The weather warmed up yesterday, it was actually 39 degrees. In fact, as I was driving through town I noticed some houses had their windows open. When I saw the first open window I thought it was an isolated incident, but then there were two more open windows on the same block. Maybe this is an indication of how warm it gets here in the spring/winter.... Of course, the weather dropped back below freezing after the sun went down so I was glad to be home listening/watching the fireworks all around us. Okay, I admit, I was actually sleeping on the couch for a while before going to bed - but I could still hear/see the fireworks when I was awake. The three of us went to a restaurant called the Mooses Tooth for pizza. The pizza was very good, and appropriately enough, we saw another moose nonchalantly standing by the side of a six lane road while we were on our way to dinner. Have you ever heard of gyro pizza before? Neither had I, but it was surprisingly tasty and I am glad there are leftovers in the fridge.
Before I go much further, I have to include some hospital/clinical stuff that I have observed. I have not oriented to the floor, and I don't think I will until February. I think I need 90 days at this job before I go and try and learn another. So whatever I say here is based only on observation.
Charting - everyone uses primarily paper except one hospital. Another hospital does do some online charting, but not all of it. PAMC is apparently moving to computer charting this year. They will also be using Epic, which I believe is what Aurora is replacing Cerner with. The expectation is that my hospital will probably switch to Epic about a year after PAMC does.
Tele techs - I think EVERYONE has them. Monitors are not left unattended. In fact, I overheard a discussion in one hospital where they were short a teletech one night and they were going to have an RN come in and pick up the shift to make sure there was coverage. She would not have pts, just watch the monitors. And I think there were only 3 people on the monitor.
Hospitals - I have been to all 4 of the players in town now. Not that I can navigate my way through them very easily. Especially the big ones. PAMC is probably like the mothership - there are multiple floors and multiple units. Renal Acute Care. Adult Acute Critical, etc etc. I don't even know what all the letters on some of them mean. I have been in a couple of the acute care units now. They appear to be set up more like a horseshoe than an L-shaped pattern like MHOB. Some rooms are bigger, some are about the same. Like so many things, it probably depends on the age of the facility. The newer facilities or units are larger with the beds positioned in the middle of the room so you can actually get to both sides of the pt easily without moving things out of the room, and the vents seem to fit in the room, they aren't just one more thing that is in your way. I have seen some IV pumps that look more like flat rectangular boxes then anything I am used to. Staffing ratios appears to be about the same in the acute care settings, and acuity based staffing seems to be something I hear a lot of buzz about.
Restraints - my facility does not like to use them. We utilize 1:1 sitters instead of restraints whenever possible. I don't know how many of our vented/trach'd pts require sedation as many of them come for vent weaning, but I do know that the facility preference is not to restrain them. There have been some accidental extubations, but they just reintubate them in needed or put the trach back in if someone decanulates themself. I do not know where the underlying philosophy for this came from, and since I haven't worked the floor I don't know how well it all comes together, but I think the idea itself is great.
So, I am learing more about what the discharge planners and the UR folks do. Things are supposed to flow in a pattern, but as always, there are obstacles that interrupt the flow of things. The biggest obstacle has to be insurance companies. Oh my, am I learning about insurance companies. See, once we get a referral, it becomes part of my job to not only make sure the pt is appropriate for our facility, but also to get their insurance company to give prior authorization for the transfer to our hospital. If the pt has medicare, there are standard criteria that if the pt meets them, they can transfer. But with private insurance, it can get very very interesting. We have to give explanations as to why the pt should come to us, how they would benefit, maybe send a letter, provide medical necessity... and then we may get approval for a week. After that, it becomes the job of someone else to contact the insurance company. And I'm not sure if that is case mgm't or UR. So the case mgm't dept has to worry from the time the pt is referred about where will the pt discharge to. This is a very real challenge here because the options are so limited. If the local snf (skilled nursing facility/nursing home) is full, you can't just look to the next town because there is a very real chance that the next town does not have a SNF. Or you can only reach the next town by plane, and they still don't have a SNF. It's a challenge. And I have never heard the word medevac so much in my life as I have heard in the last month. Pts up here are medevac'd all the time. They are put in a plane from one facility and flown here. Or, we even medevac people to the "lower 48". That's a term you hear all the time. Frequently combined with "it's different here from the ...." One hospital here is located next to Merrill Airport and there is a runway right next to the hospital. The plane can just about taxi right up to the doors of the hospital. Imagine doing that anywhere else where you have worked. I can't. I still can't imagine it and I see it a couple of times a week!
