, and a sandwich because he was very hungry even though he just had dinner an hour ago!  I delegated the nursing aid to recheck his BS 15 minutes later and he reported 219 so following doctors’ orders, we gave his routine Lantus, a long acting insulin, and based on the sliding scale, 5 additional units of Humalog because of the prn standing orders. The report from the previous shift mentioned that his blood sugar was around 300 and they also had hard time managing his sugar levels. Later that night, 3 hours after we gave him his routine Lantus, we checked his sugar levels and found that his blood sugar dropped to 53, and that he showed severe hypoglycemia symptoms such as sweating profusely, shaking, and warm skin. We repeated the same oral treatment that we had previously gave him at the beginning of the shift (apple juice, milk) and his sugar levels came up to 103. I was fine with that because it was within normal range, but I was still concerned of this fluctuation because it’s not good for the patient. This patient was a Hispanic patient who talked a lot and my preceptor avoided him so I dealt with him most of the night. His chief complaint, or the reason this patient was in our floor was because he complained about dizziness and fell both at home and during his stay at the hospital. Thus, he was on fall precautions. He had a CT scan done as well as a lung biopsy. His CT scan was negative but he had a huge mass in his lungs that thankfully was benign, but he was placed on our floor for further observation. Even though he was on fall precautions he managed to fall in the hospital the night before. I continuously checked on him and explained to him how important it was to push the call light whenever he needed anything done and not to leave the bed without our supervision. Since he had some language barrier, I asked him to repeat what I said to make sure that he understood my instructions and then I just told him that I’m here to take care of him and that he and I were a team, and so because I’m here to help him he needs to help me by being compliant with the instructions that are given to him by his doctor. I just wanted to understand more about this patient so I asked him how he manages his sugar levels at home and whether the fluctuations with his sugar levels were normal for him. He clearly stated that this was not normal for him and that his sugar levels are always around 200s and he keeps it that way because that is normal for him. The patient added that his sugar level drops easily because he consumes good amounts of both complex and simple carbohydrates including donuts every morning with his coffee. He said that whenever he is at the hospital and placed on the “diabetic diet” in addition to insulin treatments, his sugar hits bottom and nobody listens to him! I went to my preceptor and explained the situation and suggested that even though we can’t provide donuts for him because of his condition we can suggest to the doctor to lower the dose of his routine Lantus of 25 units since his sugar drops quickly and he is on a diabetic diet. He replied that it’s a good point and we will pass this to the morning shift because it was not an emergency and we do not need to wake the doctor up in middle of the night. The following morning, I was also able to do multiple orders such as lab works for our patients that require daily lab draws for their critically out–of-range electrolytes. I also did multiple doctor consultants orders for our patients. It was a very productive week!