Speaking of the Joint Commission being a pain in the a**, we recently received a memo saying the Joint Commission in its God-like efforts to keep us from killing dead people left and right has declared the code-med boxes located in the rooms unsafe. Currently, in a cardiac arrest/severely symptomatic bradycardia situation, we can bust out the lido/epi/atropine by just putting in a little three-digit numeric code. It takes like 5 seconds to get the medication out and give it to the patient. Each "resuscitation" room has its own code box with these medications right there for easy access along with a full code cart and pacer/defibrillator. It's slick.
Nope. Not anymore. No code med boxes in the code rooms anymore.
Even though we check the code boxes every morning to make sure they are stocked and that the meds are not expired, the Joint Commission is not satisfied. We must now keep our CODE MEDS in the Pyxis (access to which is granted by entering a code for the door, a 8-digit ID number then scanning one's fingerprint which may or may not work on the first 4 times you try it then flipping through a menu to find them then obtaining each of them from their little cubie) to guard against something-or-other, like the patient's heart rate returning to an acceptable range or restoration of a perfusing rhythm in a timely fashion. It makes no sense, but the general complaint is that there isn't enough control over these meds.
To reiterate: It's an ER and our code meds are behind not one but three levels of secured access. Great. Thanks Joint Commission again for your patient safety efforts.
The first time I have to run away, down the hall, enter my door access code, 8-digit number, and fingerprint while my patient is DEAD ON THE TABLE WITH NO HEARTBEAT TO OBTAIN A CODE MED TO SAVE HIS LIFE, you will be receiving a very convincingly-worded letter telling you to take your code-med edict and shove it.
Friday, April 25, 2008
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26 comments:
I think you mean JCAHO. You accidentally called it the Joint Commission.
Easy mistake to make.
Uh. I don't get it. JCAHO changed its official name to the Joint Commission like last year. Or you can call them the Medical Marijuana Advocates.
Or, you could just ignore them. Pompous assholes.
I wish.
Oh. my. god.
It might take a couple of really bad codes and a few case reviews before this is changed back, but I truly hope for your ER that this does not last very long!!! I KNOW for a fact there will be less 'saves' from full codes with the extra wait time it takes to run into the med room.
That is puuuure bullshit. I hope someone of power in your ER grows the cojones to tell the commission where to stick their foolish rules.
Somebody, somewhere has to take the hard line with these schmucks. If the reviewers are sat down with a competent ED Medical Director, who says in no uncertain terms that this recommendation is incompatible with emergency patient care, what can they do? They're as bad as the Supreme Court, unelected and unaccountable.
NK: are you familiar with Monty Python? I am so going to stalk your blog until I read the first mention of a patient taking things into their own hands, announcing "I'm not dead yet, I think I'll go for a walk" and getting their own meds.
hmmm... I wonder if a class-action suit could be brought against these ass-clowns?
The Joint Commision has to justify their miserable existence
Is it "The Peter Principle" that says, "Man accedes to the level of his incompetence"? I think the Joint Commission has made it their Golden Rule.
omg, I thought I'd heard it all with TJC stupidity......What's next, TCJ having dieticians approve every morsel of food that is put in a patient's mouth?
Dude. Don't give them any ideas, Rx!!! I mean...the patient might be allergic to one of the ingredients!
Sometimes I wonder what would happen if one of these morons were to actually end up in an ER with an actual emergency....
Forget lawsuits. If, say, my wife dies in an ER, and I find they had such a retarded protocol in place, I'm going to make myself a new wife, see, out of the parts of dismembered JAC-HO administrators.
If it's me that croaks first, I trust that she'll come up with something even more amusingly dreadful.
I really like Pyxis...when it takes my fingerprint the first time.
We're really gonna kill lots of people if we have to scan over and over again.
I'm on the floor, so I figure they'd do something snappy like this to peons like us (so we don't kill anyone), but in the ER...c'mon...where's the common sense here, kids?
All I ask of JCAHO is to "show me how". The "policy makers" are so far removed from patient care; they can not put practical application to what they ask of us. I left an education and training position because I could not, in good conscience, continue to ask of others what I couldn't do myself. Do no harm and don't eat your young.
Angela---we can't do harm if we can't do anything!
I agree, if I have to scan my fingerprint 4 times in PYXIS to get the code box or an RSI box, then I invite the JCAHO excessive CO2 producers to show me how to save lives within the confines of the rules they set. They can't do it. Most of them have been professional nursing students with all the initials behind their names and can't insert a thermometer.
And all of this security is because of the raging epidemic of epinephrine abuse ravaging the land?
Let me take a breath, and try to stay calm and reasonable. Rage and screaming are justified, however, out of respect for my esteemed colleague, Nurse K, I will try to contain myself.
We in healthcare (and no, I do NOT include the people in JCAHO as people in healthcare) are required to justify our clinical decisions by having a scientific basis for all that we do. We are sued, and loose our licenses if we fail to do this, and rightly so. So, will someone please give me one desiccated shred of scientific evidence that demonstrates that our patients are being harmed by the proximity of emergency medications in their treatment bays?
Take your time. I'll wait.
(Note to JCAHO: real doctors, nurses, and technicians call this “evidence-based medicine.” It is a really neat idea. Saves lives, actually. Look it up in Wikipedia, if one of you know how.)
If you cannot provide this evidence (JCAHO, I'm talking to you, you miserable, execrable, pustule riddled whore!) then you are requiring me to endanger my patients' lives and perform below the minimum standards of my profession in order to obviate a danger that has never been shown to exist, by a measure that has never been shown to have any benefit!
Everyone who actually takes care of critically ill people, or who ever has, knows that this rule will kill our patients. JCAHO are medical non-entities. Amateurs and frauds masquerading as doctors and nurses. Empty lab coats with clipboards and pens.
No one can serve two masters. We will either pander to JCAHO and kill salvageable patients, or we will keep our oaths and provide competent care to our patients, and tell the world that JCAHO is a murdering, incompetent, fraud. Rules like this leave no middle ground on which to compromise. Defy JCAHO, or kill your patients. Yes colleagues, it really has come to that.
(Nurse K, please forgive my rude outburst. You deserve better conduct from visitors to your fine blog, and I am sincerely sorry for making a scene. To JCAHO drones, however, I will make no apology. I meant every word and will happily repeat them. They deserve only contempt and defiance.)
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nk: "Angela---we can't do harm if we can't do anything!"
Disagree. Yes, doing nothing can harm.
I have a recurring fantasy where I go to JCAHO (pronounced Jay-COW, BTW) headquarters, throw away all their coffee cups, reset their computers to log off every time they turn away to answer the phone, and hide their clipboards. For some reason, I'm usually wearing a "Dilbert" t-shirt.
Somebody explain to me why it's OK that it takes me half an hour to get an EKG and 2 hours to get a UA, but we're concentrating on where I drink my coffee.
Nurses are the front line of healthcare and are utterly essential. The shortage is a world wide problem and you can help. There is a new social network, being pioneered by Shawn D. Mathis, that is designed to supply nurses with everything they need and to help them keep in contact with one another. It's worth checking out. http://www.mynursebook.com
Maybe JCAHO just want you to call for a paramedic when you have a patient go into arrest(?)
Where I work, we carry the usual drugs in our trauma bags, no codes (3-digit or 8-digit), no fingerprint scans, just a zipper and a check of the drug/dosage/expiry date.
^^Thanks!!
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