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Service Excellence in a Bottle… from our Pharmacy! January 17, 2007

Posted by 5 Wester in On Service Excellence.
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If there’s one department that I think deserver a SERVICE EXCELLENCE award, I would say it would be Pharmacy.

For that last few months I’ve noticed that pharmacy services has improved quite a bit. I’d have to say that the night crew is particularly attentive to the nurses’ needs that it blows me away whenever we get our meds profiled or delivered pronto!

Back in the early days (1.5 years ago at least), I’d get all flustered when after 4 hours of waiting and several phone calls, my meds weren’t profiled or delivered. It’s kinda difficult to go through your shift not knowing when your meds will arrive especially when your patient has been in pain for a while and the best you can offer is “still waiting for pharmacy”. I once told my former boss that we are only as strong as our weakest link, and from what I’ve experienced from the past it wasn’t pleasant.

Today it’s different. We have what we need when we need it. I don’t know what changed but the service sure did, and it did for the better. Way to go guys, and keep it up!

We still do get a few bumps along the way…

Nurse: “Where’s my meds?”

Pharmacy: “Didn’t find the order, when did you scan it?”

Nurse: “Oops, sorry, my bad…”

What can I say? Keep up the good work guys! 🙂

Three’s Company? January 12, 2007

Posted by 5 Wester in General Announcements.
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Ever wondered why things usually happens in threes?

This was the case on Monday night, January 8, 2007, when we had 3 people transferred to the ICU. Well, almost 3 people… ICU didn’t have any beds available for the 3rd one.

I knew it was going to be that kinda night when after getting report, we had to transfer my first patient to the Unit. “We’ve been waiting for a bed all day and they just only notified us of one available right now… we need to swap one for a tele bed.” Ok (I thought), I’ll do this one and just get it over with.

Within 15 minutes after taking report, this poor lady that apparently was suffering from a suspected brain hemorrhage was on her way to the unit. Off my hands now, I guess it’ll be quiet the rest of the evening. Boy was I wrong.

A couple hours after that, Dan “The Man” calls my attention to one of his. “My patient’s BP is dropping.” Trendelenburg comes to mind. He’s still responsive, however, the machine says 84/53 and going down. “Are you OK sir?” The patient just smiles. Somewhat tachy, we notify the MD. BP on the manual was 90/70. Time for the RRT.

RRT? Yep, the Rapid Response Team.”Hello, rapid response? We need you here… STAT!” (Well not exactly like that, but). Within a few minutes we have an ICU nurse to assist. Boluses of NS does not help… we need dopamine. After a few phone calls with the MD, we get a dopamine and ICU transfer orders. After a few minutes the patient is on his way to the Unit. Relief? We spoke too soon.

Phone rings, monitor tech on the other end. “We have SVT on 59 sustaining at 224”. Is the patient ok? Nurses come trickling in the room. Patient’s in bed, wife at bedside (probably terrified from all the commotion). “Is there anything wrong?” she asks. “Just checking… Are you OK sir?”. He’s fine, just a little bit shaken, otherwise probably nervous from seeing more than a couple of nurses in his room at one time. Lets monitor the patient and call the MD. “SVT sustained at 220”. We need RRT… again!

“Hello you, welcome back!”

“Ok, what do we have?”

“Sustained SVT. Vitals are… waiting for MD to return call.”

After a few minutes of monitoring and various other interventions, we finally got an order for a Cardizem drip…to be titrated.

“But we don’t do drips here”, protests the patient’s nurse, “not with titration!”. Have no fear, Rapid Response Team is here! At this time the ICU charge nurse appears. “We need an ICU bed, MD wants to titrate Cardizem.” “Sorry, no beds available, we’re full and we have ER on the waiting list.” After an assessment of the situation, and with the House Super’s blessing, we come to a concensus that the only way we could help the patient was to go ahead with the drip.

A few hours later we have the SVT under control. Still tachy at 126 but otherwise, not bad. Thanks to Dan “The Man” and the Rapid Response Team, it was smooth sailing by the end of the shift.

Now for the fun part… documenting the whole evening. Too bad we don’t have an RRT for that one! 😉

Just 2 Years Old Today! January 3, 2007

Posted by 5 Wester in General Announcements.
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Cake for 2 years old

Yep, I turned 2 today!

It’s been 2 years since I first walked into that room at the Edinburg corporate office for my first day of orientation, together with around 30 or so others who started out just like I did. I still remember some of the faces of those who came with me for orientation. For me, it was a new experience, i.e., new place, new job, new state, new everything.

