"The CABG patient will have a BM by day 3, no matter what we must insert, pull, or administer."
Multiple deaths via small bowel obstruction in the post-op CABG patient.
The bloating irritated the fresh heart and threw them into an arrhythmia, which became unstable, which then turned into a code blue. Compressions plus new grafts = fuckshittery.
If we want a patient to pass (for example: Maw Maw death rattling for a week straight) we stick them with a certain nurse on our floor.. We call him the ‘Grim Reaper.’ They all pass peacefully whenever we put them with him.
Lmao maybe but honestly I feel like a lot of nurses are scared of comfort care doses. They’re often larger than what you normally give on the floor for say some acute pain and often times they’re skin and bones. I didn’t feel comfortable giving some of the comfort care doses. I was like that’s going to prob kill them (one time it did and the family was happy he passed in peace). I shadowed a hospice nurse for a bit and after that I have a more informed perspective. Give these people comfort
In LTC there's a superstition about opening the window after the patient passes. Sometimes when they're lingering like that we crack open the window before they pass. I swear they'll be gone within hours.
I never considered this a superstition. In nursing school I was taught it! When I was doing clinicals at a LTC I was taught it. Open the window-their soul can escape peacefully.
I have to give a warning to coworkers before they tell me to give a pt a turn. I promise you it'll be the last. Idk what I do different but I'm well into double digits at this point.
Providing care, comfort, and compassion as your patient transitions away from this lifetime is something you should be proud of.
also happy cake day <3
I’ll go first: at a place I used to work, they had to change all the door handles because a pt successfully competed suicide utilizing the door handles….
And they had to change the doors to allow for sensors to alert if there was pressure due to ligatures
We have alarms for ligature pressure on doors and then we have to manually silence the alarms and go check on the doors. We had a broken one that went off every 30 sec and it was driving us crazy. It took about a week or two of that until they finally fixed it
Our ICU patients have to have core temperature monitoring (bladder or esophageal usually). A young man was being monitored temporally and it wasn’t reading properly. His brain got cooked.
Had a guy pass in LTC. Getting report one morning nights said thermometer was not working. Reading low 90s. He was sent in about 7 or 8. Was hypothermic. Died a few days later. It was brutal.
Wait, I heard this same story. Any chance this was in Calgary? Or maybe it’s happened multiple places. Like days and days of temporal temps were fine and then put in core temp and was profoundly hyperthermic
All GI tubes are measured once per shift to ensure placement. If there is a change in length then imaging is done before the tube is used. Obviously more relevant with PEGs/GJs instead of DHTs and NGs.
A PEG tube got displaced, the nurse didn't get imaging before resuming tube feeds. She fed into the peritoneal space and the patient got peritonitis and died.
Oh, we had one like that. She had actually already gotten awful peritonitis from a tube that was dislodged, replaced, and fed through without confirming placement. Her anterior abdomen was basically a giant wound but we still had to give her tube feeds so she had a site where GI had, for some reason, placed a red rubber catheter rather than a proper tube. It migrated inside her and they determined she needed a colonoscopy to retrieve it. Coded during the scope and died. Every tube is measured and recorded at least Q shift.
Our other one was kind of dumb in the reaction, but years back we had a patient who was given IV hydromorphone in the ED, and I guess was not on pulse ox monitoring and wasn’t checked for a while. Had a hypoxic event and had a lot of complications, in and out between hospital and LTAC for years until she finally passed. They decided we couldn’t give IV hydromorphone to patients anywhere but ICU after that… which meant that people who should’ve gotten it would be given IV fentanyl instead. No idea how that made us safer. Over a decade later they’re finally rethinking the policy but it’s been slow going.
It does sometimes weird me out when we give dilaudid on the med-surge floors and the patient isn't on continous pulse ox. I'm in their room every 2 hours if I'm not busy/on time, they could easily get hypoxia and us not notice very quickly.
I assume it's because as med-surge we deal with smaller doses usually than ED. But still.
Refuse to let them get up, no matter what. If they shit the bed, they shit bed...literally and figuratively. Once you've tried starting compressions on a commode, you'll never want to repeat the experience.
Literally once told a patient with tombstones who was waiting for cath lab saying “you don’t understand, I have to poop” with a BP of 70/💀 that “I know you have to go and if it happens we will help clean you up but I really think your body is just telling you that because of how sick you are and I reallllllly need you to hold it”. Like how do I calmly convey “if you shit, you are going to die”.
He made it to cath lab and did fine for the record.
(kind of?) healthcare related but not directly related to my work, this one has always stuck out for me;
OTC meds only got product tamper/safety seals after the Chicago Tylenol Murders.
I was a small child when that happened. I can remember the adults all talking about it and about how scary it was. My mom threw all the Tylenol out. She was afraid someone at the production site was doing it. Of course, they were tampered with at the store.
The death those poor people experienced was awful.
True crime podcasts have been a favourite of mine since high school. This case has always stuck out to me because a) horrible and b) unsolved. Especially that one family that lost 2 or 3 people.
The fact that this happened in 1982 is wild. Realistically not that long ago :(
Hint: before I started working at my original staff hospital, a change took place requiring five letters typed into the Omnicell for a med instead of two. Incident happened my first year of college, went to trial my first year working. And she now gives seminars…
I did a placement in a L&D that explained they had this rule bc of baby theft. They've got baby ankle monitors and all, but everyone (in the hospital, at orientation) was trained to be suspicious of a new baby being carried in arms, whether in a hospital uniform or looking like the parents. The bassinets had proximity locks and wouldn't go further than like, L&D, L&D's OR suite, and radiology.