Ok - enough of medical stuff and on to other things. Last weekend was Christmas. It was a little melancholy as there was only one child at home and I did not have any of my decorations. But it was still a lovely day and I had the opportunity to touch base with all of my family.
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a little Christmas cheer |
The day after Christmas was bright and beautiful. At 10 AM the sun was finally up, here is the sky at sunrise
so I decided to go for a walk with the dogs. Now one dog weighs 14 lbs and the other weighs 85 lbs, so walking the two of them together in good weather is challenging. Walking them both on icy roads is a little interesting. So we headed out to the lake in 9 degree weather. There are no sidewalks on my street, but the snow was packed down and I guess Rosey was able to tolerate it without difficulty this time. The crossroad by the lake is a main street with a sidewalk, and as we were going down the sidewalk I noticed this
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| moose print |
So the dogs and I snuck through the chained gate on the little park to walk out onto the lake. There was a large group of folks cross-country skiing on the ice. In fact, there is a path worn in the ice around the lake. From walkers, skiers, snow mobiles (they call them snow machines here), I don't know, but is was well used. I walked with the dogs onto the ice. They were so excited. Riley was pulling and if I had been wearing skis he would have pulled me around the lake. Even Rosey was ignoring all the little snowballs packed in her fur. I rounded my first corner on this little lake and this is what I saw:
I really was very surprised at seeing a floatplane or seaplane or whatever the call them parked along the beach in someones backyard. So, being the tourist that I am I had to take a picture.
Like many lakes, the lakefront property homes appeared to be beautiful. I walked a little farther with the dogs when I noticed this:
Can you see the planes? On closer look around the lake I saw there were several more planes parked around the lake, but I managed to not take pictures of all of them. I was afraid someone would think I was a stalker or something. So the dogs and I walked a little, but it was cold so I turned around to head home and this is the scenery those poor folks with the lake front property have to look at:
The dogs and I headed home where we warmed up, eventually.
It was a work week for Steve and I, but Jake is still off from school. One day he calls me to tell me there is a moose peeking through the window at him. Apparently, they were browsing the foundation plantings. Then they bedded down behind the neighbors RV and were still there when I came home from work. They were hard so see, even though they were so large. Two moose, a mom and baby I think, curled up together. Very cute if you can imagine something that can weigh over 1000 lbs as cute. I tried to get a picture, but it was too dark and I wasn't going to get close enough for my flash to work. Steve said we should feed them carrots, but I'm still not going to try and handfeed them. Actually, someone told Steve to feed them pumpkins and bananas. Apparently, they love bananas. However, I am still hesitant to create a moose feeding station in my front yard. I mean, these things are huge! How would I get out of my car and into the house if there was one in my driveway? I could be stuck in the car for a long time. In fact, last night we had a talk with Jake about what he should do if he comes home from school and there is a moose in the yard. How many of you parents have had to have that discussion with your teenager??
Last night, New Year's Eve, I snapped a few photos before we went to dinner. The sunset (at about 4:30 PM) was absolutely beautiful. Once again, the mountains were reflecting the pink sunset. I think you can see it a little in these pictures. Oh, we had to stop at Home Depot before we went to dinner. Sometimes when we drive through town I spend more time looking at the scenery than where I am going. Good thing I am not the driver!!
Wishing everyone the best of everything for this new year.
Until next week!
hello, does this darn thing work?
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