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It's the evening before the surgery. The doctor's in the prepping room, finishing up some necessary details before clocking out. The nurses are already running the closing reports. Some have left. Whumpee lies naked on the guerney, strapped down, a simple cloth wound tight over their mouth. Whumper can't help but smile when he notices. The nurses must have done that. Not to keep whumpee from screaming, though. But whumpee does so like to ask questions.
Whumper pulls out a sharpie. Quietly, methodically, he marks out the parts on Whumpee's body that need to be operated on. That flab on their stomach, elasticity in their neck, plumpness in their cheeks. Whumpee whimpers through their gag, trying to pull away. One of Whumper's lines gets smeared.
"Now, now, you don't want me to make the wrong incision, do you?" Whumper's tongue clicks as he swabs away the line with an alcoholic concoction.
Shaking their head, Whumpee tries to say something but the gag stops them.
"What?" Whumper asks, "You want to know what I'm changing?"
Whumpee nods, huffs smothered but fervent.
Whumper smiles, "Well, I guess we have time..."
APA concerned about far-reaching consequences from Supreme Court decision regarding therapy as âfree speechâ
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This picture is an example of a âWOWâ also known as a workstation on wheels. These computers are new to my department and came with our electronic health record system change that we experienced almost two years ago. Prior to this change we did not have medication or patient scanning in our department. We simply printed out our medication order, went to the pyxis, obtained medications and used our paper order as our way of verifying the patient and medication safely. Changing over to the new electronic health record system EPIC was a big change for our department and staff members and these Wowâs didnât help due to one main reason, the scanner was attached to the computer. Â
I would have to go back to the identification stage of the design process as I was able to identify the problem within my first couple of hours of my shift when we were using this new system of scanning the patient and medication. The scanner is attached to the computer with a short straight cord. You must be close to the patient to be able to scan them and then the medication. The problem is that emergency department rooms are small, and patients are usually bed bound and may not be able to move their extremities to assist you in scanning their bracelet. There were and still are many times that my computer either comes rolling into my patientsâ feet at the end of the stretcher, or into a visitor by accident due to me pulling the scanner closer to the patient. When we identified this problem to our management team, we asked why we didnât have wireless scanners like the rest of the WOWâs in other units do. We were then given longer, spiraled cords due to the amount of cost it would be to change out all the scanners in our department. If our nurses were involved in the identification stage of the design process this could have been something that was foreseen, and we could have acted on this design prior to it being instituted into our department, saving the hospital time, and money.Â
With the SCAMPERING method in mind I would use SUBSTITUTE toward a solution to this problem. I would substitute the scanners in our department to wireless scanners. We have an overabundance of computers and we can take the eight computers that are used by nurses daily for scanning and slowly start to change them over to wireless scanning. This would improve our employee satisfaction and may also improve our scanning percentage that at times suffers due to the amount of limited space and fast paced environment we work in. Some nurses chose to âclick offâ the medication versus scanning, or even scan the patientâs bedside labels due to the straight and spiral cords that do not allow the nurse to reach the patient. This poses a threat to our patientâs and patient safety that could be corrected by simply changing over to eight wireless scanners. The cost of the wireless scanners should never outweigh the cost of patient safety.
Currently the attached scanner is on the usability portion of the hierarchy of design. There is a major issue with the scanners function and usability due to the attached component. The attached scanners greatly affect day to day operations of the department as many nurses look for the computers that have a spiral cord as it may give them a bit more space. But we still have computers that have the straight cord. After scampering and substitution to wireless scanners, they would not only be functional, they would improve usability, proficiency and reliability from staff.
Patient Endangering, AKA The Day I Lost My Sh**
As therapists, part of our role is to make safety recommendations based on our patientsâ physical and cognitive abilities. Much of our documentation explains how much help a person needs to do various activities.
Thus when I make a recommendation like âpatient requires one on one supervision at all timesâ, I expect that to be taken seriously. And when the rehab supervisor and the entire nursing staff also recommend this I simply expect it to be done. However I was severely disappointed.
I previously introduced Nancy to you, the patient I worked with who was in a catatonic excited state. This recommendation was made for her as she was a danger to herself and others around her.
And yet I would find her wandering aimlessly down the hall alone, or screaming in another patientâs room. Frustrated, I would return her to her room where a staff member was supposed to be watching over her and several other âone on oneâ patients. The staff member was often unaware that she had been missing as he thought she was with one or another therapy discipline and in his defense, he was extremely preoccupied supervising at least 3 other patients who needed just as mention attention as Nancy.
We managed as best as we could until one day I again found Nancy ambling down the hall. I was assisting another patient to walk back to her room when I saw with horror that Nancy was about to walk straight into another patient who sat helplessly in his wheelchair. Nancy, completely unaware of her surroundings, continued to plow forward even though her leg was caught about the wheel. She keeled forward.
Forced to abandon my other patient, I reached out for Nancy and caught hold of her before she fell and before she could latch her hands onto the patient in his chair.
Furious that no one was with her again, I instructed one of the nurses to assist my other patient back to her room while I returned Nancy to safety.
Scratching and pulling at me the entire way, I slowly led Nancy back to her room.
âWhy was no one watching her?!â I cried to the nurse at the station.
The nurse was clearly just as fed up as me. âWe were told that we couldnât spare any staff to watch her! No one is going to be sitting with her anymore!â
âAre you serious? This is not ok! Sheâs not safe by herself!â
âI know thatâs exactly what I said too but apparently that doesnât matter!â the nurse lamented.
âWho decided this?â I fumed.
âThe director of nursing.â
âCome on Nancy,â I said, âweâre going to go talk to her.â
I took Nancy all the way to the office with me, afraid to leave her alone again. With every step I took I grew more and more enraged.
By the time I reached the DONâs office, I had morphed into the hulk. Without a warning I barged straight in and began to shout questions at the DON. After the surprise passed, I could see on her face she knew I was right but was going to give me her rehearsed answer anyway.
âWe cannot afford to have staff here only to be supervising patients.â
âBut she is not safe without it!â
âWe are not legally required to provide patients with one on one supervision at this facility.â
âThen she should never have been accepted here if we canât provide the care she needs!â
Another visiting manager frowned at me. âWho the hell is this?â
The DON continued however. âWell we had open beds that need to be filled and she is here now so we canât change that.â
At this point I was so far gone that tears had accompanied my rage and my hands shook. âRight! She is here! So while she is here she has to be safe!â
The other manager jumped in. âShe has no record of any falls.â
âThatâs because we keep preventing them! I just stopped her from falling in the hall!â
âWe have no evidence to show us she isnât safe,â the ignoramus persisted.
I could see I was getting no where. âWell come on Nancy! I guess Iâll leave you to start that fall record!â
The next day, someone was watching Nancy again.
I know I didnât handle myself well in this situation. Shouting at people generally solves very little. However as I neared the end of my 3 month contract I had already used up every last shred of my patience. I was tired of the unacceptable excuses like this. I was fed up with the mistreatment and neglect that I saw every day. So while I behaved poorly, I ultimately do not regret it because I knew was right and the DON did too.