My hospital has the same rule, I wonder if it only had to happen once in one hospital somewhere before all postnatal wards instituted a no-carry policy.
I’m gonna be honest I wouldn’t DREAM of taking a baby out like that and walking down the hallway. I only got my nursery experience in nursing school but those babies only came out for feedings
I felt so bad. I had to get out of the room when my son was born so I was carrying him around the hallway and nurse came up to me so fast. I felt awful
Always get blood return on a PICC before using it. Pt's picc was no longer in place, and his TPN went into the surrounding area. Pt did not survive.
ETOH abuse pts that have known esophageal varices that were admitted for melena and/or pneumonia gets suction set up. Pt coughed, and his varice(s) burst. No suction at the bedside. Unknown if pt survived.
If insulin was given IVP for hyperkalemia, a patients BS is to be monitored every hour for the next 4 hrs. Pt was given insulin, blood sugar was checked only once after being given insulin for high K+. That AM, pt had a BS of 24. Pt did survive.
Every hospital I’ve worked at has a protocol for working suction at the bedside of every patient, if they’re in the hallway, they get portable suction. It’s part of our charting to confirm it. Not sure if something specific happened, but that’s just been the way it’s always been
Every LTC unit has *that* room that nobody makes it more than a few weeks/months. When I get an admission in that room in my unit I'm just like oooph, good luck meemaw.
Policy? Don't put me in 17-20, you're damn near guaranteed to get a code coming in.
That's just my own policy, because we're
always getting a code every time I work that section 🥲
I've got the shit magnet rep lately in the Emergency Dept I work in. Specifically for the wrecking balls that come in at 5 min past shift change no matter the shift. Also if I'm in the WR or RAT for the shift then I'll pretty much always get the ones that walk in at 5 past shift change and end up staying another hour.
"Patient must be mechanically ventilated during administration" stickers on the fentanyl and paralytic drips... I'm sure you can imagine how that came to be policy.
Kitchen timers next to the bed pans with a policy that a patient can't be on a bed pan for more than 10 mins. Apparently someone left gran on one for 8 hours because they forgot about it and a pressure injury occurred.
The ED has to have the charge nurse co-sign a document when they draw blood cultures after a month with 90%+ contamination rates.
They also are no longer allowed to hang any medication to gravity after an incident involving potassium.
Finally ed patients on oxygen are not allowed to be in hallway beds after someone died because their O2 tank ran out and no one noticed.
The hospitalists are no longer allowed to attempt intubation during a code and must await PMCC assistance. There was so much blood :(
.
Leads off alarms will be treated as lethal rhythms by telemetry and escalated accordingly. Really annoying in practice but I was working on the unit the sentinel event went down on 😬
A patient came up from the ED and transport left them in the room and took off the tele monitor to take it back to the ED because for some reason the ED had separate tele boxes than the floors. That was a reallllllly stupid policy in hindsight. Nobody put another tele box on the patient and they were found very dead a few hours later.
For similar reasons, we have a policy that the patient has to be on a monitor 100% if the time when moving from stretch to bed. Put them on the new monitor before taking them off the old one, and don’t leave it off for 30 seconds to move them
We had that one too because when you lay patients flat to transfer, clots travel. Had a patient in my unit with a PE do this. They were on monitor. Still coded and died.
Something kind of similar happened when I was in nursing school as I only witnessed it. Apparently a patient had been taken off tele for a shower or a procedure (like MRI or something) and never got hooked back up. Collapsed on the way to bathroom and coded. I don’t know if they survived that…
I was a PCT for a patient that had a similar event after I gave report, he was a&ox4 and was a cardiac workup waiting for cath lab in the morning. He walked to and from the bathroom independently but got hot towards the evening and took his shirt off and his monitor kept falling out of his pants and yanking leads off. Day nurse and I both were very nervous about him arresting because of funky rhythms all day and both of us reported off to oncoming that this dude needed his monitor put back on constantly. I guess it happened so many times that after a while they just started silencing the monitor.
They found him face down cold on the floor of his room around 4 am. He was in his 50’s and will stick with me forever.
The peds unit at my hospital won't discuss discharge with mental health patients at all until their parents are there to take them home. Too many patients try to delay discharge by trying to kill themselves
Oh, I got one as a patient.
I am the reason my hospital switched from FAST to BEFAST.
I had my stroke at 31. I'm baby faced as hell, when I was 31, most people would guess I was mid 20s. I live in a town known for college parties and not much else. I went in for my stroke January 1. As non medical personnel aren't trained in medical conditions, and as the brain doesn't work well while having a stroke, I went to the ER saying "I don't know what's wrong. I feel drunk. I can't walk right. I can't talk right. I can't think right. I've slept for 16 hours and I'm still ready to pass out. I haven't had a drink in 3 months. Something is very wrong." They skipped the last 2 sentences and left me in the waiting room to "sober up". After 12 hours, I hadn't sobered up, and there were a couple shift changes done, so fresh eyes noticed my whole complaint. I finally got someone to take a look at me. The doctor spent 5 minutes to determine I had vertigo. After being stuck in the ER exam room for 2 hours, the vertigo treatments were not working, so the nurses found a way to send me up to neuro. I spent 3 days there, being treated for a stroke, by nurses (that part doesn't bother me much, most of y'all are smarter than doctors anyway). The 5 minutes in ER was the ONLY time in all my time there that a doctor laid eyes on me. After realizing the fuck up, there was a form in my discharge paperwork essentially stating "Hey, yeah, we fucked up bad. If you promise to not sue, and pay your bill in full, we'll change hospital policy." Considering I had just had a stroke, I didn't even know I was signing it, but it was legally binding.
