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By OnTheRopes ·
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Nursing and Technology

by Tig2 In reply to Edited out

First, NB, Thanks for the heads up that you will be out for awhile. Don't forget to walk during recovery- it really will help. Peck out something (pencil between teeth?) to let us know that you are okay and healing.

I know from previous posts, how hard this has all been for you. You are in my thoughts and prayers (I know... eeeww!).

Case Management tends to show up whenever there is a lengthy treatment/recovery issue. When Case Mgmt first started, it caught out a lot of "back injury" BS. The theory is that by identifying cases that are fraudulent, care costs can be controlled.

The problem that Case Mgmt initialy ran into was that a single person's judgement determined if a person NEEDED a level of care. This is a problem in that a single person's judgement may be insufficient to determine reality of need. Most insurance companies now assign reviewers in pairs. Because they use BSNs, there is more latitude to get things moving in the event of bureaucratic hold up. In general, monitored cases are also reveiwed regularly by a Medical Review board that is comprised of the Case Mgmt nurses as well as MDs in that particular discipline. The goal is to avoid cases where a person is denied care because of a mistaken belief that the case is fraudulent.

The problem is that the people in Case Management are very frequently, although qualified, not direct care providers. Generally they have moved to this kind of role because they prefer to not provide care in a standard hospital setting.

The issue of good patient communication has been around forever. The patient presents in a more ill condition than ever, there is frequently insufficient time or communication from MD to nurse for the nurse to communicate to the patient, there is frequently an assumption that proper communication has occurred, and frankly, personality is everything.

I went to nursing school with people that should not be permitted to be around people. I have known both MDs and nurses that have ZERO people skills. On the other hand, I have seen caring and committed people that simply changed as a result of caring for patients that you can't fix. Caring too much can cause people to get out of the field.

IT is its own problem. Striking the careful balance between IT SLA and medical SLA is difficult at best. Many healthcare organisations place too little value on their IT systems. And there aren't many like me- Licensed Nurse but geek off the job. And even I got out of nursing to do IT full time.

The battle that you have been facing is compounded by the fact that any MD anywhere will use progressively more severe approaches to fix the problem instead of going directly to the solution. And they do that to avoid malpractice. The Oath says "First, do no harm". That to an MD means do the least first, the next most aggressive second, etc.

So personal opinion time- I have long thought that the best approach is tort reform. Both MDs and nurses carry personal malpractice insurance because they don't dare treat a patient without it. Guess where that cost goes? And the most common approach in malpractice is to sue EVERYONE in the patient care line. You almost don't want to take a patient's vitals because you could find yourself drawn into a suit. While completely ridiculous, this is the way the country deals with medical malpractice. And until it changes, the frustrations that you have dealt with will continue.

I don't honestly know if nationalising the system is the right answer. There has to be a system of checks and balances- they call it "practicing medicine" for a reason. But it doesn't help the system one iota when your MD and nurse fear you- you could be the next lawsuit, after all. The system MUST be re-examined but will only get there through the Lawyer's lobby and the Insurance lobby. And those two groups wield a lot of power.

I understand your frustrations. I am glad to know that you are at least scheduled now and can hopefully see a light at the end of this tunnel.

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by OnTheRopes In reply to Nursing and Technology
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Procedures X-(

by rob mekel In reply to Edited out

I still get angry over the procedures my GF got into while recovering from her cancer-surgery.

The physiotherapist had to go to tons of paper work, filling in plans on how to proceed to her recovery. She asked him how much of his time he was spending on filling in the forms. The answer was: more then 40% !!! on the forms. That is if his plan was approved right away. On the average it was about 60% of his time. Taken into account that it took her 4 weeks to get an appointment, @#$%@# X-( , well she should have gotten an appointment with in 2 weeks so the physio could treat her the right away. It would have saved her probably 6 weeks of treatment of the 12 weeks she needed now. And that is because early treatment does help on speeding up the recovery.
In totally if she had the right and proper treatment right away then she only would have needed half the recovery time she spend now.

Her income insurance company is now suing her health-insurance company for lacking her recovery.
But this is 1 of the first times they ever do this. I guess in the end lawyers will benefit of this.

I hope it will not be the case in neither of the cases of all of you. In fact I hope none of you will need any recovery whatsoever. :)


Edited because of emoticon mal-treatment by me

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There is no question...

by Tig2 In reply to Procedures X-(

That reforms are needed everywhere. I don't know that any country has 100% of the answer but I will bet that IF we worked together we could find improvements.

I personally believe that the lion's share of the problem is that everyone wants to sue. What silliness! Certainly there are cases that are legitimate but not the majority. If tort reform- at least in the US doesn't happen, costs will continue to rise as healthcare professionals have to have more to protect themselves from... their patients!

Rob, I sincerely hope that your GF is better. Cancer surgery is NO fun and has more impacts in recovery than just one's health. She will join NB in my prayers.

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Tnx TT :)

by rob mekel In reply to There is no question...

She has and still is recovering fine. Alltho the power in her leg still isn't as it should be, she play's tennis and does fitness-training just great. :)

I'm very happy for her that the chondrosarcoom (don't know if this is the right name in English) she had was of the right type (alltho malicious but not spread, that is as can been told/seen) and on the right spot (if you can speak of a cancer being on the right spot, just down her knee between the bone-membrame (is it called that way?) and her Tibia) so she could be helped by surgery.

