Sunday, September 4, 2016

Things that really bug me

Some of the people at work complement me on my relaxed laid back demeanour.  I would rather they complemented me on how intelligent and handsome I am but I have to take whatever complements I get.   Under that calm exterior lies a smouldering pit of resentment.  

Let me air my grievances.

1.  Electric beds.  Not electric OR beds, but I will get to those.  I am talking about the electric beds from the ward.  It does make sense to reduce the number of times patients are transferred and so some patients go to and/or from the OR on these beds.  Except, these beds are never at the same height as the OR bed which means plugging them into an electric outlet.  Of course they come with ridiculously   short power cords (short enough not to reach the wall but not short enough to not trip over) which means finding an extension cord so that they can be plugged in.  Did I tell you most of the beds in our hospital now have two plugs both of which have to be plugged in, so now two extension cords.  Aside from the fact that we really don't need two more things to trip on in the OR there is a potential electrical hazard here.  When I was a resident we had to learn about electrical safety and it seems that by law most devices in the OR are elaborately grounded to prevent shock to the patient and staff.  And apparently if you use an extension cord, this exposes the patient to micro or macro shock.    (Like I said, I learned about electrical safety, I didn't say I understood it.).  Oh and the new beds come with a piercing alarm which goes off if the bed is unlocked while plugged in, like for example when you are pushing it towards the OR table so you can move the patient.   

A lot of this could be fixed if the beds came with batteries which our OR beds do and which the hospital beds in the hospital in Ecuador where I sometimes work do (the floor nurses would still forget to charge it) or if they allowed the option of manually raising and lowering them without plugging in the bed.

Electric OR beds I for the most part like.  I miss strengthening my legs pumping up the table.  I don't miss wrecking my back bending over to crank the handle.  The only problem I have is with the surgical princesses who insist on moving the bed up and down side to side every 5 minutes.  Cuts into my phone call, Internet and of yeah monitoring the patient time.

2.  IV poles with more than 4 legs.  Space is limited in the OR.  OR tables are rectangular as are beds and stretchers. This means that the right angle of the IV pole with 4 legs fits in nicely against these objects saving space during cases or when you are taking the patient to recovery room or ICU.  Life was good the universe was in balance.  25 years ago the first 5 legged IV poles appeared.  Now they seem to have taken over.

Sadly this picture is typical.  Look at them:  three  5 legged poles (and in the background a lonely 4 legged pole)

Proponents of these claim they are less likely to tip over.  As we all know, if you load enough infusion pumps, blood warmers etc onto on of these, they can and will tip over especially if you add a urology size bag of fluid or two.   They will tip over most likely because some clumsy oaf like me trips on the legs.  And suggesting that adding legs makes them more stable shows a lack of knowledge of geometry because as I learned in Grade 7, three points define a plane which is why for centuries milk maids use three legged stools because they don't tip over.  Not to mention tripods.

3.  Infusion pumps.  Okay I use infusions all the time and would hate to go back to the situation like when I was in medical school where nurses counted drips to figure out how fast the infusion was going.  (My wife when she re-certified for nursing had to learn about drip counts; "nobody does that anymore," I told her.). I certainly don't object to having some medications run thru infusion pumps and I can see that in fragile patients and children, making sure they don't get too much fluid is important.

What really bugs me is the 20 year old with the fractured ankle who comes down with his IV running through an infusion pump.

And do they have to be so freaking complicated.  This is the 21st century.  I am a PC guy but when I got my i phone, I had it figured out and running within minutes.  Why do we now have to have hour long inservices on these pumps before we can use them.  Do people not realize that this is inherently dangerous?  Nowadays when an ICU patient comes down with 10 of these running, I usually try to ignore them, occasionally starting my own IV line.  This would be fine except the ICU nurses always set the VTBI (volume to be infused) to a low number so it will run out during the OR and the alarm(s) will go off forcing me to deal with it.  I think they do it intentionally.  

And can they trust people?   Why is everything locked up.  We got new PCEA pumps for OB recently.  We actually got to play with them at rounds before they went into service and liked  them (not that it would have made any difference if we hated them, they were already bought).  So a couple of weeks ago I decided I would use it on a patient, the pump was now inside a plexiglass locked case which not only made it difficult to read the screen but required a key which the nurses took 10 minutes to find.  Plus in addition to a key to lock the case, there was a second different key on the pump which the nurses also had to find.  