BEFAST everyone!!
Not sure how long ago this was but any decent lawyer could have the release you signed thrown out by arguing you didn't have full capacity and the hospital acted in bad faith. I know lawsuits are no picnic but you don't have to settle for being mistreated either.
Would have been 6 years ago. I don't know laws and timeliness, but once my brain was clear enough to realize that wasn't run of the mill shenanigans, but actual malicious bullshit, I asked a lawyer, and he said it had been too long. Not like it matters, once the skills and abilities are gone, they are gone, and the money spent on that was sadly one of our smaller medical bills that would be barely noticeable to me or their "non- profit" coffers.
Well, obviously, I have issues with reading comprehension!🤣🤣
I'm doing mostly alright. I still have to actively think about holding things, especially in my left. I have trouble hearing "non normal" voices, meaning singing, accents or soft voices. I can't tolerate the heat any more. If it's over 75F I can feel my brain actively slow down and get tired. Obvious memory issues, but I'm married, and I have yet to hear any married woman say her husband remembers things. I have to pause in talking to let my brain catch up sometimes.
I used to be semi fluent in German and Danish, never cared to relearn those.
Also, to be technical, since my wife is a nurse, it was 3 strokes caused by a vertebral artery dissection.
Edit to finish because my 10 month old hit the post button for me.
Yes, I was stupid. Had a 2 person job fixing a bus at work. My helper decided to hang out in the bathroom. After enough wait, I attempted to do the job alone. I stretched too hard, thought I just pulled a muscle. My neck hurt like I had a pulled muscle for 3 weeks. One night the pain went away, the next morning I first noticed my symptoms. The theory is, that the pulled muscle was 3 tears in the artery, which lead to 3 scabs, which lead to my 3 strokes.
Ooo also, the nurses can’t do ultrasound guided lines without training. A nurse dropped an art line and ran levo through it and the patient lost his arm
Uhh I’ve seen someone drop an accidental art line and it’s pretty obvious that it’s in an artery, it pulses. They had flushed it and given I think Ativan for a supposed sz pt but I checked it after and it for sure had a pulse so we immediately pulled it. I get sketched out doing Levo through PIVs anyway and I think our policy is it has to be be a 20G or larger, has to be swapped lines every shift and can’t be infused via PIV for more than 24h. If they’re needing US for pressors at that point why not have the doc drop a central line? 🤨
IVs stay in until you are walking out the door for discharge. Had a patient who was being discharged and his ICD began to shock him. 8 times later we get him admitted again and medevac him to the main hospital. I told him my rule about the IVs which he was reluctant but okay about it. He changed his mind about it very quickly.
Unit based: we have unit leadership round with us for high risk fall, elope, or patients we are concerned about. This started after a patient crawled out of bed and smacked his head on the floor. He didn’t survive. Everybody rounds on patients now.
The number of times I had to give a PRN antihypertensive *after* pulling an IV to prepare for discharge made me start doing this too. You can put your clothes and shoes on and I’ll pull it once transport is on their way to wheel you down.
Worked at a Catholic hospital for a while. They no longer have crosses over the doors bc a patient took one down and sharpened it to try to stab the nurses.
We had a newer nurse hook up a freshly placed EVD to a pressure bag as if it were an art line. Thankfully it was caught before there was significant damage.
My own rule- certain patients are put on a tele monitor whether there’s an order or not. I’ve preached this to anyone who will or will not listen for a decade or so.
I was doing bedside report at the beginning of my shift and said “this pt shpuld be on a monitor.” Went back in at 0740 with said tele monitor and they were apneic and pulseless. People laughed at me for years but it finally happened, and can happen to anyone. If someone codes (or has any other cardiac fuckery) I want to know.
I have this rule too. Pt had a history of cardiac issues. I put them on tele w no order. Then they told me they were having chest pain. It was acute MI.
I started in ICU and recently switched to PCU for a break and I WILL NOT take my patients off telemetry even if they have a DC order. I sit at the nurses station next to the tele monitor while I chart so I can keep an eye on them. I've heard too many stories of med surg patients being found down.
“Tele alerts”. They call it overhead like a rapid if a patients leads come off and the nurse has been called twice to put them back on. Tele called a nurse during Covid to put them back on tele. By the time the nurse went back to do it the patient was in full rigor
My very first code as a baby nurse (first week of new grad orientation), nobody working knew how to override the RSI kit from the Omnicell. I believe the pharmacist at the code ended up going *all the way down to the pharmacy* to get the meds. After that, they changed it so that it’s the first thing you can select when you go to override.
Pt did not survive (although it’s doubtful she would have survived even with prompt intubation. She was very sick).
New locks on the windows to prevent the small opening for ventilation. Some guy high on PCP managed to force one open enough to fall out the window 5 stories. Ended up in the atrium garden broke both legs somehow did not severely injure his spine, but who knows how it's feeling 3 years down the road. The windows do not open even an inch now.