Thanks again for the best wishes TT


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IT Training for Nurses

by DMambo In reply to Nursing and Technology

Tigger's right that there aren't too many like her. My wife is an Advance Practice Nurse, she's got 12+ years acute care experience and now she's a primary care provider in the VA system. She's wicked smart, and a great person to see if you need medical care. But she has a little "issue" with "the computer stuff". Her main complaints are that the systems take her away from the patient care (although she understands the need and benefits of electronic documentation) and that the system training is not adequate. Add to that the fact that most nurses are in the profession because they have some sort of sick, twisted inclination to help other people, and you'll probably find that many do not enjoy the isolated screen time that we all cherish so much.

Further, in most settings, the training needs to be done on 3 shifts, weekends, etc. The systems have to be user friendly, intuitive and secure. It's a stretch for any IT dept.

As far as the costs, I think it was Maxwell who posted the question looking for the 5 words of why health care in the US is so expensive. He was looking for "someone else pays for it" as I recall, and I agree that's a big chunk of the answer, along with the cover-every-possibility mentality that malpractice suits engender.

Well, if you're still reading, good luck with everything, Never. I hope you're back to form quickly. Get off that Oxy as quick as you can. It's nasty stuff.

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by OnTheRopes In reply to IT Training for Nurses
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HIPPA and Standardisation

by Tig2 In reply to Edited out

NB- First, the OxyContin- Mambo is absolutely correct, that stuff is unholy dangerous. While I DON'T want you in pain, I do want you to remember that you aren't relieving pain, you need to MANAGE it. If you are resistant to lesser drugs, ask your MD if there is a median between Ibuprophen and the Oxy. You are likely to be resistant because you have been managing to a pain level for so long. No easy answers but let me know if I can help in any way.

It was thought at one time that HIPPA would lead to record standardisation. The road block is that no one can define an adequate standard AND get industry buy in. This is key because care providers have had for years rules for how records are created, stored, and referenced. Nursing school taught me how to chart on a patient and correct charting was an element of licensure. The transition from a paper standard to an electronic standard is difficult. I know of multiple web-enabled databases that will provide diagnostic paths to determine ailment and treatment but know of few that are a paperless trail of patient care.

Keep in mind that I have not provided patient care in more years than I am willing to admit to...

When I WAS nursing, I had a notebook and pen in my pocket constantly. I often had little or no time to capture my impressions at the point of patient care in any formal fashion. I jotted notes that I referenced when I charted. Today I would use my PDA to take notes. But I am a geek. In today's world, the nurse would be transcribing from notes to chart and from chart to electronic file. Not so good as the room for error has just increased. In a written chart, if I made an error, I drew a line through it, initialed it, and wrote my correction- where possible, on the same line. Note that the error HAD to continue to be readable. How do we do that electronically? There is a legal rationale for the line out.

In my personal opinion, one's drivers license or ID would be the optimal place to put one's medical history. The problem is that I do not have a sense that my medical history would be safe in that data store. The VA recently had to admit the loss of data on 26 million veterans and current military. Without improvements in data security, I don't think that we can get to a place of standardisation or any robust history access.

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Edited out

by OnTheRopes In reply to HIPPA and Standardisation
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Before you go .....

by gadgetgirl In reply to Edited out

look at alternatives! You don't always have to type - how about downloading a trial version of ViaVoice or Dragon Dictate or something of that ilk?

Hey, I'm just trying to keep you online here! Oh, and just because you can't type too well doesn't mean you can't still READ the posts, you know!

The time before last that I broke my right wrist (nope, NB, don't go there and ask how many breaks I've had.... it's tooooo embarrassing!) I actually found that I could type if I pushed a crotchet needle up the plaster - hits the keys just nicely.... Ok, so you don't have one already, that I understand!

NB, I work in the medical profession in IT. It stinks. I'm a security pro in the NHS. The Trust I work in has just merged, which means that we now have 100+ locations, 5000 staff, no merged policies, procedures or processes even though both halves of the merged Trust provide the same services - for the Mental Health side of things. And yes, we have "Secure Units" too.

And for all that, there is me. I'm it. I'm the only security pro in the Trust. <mutters incoherently>

Just from what I see from my side of things, there is a distinct lack of communication on every level here in the UK. I'd love to give you examples, but professional conduct forbids. There is a degree of apathy that I've never bashed heads with before, and an extreme aversion to change, even when change is proved to be better both for the profession and the patients.

I'd love to go on; I'd especially love to tell you about the particular excrement which hit the oscillator this morning, but that would be sub judacae now. (It's a doozy. Take my word, it's the best one yet)

However. Thanks for the partial ability for a sound off....

Now then. How long are you expecting to be off line? Are you in hospital for long, or just the day/overnight? Got physio booked?

Have you told the dogs? They're sure to tell you that there is no greater physio for a broken arm than playing with, squishing and throwing a soft dog ball. And they should know - every cat or dog I've known thinks they were born with medical knowledge of humans....!!!

I'll start sending the healing thoughts over the pond now, so that they gather strength in time for the 19th and after. I could get a bit busy between now and then, so have a better to stash ready for after the op.

All the luck, babz


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