Oopsy! 9,999 Units of Blood

photo: jparadisi 2011

I don’t remember what year of my pediatric intensive care career I discovered an aptitude for electronic devices, but I do remember I was caring for a patient with multiple monitoring lines: intracranial pressure (ICP), arterial pressure, central venous pressure (CVP), pulse ox, transcutaneous CO2 monitor (TCOM), as well as intravenous access lines and realizing that if I could maintain all of those wires and tubes safely, I could probably set up my stereo system at home without help. And I did. Next, I discovered setting up a computer and adding on a printer wasn’t difficult either. I plunged ahead fearlessly, learning to use ATMs and grocery self-checkouts before some of my male friends (sorry, that’s sexist). Today, I own a trove of personal electronic devices, including a smart phone, tablet, and a reader. I fully credit my initial interest and competence in electronic devices to my ICU nursing background.

That’s why it’s so funny that last week, I accidentally “released” 9,999 units of red blood  for a single patient on our hospital’s new electronic medical record system (EMR). Fortunately, in EMR lingo, “releasing” 9,999 units of blood is not the same thing as preparing 9,999 units in the blood bank, so only the two units ordered by the physician were prepared. No blood was wasted due to my error. The problem was accounting in nature: I couldn’t clear the remaining 9,997units from the EMR.  A very nice peer specialist came to our department and explained my error before he fixed it. Maybe it was inappropriate, but I couldn’t help but break into a quiet chorus of “9,999 units of blood on the wall, 9,999 units of blood… Take one down and pass it around, 9,998 units of blood on the wall.”

You’ve Come a Long Way Baby. Maybe.

Untitled. photo: jparadisi 2011

A friend of mine talks about aspects of one’s life occurring between bookends.  People use the cliché “things come around full circle” to mean the same thing, but I like my friend’s reference to bookends better. Coming full circle suggests ending back where one started, but the bookends metaphor implies a linear journey that includes revisiting one’s past, which is unavoidable if you live long enough. Personally, I prefer the bookends metaphor to the circle one, because I think moving forward is an important attribute of  happiness.

Today was my second shift using the new electronic medical record. Yesterday I practiced order entry, updating the home medication list, and documenting blood transfusions. Today, I focused on medication administration. The way the EMR works in our hospital, patients wear a bar code wristband and the medications are bar coded too. When giving a medication, the nurse deploys a laser scanner the size and shape of a pistol to scan both the patient and medications, verifying that the right patient receives the right medication, an important upgrade in patient safety. Scanning the bar codes exactly right so they register in the EMR is tricky. Most of the time I had to repeat the scan more than once before I got it right. I’m thinking it’s not very different from learning to start IVs: eventually my small motor coördination will develop muscle memory, and I will have a “feel” for getting it right the first time. It just takes practice.

Sometime during the course of the shift, however, I told a coworker that if my scanning ability doesn’t improve, my plans for a career at Whole Foods are doomed. We laughed. Then I remembered something from my nursing school days:

When I entered nursing school there was a nursing glut. Nursing shortages hadn’t occurred since before Salk invented the polio vaccine, and tuberculosis ran rampant. Around the same time, grocery store chains were investing in a new technology using lasers to scan bar codes on grocery items for prices at check out. After attaining my Registered Nurse license, I could look forward to eventually earning the same hourly wage as grocery clerks then. All through nursing school, both instructors and students joked about “scanning cans” for a living, if our careers in nursing didn’t pan out.

My very first nursing job paid an hourly wage of thirteen dollars and some change. Six months after graduation, the first wave of a nursing shortage hit where I lived, and my hourly rate nearly doubled in a single pay raise; a windfall. I never thought about scanning cans again, until today when I aimed a laser scanner at a patient’s wristband and medications, and I realized I have traveled a straight line punctuated by a bookend.

Welcome Back

Welcome Back photo: jparadisi

Reluctantly, I sit at my computer writing this post. Tomorrow I will spend eight hours at a training computer learning the electronic medical record system, Epic. The following day, I will spend another eight hours doing the same thing. I previously posted that our hospital converted from paper charts to EMR last week while I was on medical leave. I am making up the classes that my colleagues took last month. Although I’m not thrilled about spending so much time at a computer, I am looking forward to participating in patient care again.

I provided precious little help to my coworkers during the two shifts I worked last week, since besides having limits on lifting, I won’t have a computer sign on until I complete the two classes mentioned above. Instead, I spent much of my time following coworkers who kindly taught me as much as they could about Epic in a live patient care setting.

The hardest thing about those two shifts was my feeling of incompetence, because nothing in our unit operates the way it did before EMR. I can’t even open a patient’s chart, look up the name of their doctor, or find an order without a sign on. I’m used to being nursing muscle, not a helpless bystander. I felt uncomfortable, and I have to admit, mildly anxious.

The funny thing was, because Epic is still so new, my coworkers are struggling too. In that way, we remain on level ground, although at least they can access charts, and record the care they gave. However, I could see how learning to navigate the new system slows them down. One way that I helped was to listen thoughtfully as they described the frustrations of providing patient care while simultaneously learning a new system. I let them vent, and I learned from their experiences.

Week by week, things will improve. I hope so, because EMR isn’t going away.

Did I mention that despite all of the controlled chaos at work, I brought a cake to work for my coworkers on my first day back? And that one of them found time to bring in flowers for me?

Remember: be nice to one another.