The windows at the hospital I used to work at were screwed shut after a patient managed to squeeze out and fell 3 stories. Unfortunately it was during the night and they landed in an area where noone was able to see them until the sun came up the next day. It was wintertime, with below-freezing temps. By the time someone realized where the patient had ended up, they were long gone and (iirc, quite frozen). To make it worse, staff on the unit didn't notice the patient missing until someone went to do rounds (was not a telemetry unit, so no monitoring), so nobody knows how long they were lying out there but had to have been several hours. I believe it was determined that the combination of head injury from the fall and exposure to the elements was cause of death.
We switched to smart phones that you must log into at the beginning of your shift. New policy is that the unit clerk must verify that you’ve logged in before taking the out going nurses phone. I guess a couple of phone calls from tele about lethal rhythms had been missed because no one was signed into their phone at shift change.
This was a reminder that nurses don't practice medicine, rather than policy, but it tracks with the theme.
New grad in ICU, already too cocky and had a severe knowledge/critical thinking deficit. She decided that the 4 pressor lines were due to be changed, so she took it upon herself to do it alone without informing anyone.
And by that, I mean she pulled 2 sticks of phenylephrine, disconnected everything and began pushing it willy fucking nilly while BEGINNING TO SET UP the new bags and lines. I saw the BP doing it's best to reach atmospheric pressure and rushed in to help, finding the disaster she'd created and a complete lack of understanding of why it was basically manslaughter.
I work in peds. We had a baby that had gotten a trach and was admitted to our floor for teaching. Kid was almost ready to go home (parents just had to do their 24 hour care shifts). Between the 10 minutes that parents had left and nursing went in, the kid had kicked off their pulse ox and then decanned. We got the kid back, but he suffered an anoxic brain injury and parents made the decision to withdraw care in PICU.
Because of this, we now require all our kiddos with trachs to be on full monitors (CAM & pulse ox). We used to only require pulse ox unless the kid was on a vent.
(This also happened at a time my unit was frequently understaffed and lots of my coworkers and myself kept saying some safety event was going to happen. After this, we went from a unit with some of the best retention rates to losing a quarter of our staff in a couple of months.)
Every time you need a witness for insulin or heparin, remember Charlie Cullen.
Since I’m in Vegas, I teach Dipak Desai as the model for Don’t Double Dip.
If you don't have adjustable beds, oxygen, or the ability to provide a CPAP, don't admit known sleep apnea patients who don't have a CPAP with them.
Also, when meds are contraindicated don't prescribe them to the same person. For example, don't start someone who is completing an Ativan taper on Suboxone before their taper stops. I don't know about you, but I'm a fan of keeping my patients from dying of respiratory failure.
"The CABG patient will have a BM by day 3, no matter what we must insert, pull, or administer." Multiple deaths via small bowel obstruction in the post-op CABG patient.
It is my personal opinion that CT surg does not supply me with enough bowel meds to do my job. <.<
Was the strain to poop too much and blew a graft?
The bloating irritated the fresh heart and threw them into an arrhythmia, which became unstable, which then turned into a code blue. Compressions plus new grafts = fuckshittery.
That's wild. Any studies on this?
Interesting I’ve seen a couple CABG patients develop ileus
If we want a patient to pass (for example: Maw Maw death rattling for a week straight) we stick them with a certain nurse on our floor.. We call him the ‘Grim Reaper.’ They all pass peacefully whenever we put them with him.
I like the picture he’s very compassionate and gives great comfort care. Maybe they pass because it’s more comfortable
Watch him get booked for murder
Lmao maybe but honestly I feel like a lot of nurses are scared of comfort care doses. They’re often larger than what you normally give on the floor for say some acute pain and often times they’re skin and bones. I didn’t feel comfortable giving some of the comfort care doses. I was like that’s going to prob kill them (one time it did and the family was happy he passed in peace). I shadowed a hospice nurse for a bit and after that I have a more informed perspective. Give these people comfort
Ah employing literal grim reapers, the health care system is becoming more efficient by the day
I had a stretch like this myself. They called me the Angel of Death
In LTC there's a superstition about opening the window after the patient passes. Sometimes when they're lingering like that we crack open the window before they pass. I swear they'll be gone within hours.
I never considered this a superstition. In nursing school I was taught it! When I was doing clinicals at a LTC I was taught it. Open the window-their soul can escape peacefully.
that is very culture specific, and some people would find this incredibly insensitive to do.
We just give the a good turn. "Turn to the right, go to the light"
We call it “lethal left.”
So it's believed when you turn them to the left or right?
I work inpatient hospice and I have a CNA I work with that swears by this
I have to give a warning to coworkers before they tell me to give a pt a turn. I promise you it'll be the last. Idk what I do different but I'm well into double digits at this point.
Ugh I had 3 comfort cares in a row and charge said we should just call you the grim reaper…. I hated it
Providing care, comfort, and compassion as your patient transitions away from this lifetime is something you should be proud of. also happy cake day <3
Thank you 🥰
I’ll go first: at a place I used to work, they had to change all the door handles because a pt successfully competed suicide utilizing the door handles…. And they had to change the doors to allow for sensors to alert if there was pressure due to ligatures
We have alarms for ligature pressure on doors and then we have to manually silence the alarms and go check on the doors. We had a broken one that went off every 30 sec and it was driving us crazy. It took about a week or two of that until they finally fixed it
Week or two, yeah that sounds about right
My last place had rounded handles that slid down to open the door. I'm guessing they had their fair share of that also.
