Sunday, April 28, 2013

Trauma priorities

So this ER that I'm in right now is all about trying to become trauma-certified. We had this big long lecture from management today during our pre-shift huddle regarding how we're pretty much awesome and a trauma center already and the only thing we lack is the designation.

During this lecture a few people were singled out about how they filled out the trauma charting wrong, by putting "4 hours ago" as the time of injury as opposed to "Sunday 4/28/13 @ 0400." Not a huge deal, and something that seems easily remedied by a quick mention instead of a berating. We were also all given a stern talking to about how the triage nurse and the secondary assessment nurse cannot under any circumstances be the same person. "These are huge issues, people! This is the kind of stuff that makes us trauma!" said Management.

Except, not.

Eight hours later, when my room gets a direct bed from triage, I find a little girl sitting in a wheelchair because her drunk friends got in an accident and were too scared to call an ambulance. They called another friend to come pick her up and drop her drunk self off at our door. I'm like, "hey girl, I see your obviously fractured femur, and I'm gonna help you."

I'm gonna help by putting on that Hare traction splint. But wait! There isn't a single traction splint to be found in this ER. Anywhere. I had to borrow one from EMS.

Because we're a trauma center. Except, not.

I can't even imagine how terrible we'd be if I had also charted both a primary and secondary assessment under one name. Oh, the horrors.


Aesop said...

OMG. Your facility (like you didn't know this already) is run by morons.
Trauma is all about staff, and stuff. Neither item is interchangeable, nor optional. If you don't have the stuff, you aren't trauma.
If you don't have the staff, you aren't trauma.
And separate nurses doing primary and secondary assessments is in the dictionary. In fact, it's the picture under the definition of "asinine". When I get a trauma patient, take the report, do the primary survey, and do all the work in the work-up, I'm not going huntiong for a second nurse to bother with the secondary survey, since it's redundant, stupid, and time-wasting. The only thing that matters is two good assessments, regardless of how many nurses are used.

I think your facility is jonesing for the Drama designation, not the Trauma designation.

There should be a badge for that, just like the little shiny silver plastic Pretend Fireman badges in cereal boxes.

And there's nothing wrong with "4 hours ago" as long as somewhere else on the charting is a spot where the "now" time is recorded. We're supposed to be charting this for other medical professionals, not for retards or JCAHO (but I repeat myself).

I'm betting when the bills for being a trauma center start to come in for all the uninsured/indigent trainwrecks, the bloom will be off the rose, and your facility will quietly and happily slide back into being a non-trauma designated ED that gets a lot of trauma regardless of the designation. And they'll save money on Hare splints, because seriously, why would you ever want one of those in the emergency dept. supplies? It's not like people ever come to the hospital for broken legs, right?

Shrtstormtrooper said...

Right?! I couldn't believe it when management got all up on us for that minor stuff when the glaringly obvious necessities for basic traumas are missing.

But, you know. At least I got a blog post out of it...

Eddie said...

Can you shoot me an email chica? =)

CNA Nursing Jobs said...

Well, the readers will laugh at this. But, I'm sure you will get through that, continuous training and understanding every aspect of that.