After the intros, I heard some talk about the department I was going to serve. I heard comments like “5 West? That’s the worst place you can be.” I thought to myself… it can’t be that bad, people said the same thing about 6400 Telemetry at Loma Linda University. Out of the 6 nurses who came on board at 6400, I was the only one left within the 90 day orientation period. My colleagues were asking me, “Where did the rest of you go? You’re the only one left from your group!”

I remember the time they talked about “SERVICE EXCELLENCE”. They even had group dynamics and had us come up with great essays on “teamwork” and “service”. For some reason, I felt that it was phony, insincere. I though, nah, its probably just talk. Boy was I wrong.

My first year was rocky. I guess the adjustment period was something I didn’t expect. It was like living in another country. Was I still in America? After a while that “SERVICE EXCELLENCE” thing just faded like a tragic movie. There was the talk, but not the walk. Eventually my ideals faded into obscurity, and most of my colleagues succumb to the deafening silence of management’s inattention to their needs. I often hear comments like, “It’s no use, nobody listens, I was like you before but now ‘I just work here’. After my contract is over, it’s hasta la vista baby!”

And so they left… some after 2, some after 4. I’m going on my 2nd year, and since 01/03/05 to 01/03/07, there has been about 11 good nurses who left. On my first year it seems like we were losing a nurse every 2 months. Most of them just disgusted by the whole deal. I’m glad to say it’s been better since then. At least we showed some improvement. Unfortunately, MMC hasn’t figured out how to retain nurses. And sadly like the others, we’re on a countdown to how many more are leaving after their 2 or 4 year contract is over.

Yep, 2 years gone, 2 more to go. What does the future hold for me in 5 West? Only God knows. After all, He’s the One that put me here. Despite all the hardship, there’s one thing that I do know. I was put here for a reason… a purpose. Whatever that may be, He will reveal it someday. For now I’m content with where I am. Like the 40 years in the wilderness, I’m on my 20th year. Although not perfect we’re getting there. The bad weeds have been plucked out making room for the good grass to grow. I’m optimistic, it will be better… it has been better.

Happy New Year! January 1, 2007

Posted by 5 Wester in General Announcements.
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2006 is gone, 2007 is here, a new year, a new chapter.

Last year has been a blast! I’m sure like me you’ve had your ups and downs, and for all they’re worth, we can only look back and take inventory of last year’s events, the choices we’ve made, and the results of those choices. The old year has gone, and before long, it will only be a distant memory. A new year lies ahead, uncharted waters, an ocean full of possibilities.

If you’re like most people, this would be the time of the year when we come up with promises to ourselves we don’t usually keep… you know what I’m talking about, the new year’s resolution. Just like the latest “Weekly Dose” newsletter by MMC, it encourages us to start the year right by following the Standards of Service Excellence UHS so very much advocates. I suppose this is all good, if only people actually care about service excellence to make it work. But what do you do when management themselves don’t practice “Service Excellence”?

Take for example the last couple of days on the weekend when Al “Bundy” comes strutting up to the nurses’ station like a pompous windbag and tells us that we would have to take in more patients than our staffing matrix states we can. He even has the audacity to state that we don’t have the authority to refuse admissions from the ER despite the fact that staffing is at an all time low. What an insult to whoever invented the system of diversion. My question is, “What is the use of guidelines if nobody bothers to follow them?”, which brings me to conclude that this “Service Excellence” thing from UHS is bogus! It’s nothing more than a lofty idea that works best in theory than in actual practice.

For the last 2 years I’ve been working at the “Motel 6” of healthcare who claims to be the “Ritz-Carlton”. The sad thing is, Motel 6 has a better system of service delivery than MMC could ever have in probably the last 13 years! I don’t know about you, but I’d want to be proud of where I work. Unfortunately the management at MMC doesn’t feel the same way. All UHS corporate office needs to see is how much money they make, and all MMC management has to worry about is how good they look on paper, the financial paper, but on who’s expense? Ours of course!

I guess it’s time for real change, and I believe it is coming soon. It started last year when our beloved director of about 10 years left… bad weeds out, room for good grass. We just need to take care of the rest of them. I hope they step out to the plate because I’m sure that like those that left, they might be next. I think it’s about time we, the staff, stop bending over and taking it up our *ss… we know what’s safe for our patients, lets stand up for them!

Like I said, 2007 brings in an ocean of possibilities… we just have to be patient because I know that soon this “Service Excellence” thing will someday, somehow, be a reality! And to that a toast…

May 2007 bring in the promise of a new beginning, the true meaning and realization of “Service Excellence” for us and for our patients as well. Have a prosperous and happy new year in 2007!