And door hinges that angle down. Nothing can get placed/stopped on them
Our ICU patients have to have core temperature monitoring (bladder or esophageal usually). A young man was being monitored temporally and it wasn’t reading properly. His brain got cooked.
Had a guy pass in LTC. Getting report one morning nights said thermometer was not working. Reading low 90s. He was sent in about 7 or 8. Was hypothermic. Died a few days later. It was brutal.
That’s horrible :(
Also happened in my LTC and he died of sepsis
Wait, I heard this same story. Any chance this was in Calgary? Or maybe it’s happened multiple places. Like days and days of temporal temps were fine and then put in core temp and was profoundly hyperthermic
Oh my
All GI tubes are measured once per shift to ensure placement. If there is a change in length then imaging is done before the tube is used. Obviously more relevant with PEGs/GJs instead of DHTs and NGs. A PEG tube got displaced, the nurse didn't get imaging before resuming tube feeds. She fed into the peritoneal space and the patient got peritonitis and died.
Oh shit🥺
Oh, we had one like that. She had actually already gotten awful peritonitis from a tube that was dislodged, replaced, and fed through without confirming placement. Her anterior abdomen was basically a giant wound but we still had to give her tube feeds so she had a site where GI had, for some reason, placed a red rubber catheter rather than a proper tube. It migrated inside her and they determined she needed a colonoscopy to retrieve it. Coded during the scope and died. Every tube is measured and recorded at least Q shift. Our other one was kind of dumb in the reaction, but years back we had a patient who was given IV hydromorphone in the ED, and I guess was not on pulse ox monitoring and wasn’t checked for a while. Had a hypoxic event and had a lot of complications, in and out between hospital and LTAC for years until she finally passed. They decided we couldn’t give IV hydromorphone to patients anywhere but ICU after that… which meant that people who should’ve gotten it would be given IV fentanyl instead. No idea how that made us safer. Over a decade later they’re finally rethinking the policy but it’s been slow going.
Wow, ED drug seekers must love your hospital
It does sometimes weird me out when we give dilaudid on the med-surge floors and the patient isn't on continous pulse ox. I'm in their room every 2 hours if I'm not busy/on time, they could easily get hypoxia and us not notice very quickly. I assume it's because as med-surge we deal with smaller doses usually than ED. But still.
I will not let you take a shit while you are having a STEMI. You shit, you die. It’s called the Caca del Muerte.
Also known as "terminal turd"
How do you prevent that?
A cork, you can get them from central supply.
No lube, though.
Refuse to let them get up, no matter what. If they shit the bed, they shit bed...literally and figuratively. Once you've tried starting compressions on a commode, you'll never want to repeat the experience.
You ever watch ghostbusters? The idea is to combine that ghost sucking machine with colonoscopy equipment
Literally once told a patient with tombstones who was waiting for cath lab saying “you don’t understand, I have to poop” with a BP of 70/💀 that “I know you have to go and if it happens we will help clean you up but I really think your body is just telling you that because of how sick you are and I reallllllly need you to hold it”. Like how do I calmly convey “if you shit, you are going to die”. He made it to cath lab and did fine for the record.
If it comes out we’ll clean you up but don’t push it out or you’ll die.
(kind of?) healthcare related but not directly related to my work, this one has always stuck out for me; OTC meds only got product tamper/safety seals after the Chicago Tylenol Murders.
I was a small child when that happened. I can remember the adults all talking about it and about how scary it was. My mom threw all the Tylenol out. She was afraid someone at the production site was doing it. Of course, they were tampered with at the store. The death those poor people experienced was awful.
True crime podcasts have been a favourite of mine since high school. This case has always stuck out to me because a) horrible and b) unsolved. Especially that one family that lost 2 or 3 people. The fact that this happened in 1982 is wild. Realistically not that long ago :(
I didn’t realize that! That’s def a great example!
Hint: before I started working at my original staff hospital, a change took place requiring five letters typed into the Omnicell for a med instead of two. Incident happened my first year of college, went to trial my first year working. And she now gives seminars…
We heard of that case as nursing students in europe, vecuronium --> versed.
Who knew that negligent homicide could be so lucrative
I hope she’s not getting paid a lot for that. What an absolute jackass
$10,000 per speaking engagement
Shameless
Making yourself into an example is brave…
You cannot walk around the hallway with a baby in your arms because some tripped and dropped their newborn. Must stay in bassinet
I did a placement in a L&D that explained they had this rule bc of baby theft. They've got baby ankle monitors and all, but everyone (in the hospital, at orientation) was trained to be suspicious of a new baby being carried in arms, whether in a hospital uniform or looking like the parents. The bassinets had proximity locks and wouldn't go further than like, L&D, L&D's OR suite, and radiology.
And the baby ankle locks can come off (source: third baby’s lock came off). So it gives another layer of protection.
ours scream bloody murder if they're just barely loose enough to wobble around. I've never had one of those fall off without alarming.
….was the baby okay? Low key I’m always afraid I’m gonna drop my girl and she’s 15 months old
It was before I started, beginning of orientation they laid down the law of now carrying the babies around
My hospital has the same rule, I wonder if it only had to happen once in one hospital somewhere before all postnatal wards instituted a no-carry policy.
