One of my biggest peeves is the ever increasing paperwork load that keeps nurses from actually taking care of patients. Well, JACHO and CMS are at it again. Somebody without a clue complained that there are nursing home patients with dementia are restrained and therefore we need to completely regulate the use of restraints with tons of new paperwork. No one bothered to explain to the regulators that the nursing home patients have dementia which means that they dont remember that they cant walk so they try to stand and fall and hurt themselves. Anyway, JACHO and CMS came up with all these new regulations for the use of restraints. So, here we are in the ICU where a patients who has ODed on xanax is waking from his coma and tring to pull out his IV, endotracheal tube and ng. Since he has to be restrained for this, the nurse must document every thirty minutes the need for and the degree of restraints. To comply with JACHO and CMS this is a three page form that must be filled out either on paper or in the electronic chart. Since the nurse is the one who has to do the documentation, you either need to get another nurse to watch the combative patient and take them away from their patient or you leave someone less qualified to take care of the patient.
I wonder how many pateints will self extubate themselves and die because of these new regulations? At least they will leave behind a nice chart.
6 comments:
It's ridiculous Throckmorton and I am sorry it seems to be the status quo now. Frustrating too!
When the charting is this detailed and repetitive, there has to be a new way.
Video. Everything can be filmed to a TIVO-like device from three camera angles. The doctors and nurses can narrate what they are doing to their new, wireless, head mounted phone sets. The society seems to want a video of everything important: police stops, intersections, parking lots, hospital waiting rooms, ATM's, and now ED's and surgeries. I would vote also for billing department interactions.
() There are already medical coders to translate charts to bills, so why not medi-video coders to translate medical video to charts to bills.
() These videos would be instructive for teaching "in the field" treatment practice.
() Charismatic doctors with clear voices and a dramatic flair would find promising careers on new medical programs. Like the ones that currently use police dashboard video of traffic stops. For example, "I'm intubating the patient, I think he has a chance now, if we hurry."
() Nurses would also find careers, following the idioms of soap-opera but acted dramatically in real life, like "Oh, doctor, you were so strong and direct."
() Juries would find malpractice cases much more entertaining.
(I think I'm joking. Time will tell.)
Mr. Garland.
Its interesting that you bring this up. I proposed it once. We do have video systems in the ICU rooms that go to monitors so that we can have extra eyes watching the patients. I suggested that we record all these. I though the cost would be the thing that shot it down or at least some ill found risk management thing. Instead, it turns out it is against HIPPA!
Mr. Garland.
Its interesting that you bring this up. I proposed it once. We do have video systems in the ICU rooms that go to monitors so that we can have extra eyes watching the patients. I suggested that we record all these. I though the cost would be the thing that shot it down or at least some ill found risk management thing. Instead, it turns out it is against HIPPA!
If you tell the patients that they could be on a TV series, they will all sign a release. (smile)
"Bureaucratic interlock" is the prime danger in any top-down control, such as government controlled healthcare.
The rule-makers pass expansive regulation in each area. The rule followers do not want professional ruin. They follow the regulations closely, something that the rule-makers don't really consider. The rule-followers adapt, evade, and find more expensive ways to accomplish something without breaking the rules.
Eventually, there is expensive gridlock as only the most insane policies can satisfy the regulations. At that point, the rule-makers can't even respond, because the interlocking mess cannot be repealed in pieces, and no one will admit the failure and start over.
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