Wednesday, April 9, 2008

I speak in code

Last year, I bought myself a shirt that says:

Do You Know The Code?

I wore this shirt around the house and wouldn't tell anyone what it meant. It drove my husband somewhat nuts (a short drive). My son couldn't take it and googled the meaning. He didn't tell my husband what it meant. Whenever I wore it out, someone would come up to me and say, "yeah, I know the code," or smile in secret recognition. Inevitably, it was a woman who knew the code. Last spring, I flew to Virginia to see my sister's new home. We went hiking in the Blue Ridge Mountains and I wore my shirt. On our way back up the trail, a man asked me if I'd hiked K2. I'm still laughing. I don't think I told him what the code meant.

Nursing was my calling in life. Or was it? It was pretty common for young girls growing up to want to be a nurse. I wanted it. I didn't go after it until my mid 20s. I am now a seasoned warrior on the nursing front. And I speak in code.

My life at work is made up of acronyms and short cuts like symbols and atomic names that I have use for decades. It seems I can't use too many of them anymore. The Joint Commission doesn't like it. Now I must spell the whole thing out. Morphine instead of MS. Magnesium Sulfate instead MgSO4. I have to change though in an effort to meet standards set by a bureaucrat. I hear what I've done for 25 years isn't safe. So instead of getting me more help to make me safe, they've gone and made it a bit tougher. And I'm having a bit of a time deciding if it's made my patients safer.

I wasn't very likely to mix up morphine and magnesium in the past. Just the dosage alone would keep me from going out on that limb. To give you 4mg of MS (morphine sulfate) is a likely dose. 4mg of MgSO4? Spitting upwind. I'd probably give you many grams-not milligrams of magnesium to fix your shortage. And I wouldn't be likely to push it either, I would hang it in a drip form. Say you are the doc and write 4gm MgSO4 IVP and I think you mean morphine. Do you think I might be cursing you because now I have to pull up 1000 syringes of morphine to make the dose you want, or do you think I'd question either the order or my interpretation of the order? Also, I have a fairly good understanding of just about how much morphine would kill a human. I've never in my career "pushed" more than 10 milligrams. If you're wondering what I'd do, I'd question myself.


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Rudee said...

Not that kind of blog....Too bad, so sad Jason

Baywood Yarns said...

I'm not sure JCAHO is uniformly helping patient safety, despite good intentions. As if writing the chemical formula for something is less safe than a long name? Ugh!

Rudee said...

Aha Joanne! Therein lies the crux of the problem: I don't believe JCAHO (or as they like to be called now, the Joint Commission) has good intentions. I think they're out of touch. The way they instill fear as they sweep down upon a hospital for inspection is ludicrous. For a week, we all straighten up and fly right. Coffee cups are hidden along with every single scrap that has a patient's name on it. When they leave, it's business as usual. Some days, I can barely make it through the day with the high acuity of patients I take care of and the never ending heap of BS piled upon us from outside organizations. Whew. I feel better now!

I know I should knock on wood when I say this, but for some peculiar reason, I have never once been working on a day we've been inspected. That's an incredible track record that I am perversely proud to brag about. Not once. Perhaps it's a good thing since I think I know what I'd tell some bureaucrat who hasn't been at a bedside since school..... I do have a mouth!