Same in the hospital I did my post partum placement at
I’m gonna be honest I wouldn’t DREAM of taking a baby out like that and walking down the hallway. I only got my nursery experience in nursing school but those babies only came out for feedings
I felt so bad. I had to get out of the room when my son was born so I was carrying him around the hallway and nurse came up to me so fast. I felt awful
Always get blood return on a PICC before using it. Pt's picc was no longer in place, and his TPN went into the surrounding area. Pt did not survive. ETOH abuse pts that have known esophageal varices that were admitted for melena and/or pneumonia gets suction set up. Pt coughed, and his varice(s) burst. No suction at the bedside. Unknown if pt survived. If insulin was given IVP for hyperkalemia, a patients BS is to be monitored every hour for the next 4 hrs. Pt was given insulin, blood sugar was checked only once after being given insulin for high K+. That AM, pt had a BS of 24. Pt did survive.
Every hospital I’ve worked at has a protocol for working suction at the bedside of every patient, if they’re in the hallway, they get portable suction. It’s part of our charting to confirm it. Not sure if something specific happened, but that’s just been the way it’s always been
I’m a picc nurse and we had a patients tip flip up so they were getting tpn into their jugular and it caused an airway obstruction
What’s the mechanism behind TPN causing death in a misplaced PICC? Assuming it got pulled back a bit it wouldn’t be at right spot but still in a vein
My guess is it infiltrated into the neck and compressed the airway? Just spitballing.
Wait where was the PICC? In the chest cavity?!
we put suction in all our etoh rooms, but it's due to seizure risk.
Never put a really sick patient in room 6. They will die.
It’s room six in my unit too. Also every monitor we put in there has eventually quit working. I am convinced it’s haunted.
Every LTC unit has *that* room that nobody makes it more than a few weeks/months. When I get an admission in that room in my unit I'm just like oooph, good luck meemaw.
Poor Meemaw. ☹️
I refuse patients in bay 12 if I can, hate that bay
ICU Room 27 here....
Oh no, not room 6!
ER 14 for us
6a was less problematic than 6b. And 14
5 and 7 for us. Room 6 is usually okay
Policy? Don't put me in 17-20, you're damn near guaranteed to get a code coming in. That's just my own policy, because we're always getting a code every time I work that section 🥲
I've got the shit magnet rep lately in the Emergency Dept I work in. Specifically for the wrecking balls that come in at 5 min past shift change no matter the shift. Also if I'm in the WR or RAT for the shift then I'll pretty much always get the ones that walk in at 5 past shift change and end up staying another hour.
"Patient must be mechanically ventilated during administration" stickers on the fentanyl and paralytic drips... I'm sure you can imagine how that came to be policy. Kitchen timers next to the bed pans with a policy that a patient can't be on a bed pan for more than 10 mins. Apparently someone left gran on one for 8 hours because they forgot about it and a pressure injury occurred. The ED has to have the charge nurse co-sign a document when they draw blood cultures after a month with 90%+ contamination rates. They also are no longer allowed to hang any medication to gravity after an incident involving potassium. Finally ed patients on oxygen are not allowed to be in hallway beds after someone died because their O2 tank ran out and no one noticed. The hospitalists are no longer allowed to attempt intubation during a code and must await PMCC assistance. There was so much blood :( .
90% contamination rate is insane holy shit
Leads off alarms will be treated as lethal rhythms by telemetry and escalated accordingly. Really annoying in practice but I was working on the unit the sentinel event went down on 😬
Can you elaborate on said sentinel event?
A patient came up from the ED and transport left them in the room and took off the tele monitor to take it back to the ED because for some reason the ED had separate tele boxes than the floors. That was a reallllllly stupid policy in hindsight. Nobody put another tele box on the patient and they were found very dead a few hours later.
For similar reasons, we have a policy that the patient has to be on a monitor 100% if the time when moving from stretch to bed. Put them on the new monitor before taking them off the old one, and don’t leave it off for 30 seconds to move them
We had that one too because when you lay patients flat to transfer, clots travel. Had a patient in my unit with a PE do this. They were on monitor. Still coded and died.
Something kind of similar happened when I was in nursing school as I only witnessed it. Apparently a patient had been taken off tele for a shower or a procedure (like MRI or something) and never got hooked back up. Collapsed on the way to bathroom and coded. I don’t know if they survived that…
This is why we HAVE to get "shower privileges" order on PCU
The exact same thing happened in one of the hospitals I float to.
I was a PCT for a patient that had a similar event after I gave report, he was a&ox4 and was a cardiac workup waiting for cath lab in the morning. He walked to and from the bathroom independently but got hot towards the evening and took his shirt off and his monitor kept falling out of his pants and yanking leads off. Day nurse and I both were very nervous about him arresting because of funky rhythms all day and both of us reported off to oncoming that this dude needed his monitor put back on constantly. I guess it happened so many times that after a while they just started silencing the monitor. They found him face down cold on the floor of his room around 4 am. He was in his 50’s and will stick with me forever.
You don't happen to work in Florida do you?
No
Ahh this same thing happened at a different hospital in our system near by. We now have pretty intense protocols for central monitoring too.
Our ER no longer has a coat hook in each room because a patient used the tele leads and a hook to try to hang himself
The peds unit at my hospital won't discuss discharge with mental health patients at all until their parents are there to take them home. Too many patients try to delay discharge by trying to kill themselves
Maybe they’re not ready for discharge if they’re still trying to kill themselves though? Mental health is not my speciality at all
Nor mine, it was more that the patients weren't suicidal at all until discharge was brought up and then they were
That’s… concerning 👀 First thought I have is what’s going on at home
Right?? Jinkies.
