The Great Shake Out Part 1

It’s 0200.

You have a 4 year old patient who continues to ring his call light, it finally dawns on you that the reason you’ve been feeling so light headed is because you forgot to take your break and eat lunch. You have been on top of all your meds so far tonight, you have made sure all your 4 patients have gotten their dinner tray. Everyone has eaten, well except for one person you. Sigh.

You go to the nurses station to finish up all your charting, then hopefully sneak in a bite of a granola bar you have hidden in your scrub pocket. As you unwrap the granola, your swivel chair starts shaking. You turn to make sure it’s not Jane the new nurse messing with you. Then you realize everything starts shaking and moving. Some of the nurses are ducking underneath the desk, you end up running to room 2. That’s where little 4 year old David, your patient, is sleeping, you need to make sure he’s ok. As you get your bearings, it feels like the entire floor is rolling in waves underneath your crocs. You start running to the room, desperate to reach him before he gets injured (as all your other patients have their parents at the bedside). Everything starts falling apart, chairs start rolling, you can hear the patients start crying, things start falling apart. And all you can do is pray that no one get’s injured.

Does this sound familiar? Though this specific scenario described is not actual, this has and can happen. A clip is included of one of our most unfortunate catastrophe’s hurricane Katrina to allow us to understand what situations could occur within a healthcare environment.

Any natural disaster can hit, if where you live is more prone to tornado, tsunamis, earthquakes, volcano, anything that can endanger the life of your family and yourself. The reason I bring up emergency preparedness is because it affects each of us, no matter where we live or vacation at.

Ideally, if disaster strikes, I would like to be at home with my family. I would think that’s true for everyone.  Healthcare, we are a different story are we not? If disaster strikes, we can’t ask the masses to stay at home and not come to the nearest hospital or medical area. We are the ones’ that the injured go to, and if you are “lucky” enough to be at your place of work during a disaster strike. You may be stuck there, you could be stuck at your place of work for days. You may not be able to get out and others who could relieve you may not be able to get to work.

If an earthquake (disaster) hit right now, and you are at work, how confident would you feel of your family’s/pets’ safety. That is if you are unable to see or hear from them for 72 hours? That to me would be my most pressing matter.  When disaster strikes, your focus is on your safety and your families safety. Which brings me to this. I have decided that even thought my family may not be completely prepared, I should start the first step.

Last year for Christmas I bought my immediate family a backpack first-aid kit. I looked all over for an emergency kit. I wanted a kit that I could carry, if I had to run and get the heck out of dodge. So of-course I sure as heck would want something that would actually be useful.

I then found a kit that I felt would be very useful to my family. I found the kit to be the easy on the wallet and it contained numerous essentials that I didn’t even think of.  I ordered it off of Amazon (the link is below to the same one -backpack is a different color-that I ordered), what I like about this kit is first off I didn’t have to put it together (lazy I know). Second, the food and water had a 5 year shelf life. So the question here is why on earth would I get a kit that would expire? Because I rather have my family prepared and change out the kit expired contents every so often then with nothing.

Mayday Deluxe Emergency Preparedness Survival Backpack Kits (4 Person)

Screen Shot 2014-02-17 at 7.41.07 PMWhat I found helpful is I am putting together a tub (that also contains the backpack) together that is dedicated to emergencies for my family. I need to have the emergency supplies stored at an easy access area. So we decided that the emergency tub will be stored in the shed out back (I chose the shed over the house because if I had to dig through rubble, I would rather dig through a destroyed small shed then a two story collapsed house). It was decided that as a habit, every daylight savings time day the emergency kit and tub will be looked through an updated (for expired items). I thought it may be easier to remember that way, but honestly you could do it however works for your family.

Being prepared honestly is not enough, sure you may know what to do and you may even have a kit ready. But let’s be honest, does your family feel the same way? Do your teenage children know how to survive on their own, what about your dogs who are stuck in crates or even the garage while your at work. Do you have someone who can help your pets if you can’t get home- a neighbor, a friend? Would everyone be safe and know what to do?

I hope that by asking you these questions it can start getting you to think about how to better prepare yourself and your family if a natural disaster strikes. If you are stuck at the hospital/work or someplace else taking care of others. Who will take care of your family? I will post a part 2 on what I’m doing to help my family get better prepared. If you enjoyed this post, please make sure to follow this blog.

How ready will everyone be? What about you? Are you prepared?

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The Fork. The Bend. The Road. And Ramen.

