in the hospital last rotation, i saw a patient’s name on a lot of medication i prepared. today i heard the hospice nurses talking about possibly admitting a new patient. had the same name. sad.
saw a patient taking ketoconazole 400 mg three times a day. salvage therapy… we really can’t cure much.
was driving to rotations yesterday. start at around 9 am now, so it is prime time for traffic. i tried a different route so i was using a gps. this path was only on the highway for about 3 miles, so time in traffic is spared. anyway, while i was on that last section on the highway, the gps suddenly asked me if i want to switch to pedestrian mode. i don’t know if this was because i was driving so slowly. sigh.
hospice is the only place where the care team hopes the patient dies (peacefully and painlessly). so opposite of school. a nurse said “i hope the patient dies next week.” but i guess that’s what they are working for.
what is there to write? i am assigned to hospice this rotation. that will definitely be interesting. nothing acute now. just chronic, slow. also assigned to drug education. that’s cool. education is fun. that’s why i’m in school for forever.
short weekend. failed at doing anything productive. need to catch up before starting again tomorrow. sigh.
there was a patient today, doctor ordered sodium bicarbonate in normal saline. usually it’s ordered in 5% dextrose, because sodium bicarb + normal saline is hypertonic. so i called doctor and asked if there was any reason to use normal saline and if i could change it. she said no reason and i could go change it. then later, another order for same patient for vancomycin. i called to ask if she wanted pharmacy to dose and put it on protocol. she said okay. then a few hours later, right before my lunch time. a bag of sodium bicarbonate in 5% dextrose was sent back. there was a note that said “please return, patient just expired.” and that’s it. i don’t really know where to go with this story. but the end.
anyway, there is a nursing strike tomorrow. so this previous week, the doctors have been trying to discharge as many patients as possible and admit as few as possible. pharmacy is planning for chaos because usually the medications are dispensed in automatic pyxis machines. but tomorrow will all be temporary, floating nurses who don’t have access, so pharmacy has to basically deliver every single medication. unions and corporations are really horrible. healthcare is supposedly about helping the community, but add all these external influences and now all the patients will be basically abandoned in the hospital. sure, protect your pension or try to cut costs by cutting pensions, but don’t leave all the cardiac ICU patients unattended. and what about that 20 week premature baby? what about the whole room of premature babies? just leave them in the hands of some random nurses that don’t even know the system. ugh. ridiculous.