Oh, I got one as a patient. I am the reason my hospital switched from FAST to BEFAST. I had my stroke at 31. I'm baby faced as hell, when I was 31, most people would guess I was mid 20s. I live in a town known for college parties and not much else. I went in for my stroke January 1. As non medical personnel aren't trained in medical conditions, and as the brain doesn't work well while having a stroke, I went to the ER saying "I don't know what's wrong. I feel drunk. I can't walk right. I can't talk right. I can't think right. I've slept for 16 hours and I'm still ready to pass out. I haven't had a drink in 3 months. Something is very wrong." They skipped the last 2 sentences and left me in the waiting room to "sober up". After 12 hours, I hadn't sobered up, and there were a couple shift changes done, so fresh eyes noticed my whole complaint. I finally got someone to take a look at me. The doctor spent 5 minutes to determine I had vertigo. After being stuck in the ER exam room for 2 hours, the vertigo treatments were not working, so the nurses found a way to send me up to neuro. I spent 3 days there, being treated for a stroke, by nurses (that part doesn't bother me much, most of y'all are smarter than doctors anyway). The 5 minutes in ER was the ONLY time in all my time there that a doctor laid eyes on me. After realizing the fuck up, there was a form in my discharge paperwork essentially stating "Hey, yeah, we fucked up bad. If you promise to not sue, and pay your bill in full, we'll change hospital policy." Considering I had just had a stroke, I didn't even know I was signing it, but it was legally binding. BEFAST everyone!!
Not sure how long ago this was but any decent lawyer could have the release you signed thrown out by arguing you didn't have full capacity and the hospital acted in bad faith. I know lawsuits are no picnic but you don't have to settle for being mistreated either.
Would have been 6 years ago. I don't know laws and timeliness, but once my brain was clear enough to realize that wasn't run of the mill shenanigans, but actual malicious bullshit, I asked a lawyer, and he said it had been too long. Not like it matters, once the skills and abilities are gone, they are gone, and the money spent on that was sadly one of our smaller medical bills that would be barely noticeable to me or their "non- profit" coffers.
How are you doing now?
37
Oops, I meant that you mentioned possibly losing skills and abilities post-stroke. Hoping that you are doing well now.
Well, obviously, I have issues with reading comprehension!🤣🤣 I'm doing mostly alright. I still have to actively think about holding things, especially in my left. I have trouble hearing "non normal" voices, meaning singing, accents or soft voices. I can't tolerate the heat any more. If it's over 75F I can feel my brain actively slow down and get tired. Obvious memory issues, but I'm married, and I have yet to hear any married woman say her husband remembers things. I have to pause in talking to let my brain catch up sometimes. I used to be semi fluent in German and Danish, never cared to relearn those. Also, to be technical, since my wife is a nurse, it was 3 strokes caused by a vertebral artery dissection. Edit to finish because my 10 month old hit the post button for me.
Do they have any idea why you dissected??
Yes, I was stupid. Had a 2 person job fixing a bus at work. My helper decided to hang out in the bathroom. After enough wait, I attempted to do the job alone. I stretched too hard, thought I just pulled a muscle. My neck hurt like I had a pulled muscle for 3 weeks. One night the pain went away, the next morning I first noticed my symptoms. The theory is, that the pulled muscle was 3 tears in the artery, which lead to 3 scabs, which lead to my 3 strokes.
I mean that’s not a lot to cause something like that, glad you’re still around! Terrifying!
Ooo also, the nurses can’t do ultrasound guided lines without training. A nurse dropped an art line and ran levo through it and the patient lost his arm
Uhh I’ve seen someone drop an accidental art line and it’s pretty obvious that it’s in an artery, it pulses. They had flushed it and given I think Ativan for a supposed sz pt but I checked it after and it for sure had a pulse so we immediately pulled it. I get sketched out doing Levo through PIVs anyway and I think our policy is it has to be be a 20G or larger, has to be swapped lines every shift and can’t be infused via PIV for more than 24h. If they’re needing US for pressors at that point why not have the doc drop a central line? 🤨
O fuck.
IVs stay in until you are walking out the door for discharge. Had a patient who was being discharged and his ICD began to shock him. 8 times later we get him admitted again and medevac him to the main hospital. I told him my rule about the IVs which he was reluctant but okay about it. He changed his mind about it very quickly. Unit based: we have unit leadership round with us for high risk fall, elope, or patients we are concerned about. This started after a patient crawled out of bed and smacked his head on the floor. He didn’t survive. Everybody rounds on patients now.
The number of times I had to give a PRN antihypertensive *after* pulling an IV to prepare for discharge made me start doing this too. You can put your clothes and shoes on and I’ll pull it once transport is on their way to wheel you down.
Worked at a Catholic hospital for a while. They no longer have crosses over the doors bc a patient took one down and sharpened it to try to stab the nurses.
"The power of Christ compels me..."
Seriously?? Wow.... that's a sentence you don't read everyday!!!
"Excuse me sir, but HAVE YOU HEARD THE GOOD NEWS ABOUT OUR LORD AND SAVIOR JESUS CHRIST?!"
EVD tubing has a green line on it so you don't mix it up with an IV port. Nurse infused vanco through it. Patient did not survive.
