Sunday, October 16, 2011

Constant Vigilance

Walked in this morning to find that even my favorite doctors don't remember to update their orders.  Although Bograd put it in the treatment notes, our nurse today was "old school" and would only follow orders.  So she refused to do the one hour unclamped, two hours clamped scheduled for the G tube, and the covering ASOD didn't know the reasoning and was not going to mess with it.  I wasn't going to care.  I was going to follow what Bograd told me int he PACU yesterday, but to cover myself I asked her to page Bograd on his day off to call Wagner and fix it.  It was fixed, but why was it necessary?

Then Goodlett never updated the nutrition order and Derek was still listed as NPO (nothing by mouth from OR yesterday), so when we went to order him something to eat, dietary told us we weren't allowed to order him anything.  He wanted an icecream and a gatorade.  Big deal.  But the order had not been changed, and they argued with us!  The arguing was not necessary.  Ever heard of working with us?  By the time we would have gotten to the ASOD and gotten the orders changed, it would have been too late to call back and order something.  Thankfully, through the corpsmen, we met someone in dietary who sent up a tray notwithstanding the orders.  Goodlett will get a piece of my mind tomorrow, on his last day.

Off to CT scan, which is never fun because moving is a chore.  Getting into the tube is rough, but thankfully we had a tech who understood this time.  I put on the lead vest to help and hold him steady, but they wanted a higher scan this time.  Seriously?  What brainiac ordered that?  Last time they barely got high enough to see the abscesses and now they want to try to go higher? 

The arm blocks how much they can get him into the tube.  It's that simple.  So they left him lying on the table while calling around and trying to "make it work."  Shelly, his nurse, told them to get someone from plastics down there to look at it.  They sent the ASOD who did not know the flap, his case, etc.  He said he spoke to someone in plastics, who again, did not know his case, had never seen his arm, and had only read the notes.  Well, we all know the notes have been wrong and have been misconstrued. 

This new plastics guy, without seeing Derek, without talking to anyone who had seen Derek, and without having any firsthand knowledge of the case, wanted me to trust him when he said it was okay to remove the padding and tape the arm in place.  I'm sorry.  Not.Going.To.Happen.  I asked the ASOD what then?  How do we keep the arm stable?  He said we tape it in place.  Excuse me?  I told him to leave, and we would get what we could.  We are half way through this flap.  We are not screwing with it now.

The CT is to find out the status of the abscesses.

And the ASOD was not responding when paged for the blood pressure.  He told me it was within the parameters.  He would not have been paged if it was.  It was too high, and his nurse told me it was too high.  I asked him what he was going to do, and he said he would talk to the nurse.  No.  You talk to the patient.  You tell the patient what you are going to do.

The most important thing to come out of all this?  Communication is lacking.  Constant vigilance is required to keep on top of everything and make sure that nothing slips.  The nurses, for the most part, are wonderful.  There are some that are lacking, but most of them are wonderful.  But you have to keep on top of everything to make sure that the orders are right and that they are followed.

Poor Dr. Raymond.  He takes over for Dr. Goodlett on Monday. He is the ASOD overnight tonight.  He came in to check the woundvac tonight, and we chatted.  Does he realize what is facing him?  Maybe.  He has been dealing with me due to the plastics rotation, but dealing with me everyday?  We'll see if I can break him in.

We were supposed to get Derek in his wheelchair and outside today.  That was the plan.  CT took too long.  Maybe tomorrow.

Good night.  God bless.  Onward and upward.  The battle continues.

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