Thursday, July 17, 2008

Enter the Collective

We're rolling out a new computerized charting system and I was conned into being a "superuser". Flattery will get me to do too many things against my better judgment, and so here I am.

In order to learn the new system, I had to orient on one of the floors already using it. An adult medical floor. My preceptor was a very knowledgeable and very upbeat nurse who'd been using the system for nearly a year. She loves it. She's sure everyone will.

Resistance may be futile, but some days, it's my middle name. Eventually we will all be assimilated.

I have seen and toyed with the system. She's right. We will eventually come to like most aspects of this system. It has a few flaws, but overall it's pretty well designed.

The first part of the system we'll be using is the medication administration record (MAR), so off we went to find, administer, and document medications. Generally this went smoothly as there's no stopping to locate labs before you give medications. Coumadin? Click a button and there's your INR so you know whether it's safe to give the dose. Insulin? The blood sugar is there too - and you have to prove that you read it by entering it as you enter the insulin dose. The system even includes a spot for the second nurse to co-sign insulin and other meds which require that.

Most of the meds given, we were off to see her last patient. She pulled up his MAR and scanned his ID bracelet and the medication. They matched.

"Mr. Jones, we're here to give you your medications."

"What did you call me?"

She knows this patient. He's been on her floor for several days, but she did not simply ignore the question.

"Sir, what is your name?"

"I don't know."

"Do you know where you are?"


"Do you know what year it is?"


To me, "You ask him his name" (so I did)

Again, "I don't know"

To me, "I'll show you his diagnosis later. This isn't unexpected."

To the patient, "Mr. Jones, I have your medication."

"What's it for?"

"It's for your stomach."

"What's it called?"

"Protonix, it's for your stomach. For the acid."

"Why are you giving it to me?"

"Your doctor prescribed it. It's for your stomach."

"I don't know if I'm supposed to be taking that."

And on for several more minutes before she simply asked him to open his mouth, which he did. She placed the pill in his mouth and spent the next several minutes coaxing him to swallow.

THEN she told me that she'd thought about working in the NICU, but didn't think she could do what we do. Right. Those of you who care for confused elderly patients have my undying admiration. I could probably learn to do what you do, but I'm not sure I could learn to love it like she does.


The MSILF said...

As I am currently in "pnimit" or internal medicine, I also wonder endlessly about the nurses who continue to work there year after year...

Beverly said...

I will take my critically ill newborns any day, right?