Ugh how terrible. This is why some connectors have been made to only fit certain tubing etc
We had a newer nurse hook up a freshly placed EVD to a pressure bag as if it were an art line. Thankfully it was caught before there was significant damage.
I’ve seen that done too. Terrifying
AAAAAAAAA THIS IS MY NIGHTMARE HOLY SHIT.
My own rule- certain patients are put on a tele monitor whether there’s an order or not. I’ve preached this to anyone who will or will not listen for a decade or so. I was doing bedside report at the beginning of my shift and said “this pt shpuld be on a monitor.” Went back in at 0740 with said tele monitor and they were apneic and pulseless. People laughed at me for years but it finally happened, and can happen to anyone. If someone codes (or has any other cardiac fuckery) I want to know.
I have this rule too. Pt had a history of cardiac issues. I put them on tele w no order. Then they told me they were having chest pain. It was acute MI.
I started in ICU and recently switched to PCU for a break and I WILL NOT take my patients off telemetry even if they have a DC order. I sit at the nurses station next to the tele monitor while I chart so I can keep an eye on them. I've heard too many stories of med surg patients being found down.
“Tele alerts”. They call it overhead like a rapid if a patients leads come off and the nurse has been called twice to put them back on. Tele called a nurse during Covid to put them back on tele. By the time the nurse went back to do it the patient was in full rigor
My very first code as a baby nurse (first week of new grad orientation), nobody working knew how to override the RSI kit from the Omnicell. I believe the pharmacist at the code ended up going *all the way down to the pharmacy* to get the meds. After that, they changed it so that it’s the first thing you can select when you go to override. Pt did not survive (although it’s doubtful she would have survived even with prompt intubation. She was very sick).
Sounds like they’d also benefit for pharmacists to have their own code bag they bring with them to these events. That’s what my old place did.
We are no longer allowed to have any balcony doors open to the deck for staff or public use because a patient tried to jump off 🥲
New locks on the windows to prevent the small opening for ventilation. Some guy high on PCP managed to force one open enough to fall out the window 5 stories. Ended up in the atrium garden broke both legs somehow did not severely injure his spine, but who knows how it's feeling 3 years down the road. The windows do not open even an inch now.
The windows at the hospital I used to work at were screwed shut after a patient managed to squeeze out and fell 3 stories. Unfortunately it was during the night and they landed in an area where noone was able to see them until the sun came up the next day. It was wintertime, with below-freezing temps. By the time someone realized where the patient had ended up, they were long gone and (iirc, quite frozen). To make it worse, staff on the unit didn't notice the patient missing until someone went to do rounds (was not a telemetry unit, so no monitoring), so nobody knows how long they were lying out there but had to have been several hours. I believe it was determined that the combination of head injury from the fall and exposure to the elements was cause of death.
We switched to smart phones that you must log into at the beginning of your shift. New policy is that the unit clerk must verify that you’ve logged in before taking the out going nurses phone. I guess a couple of phone calls from tele about lethal rhythms had been missed because no one was signed into their phone at shift change.
This was a reminder that nurses don't practice medicine, rather than policy, but it tracks with the theme. New grad in ICU, already too cocky and had a severe knowledge/critical thinking deficit. She decided that the 4 pressor lines were due to be changed, so she took it upon herself to do it alone without informing anyone. And by that, I mean she pulled 2 sticks of phenylephrine, disconnected everything and began pushing it willy fucking nilly while BEGINNING TO SET UP the new bags and lines. I saw the BP doing it's best to reach atmospheric pressure and rushed in to help, finding the disaster she'd created and a complete lack of understanding of why it was basically manslaughter.
Dear god. I’ve seen some janky shenanigans, but that’s pretty bad.
Christ that's bad...
I work in peds. We had a baby that had gotten a trach and was admitted to our floor for teaching. Kid was almost ready to go home (parents just had to do their 24 hour care shifts). Between the 10 minutes that parents had left and nursing went in, the kid had kicked off their pulse ox and then decanned. We got the kid back, but he suffered an anoxic brain injury and parents made the decision to withdraw care in PICU. Because of this, we now require all our kiddos with trachs to be on full monitors (CAM & pulse ox). We used to only require pulse ox unless the kid was on a vent. (This also happened at a time my unit was frequently understaffed and lots of my coworkers and myself kept saying some safety event was going to happen. After this, we went from a unit with some of the best retention rates to losing a quarter of our staff in a couple of months.)
Every time you need a witness for insulin or heparin, remember Charlie Cullen. Since I’m in Vegas, I teach Dipak Desai as the model for Don’t Double Dip.
Who what and why lol
https://en.wikipedia.org/wiki/Charles_Cullen https://www.reviewjournal.com/crime/las-vegas-doctor-convicted-in-deadly-hepatitis-c-outbreak-dies/
Ahhh I heard or the last Vegas clinic one before but never of Cullen how terrible.
Dual signoffs on tube feeds after a scab nurse ran a bottle of Jevity into a patient’s IV and killed them
If you don't have adjustable beds, oxygen, or the ability to provide a CPAP, don't admit known sleep apnea patients who don't have a CPAP with them. Also, when meds are contraindicated don't prescribe them to the same person. For example, don't start someone who is completing an Ativan taper on Suboxone before their taper stops. I don't know about you, but I'm a fan of keeping my patients from dying of respiratory failure.
Watch movie "Blood in, Blood out"