Re: epidural pumps
From: Joanne Bulley, MD (islesannie@gmail.com)
Thu Jan 29 19:02:59 2009
Yup. For post ops on a floor where there was a good working
relationship with the nurses etc we used to write "Advance diet as
tolerated" and the nurses did just fine at deciding when she was ready
to move to full liquids / regular diet. Now we have to write parameters
for that (As well as the pain meds as you say)
The hospital here does let us write "1-2 po every 4-6 hours prn moderate
(or severe) pain" --- the computer just makes the pharmacist put it in
as 2 orders and the nurse can then pick whether she is doing the "1" at
4 or 6 hours or the "2" pills at 4 or 6 hours.
Joanne
At Thu, 29 Jan 2009, Dr. Ainsworth wrote:
>
>This is a multipart message in MIME format.
>
>Good question, apparently JCAHO does! Interesting that we can write range
>orders for pain medications as an outpatient that patients can adjust, such
>as Tylenol #3, 1-2 PO Q4-6h. But in the hospital you can not write range
>orders that vary both the amount and time of administration. Nurses aren't
>smart enough to figure it out (don't tell my wife I said that).
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Glen Elrod
>Sent: Thursday, January 29, 2009 10:12 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: epidural pumps
>
>Its just ironic that the nurses are using 'patient safety' as the driving
>force behind not wanting to adjust rates, but we let the patients give
>THEMSELVES boluses with a PCEA. Do we really trust our patients more than
>our nurses?
>
>Glen
>
> _____
>
>From: John Perry <docjcp@hotmail.com>
>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@mail.obgyn.net>
>Sent: Wednesday, January 28, 2009 9:40:22 PM
>Subject: Re: epidural pumps
>
>The epidural pump on our unit are in locked boxes that only the anesthesia
>provider has a key too. The only buttons that the nurse's can access in the
>on/off button. If the rate needs to be adjusted, the anesthesia provider has
>to get out of bed and change the rate. That is the preference of our
>provider group. Patient's have a button to give themselves up to 4 boluses
>per hour.
>
> _____
>
>Date: Tue, 27 Jan 2009 22:06:37 -0600
>From: dr99645@yahoo.com
>To: ob-gyn-l@mail.obgyn.net
>Subject: epidural pumps
>
>General question to the group. Who in your OB departments is/are
>responsible for adjusting the epidural pump rates? Not, who gives the
>order, but who physically punches the buttons to adjust the rate.
>
>Evidently, AWHONN and ASA have been having turf war for quite a few years
>regarding who is qualified to adjust the pump. That debate has finally hit
>our humble unit and now nursing doesn't want to touch the pumps because
>AWHONN says they shouldn't, because its out of their scope of practice. ASA
>says there is no data to suggest nurses adjusting pumps is any more risky
>than patients giving self administered boluses by the PCEA. Who wins?
>
>I'll be interested to hear the responses and then how those decisions were
>taken by the 'losing' side.
>
>Glen
>
> _____
>
>HotmailR goes where you go. On a PC, on the Web, on your phone. See how.
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--
Joanne Bulley, MD
solo gyn
Keene, NH