Do they actually think malicious relatives are going to turn up granny's infusion?

4.  This:
If you are concerned about your diet, just don't eat the doughnut or the muffin.  Don't just eat the top of the muffin or cut out half or, as somebody  in the above pictures did,  2/3 of the frigging doughnut.  Because despite all the lectures and posters on hand hygiene,  I know where your hands have been and  the type of person who would do this to a muffin or doughnut is the type of person who doesn't wash his hands, so you think I or anybody are going to eat the fraction of pastry you left behind?

4.  People who drink but don't make coffee.  You know the scenario.  You drop your patient off in recovery, see your next patient and in the remaining 5 minutes before they call you, head to the OR lounge for a coffee to warm you up and keep you awake for the next case.  Except there is no coffee left.  You look around the lounge and just about everybody has full cup of them took the last coffee and didn't bother making another batch.  You could (and probably will) make another batch but you know this is going to be the time when your room turns over quickly.  Making coffee is not difficult.  Most of you went to medical school.  It doesn't take that long.  If you drink the last drop of coffee making another fzcking batch.  OK?

This by the way also applies to the first person in the lounge in the morning.  If you drink coffee, make the first pot.  Don't just sit there and when I arrive ( and I am never first) say morosely, "there's no coffee."

This applies to medical students, residents and sales reps who drink our coffee.

5.  Arm boards.  You would think by now they would have designed an arm board that attaches and detaches easily from the OR table?

6.  Residents, medical students.  Okay I was both a medical student and resident at one time, but I was much smarter, cooler, and hardworking.  Plus less klutzy.  This applies mostly to surgical staff.  I figure by now I have spent a year of my life watching students and residents painfully close incisions.  This applies to anaesthesia as well although our residents are way better and now the only medical students we see are thinking of applying to anaesthesia so actually know something.  Actually we at our place see residents so infrequently that largely I would just rather do my room by myself thank you very much.

Fellows are by the way just as bad and quite a few fellows clearly decided to do the extra year of training because they forgot to learn how to operate during the previous 5 years.  For some of them no amount of training is going to ever make them into surgeons.  

7.  The constant gaming of the "emergency list".   I know we can't just restrict our after hours work to life and limb threatening cases but when you can predict your on call workload based on what surgeons are on call things have gone too far.  Maybe things haven't changed , maybe I am getting older and crabbier.  Most of my 5 years as dept. head, I spent fielding phone calls:  from the anaesthesiologist on call complaining about what the surgeon(s) had booked; from the surgeon demanding that I call in a third anaesthesiologist to do the "emergency" case he had booked 4 days ago that had now been bumped by a real emergency.  


Oldfoolrn said...

I thought you youngsters used those new-fangled ceiling mounted IV holders especially in the OR. Just be careful not to bang your head. Wheels on an IV pole are not a wise idea especially in the OR as they introduce instability and increase surface area to trip over. Wheels also limit the contact point with the floor to a very small area. There is no good reason to use wheeled IV poles. Simply pick them up when you want to move them. Our old fashioned IV poles had 3 solid legs and were strong enough hold multiple IV bottles and if you are in the cysto room never fear just pile on those irrigant containers - that old school IV pole is not going anywhere.

Bleeding Heart said...

I have been in ORs that have them. They have fallen down before. Problem is you can't put an infusion pumps(s) or blood warmers on them.

Bleeding Heart said...

I suspect if you marketed a three legged IV pole with no wheels you would be hailed as a genius,

Oldfoolrn said...

I made my fortune by working as a scrub nurse for many years so feel free to market those wheel-free IV poles. Your mention of electric beds brought up an old memory. One of the early designs for electric beds involved a very complex design to isolate the electrical components from the patient. The patient control buttons were actually miniature pneumatic pistons connected to very thin plastic tubes. When the patient pressed a control button, the piston increased air pressure in the tube actuating the electric motor. I often marveled at how complex the solution to a simple problem could become. Everything worked OK with these pneumatic electric isolation beds until one of the control tubes leaked. At least we were supplied hand cranks as a back up.