“Alice came to a fork in the road. ‘Which road do I take?’ she asked.
‘Where do you want to go?’ responded the Cheshire Cat.
‘I don’t know,’ Alice answered.
‘Then,’ said the Cat, ‘it doesn’t matter.”  Alice in Wonderland

Everyone has their sight set on a specific career path they plan to take. Unlike Alice, we all have or had a destination we wanted to get to as a child. My destination as a girl was to become a physician. After all that’s what everyone else told me I should do. It was ingrained in my mind, just as natural as breathing. So in 5th grade with a lunch pail in hand, pony tail with an elastic scrunchy. I was ready to tackle the world as a renown physician, while of course on the side, finding the cure for any disease that came my way. That’s the way it works right? How little did that little 5th grade girl know.

Once I started college I had my eyes set on health care. Getting my prerequisites for Med School, and fueling on lots of Ramen. But little did I know that the road I was taking did eventually bend by the end of my freshmen year. I may not have chosen to stay in the physician road. I did stay in health care but instead I was lured to the wonderful road that lead to nursing.  I graduated. Passed boards. Then After writing “RN” next to my name over a hundred times I continued my journey.

Fast forward to today. I’m 31, you would thing after 10 years of nursing I would still know what I want to be when I grow up. Honestly, you could be 25 or 40 and you come to a fork or even a bend in the road and you still have no idea which road to take in your career. That’s what just happened to me. During my time working as a nurse manager, I have been offered two great career opportunities.

Here is the kicker, one is in Los Angeles, CA and the other is in Seattle, WA. Do you know how far that is on the map from Southern California? It’s precisely 1187.94 miles driving distance. These two job offers are fantastic but they couldn’t be completely different from each other. For the past 24 hours I have been breaking out in hives out of the sheer stress of deciding if A) I want to stay where I am at B) Take another job in LA C) Move to Seattle (Go Seahawks!), may I add it was 32 degrees when I was flown to look at the organization in Seattle-while it was 70’s in California. My two choices included an educational leadership role vs. a clinical leadership role. May I add I love the two? So it’s like comparing a choice of a parka and uggs vs. flip flops and sunglasses. What is a girl to do? No seriously this has been such a difficult excruciating decision.

You would think as a grown up I would know exactly what I want. Wrong. Nursing as a career has so many many many varieties. So here I was 0300 Friday morning not knowing if I was going left or right at the fork. I grabbed opinions, did research, hoped the answer would magically come into my dreams. I was sorta hoping for a dream that had magic unicorns telling me what I needed to do. Sigh, unfortunately I had no magic unicorns or dreams for that matter telling me what to do.

10What else are my choices? I contemplated having my dog Zeus decide, how? By having two paper plates filled with yummy dog food with the words Seattle on one and LA on the other. Seeing which plate he went to first. Great decision making I know. I decided to not go with that idea, considering if my dog ate that much food he would also experience the joys of a stomach ache (I added a photo of my Zeus and Toby-a good friend  Cody Krogman who is a wonderful photographer took this photo).

It stresses me out man!

So after many sleepless nights, digestive issues associated with (blah) stressful days, I finally made my decision. I chose not to listen to the Cheshire Cat, I chose my own destination. My own road. My own path. I chose the path to educational leadership. Do I regret it no.

So my answer to you my dear Cheshire Cat is no the road I choose may not matter to you but it matters to me. After all I’d rather live a life of “oh wells” than “what ifs”.

The Super Bowl: A Sex Trafficker’s Playground

This is a very informative blog post especially with today being Superbowl Sunday. This is about a secret that I never was even associated to the Super Bowl (by associated I mean why this is such an issue around this time.

Forte E Bello

woman hostageIn just a few short days hundreds of thousands of visitors will flood to the MetLife stadium in New Jersey for Super Bowl XLVIII. Many visitors will be coming to show their pride and cheer on their favorite team, but tragically, thousands more will be coming for something entirely different. What most people don’t know is that the single biggest game of the year has also been called the single largest human trafficking event on the planet.

Just beyond the stadium lights, hidden within the shadows will be thousands of victims, women, children and even men, caught in the inhumane web of sex trafficking. For them this day will bring something much different than football, loud cheers, hot dog stands and painted beer bellies. For them it will bring pain, abuse, repeated rapes and even fear of death. The exact numbers of trafficking cases in a given year or…

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Heart Attack and Stroke Debacle

Heart Attack and Stroke Debacle

Screen Shot 2014-02-02 at 12.32.06 AMNew AHA-ACC (American Heart Association and American College of Cardiology) guidelines are causing quite a debacle in health care. In 2013 the AHA-ACC implemented four new guidelines on the management and assessment of cardiovascular risk factors (New York Times, 2014). The goal of the risk assessment guideline/tool is to predict a patients 10 year risk of atherosclerotic cardiovascular disease (ASCVD), heart attack and stroke .

The risk assessment looks at race, sex, high-density lipoprotein (HDL) cholesterol level, total cholesterol level, use of antihypertensives, diabetes, smoking status and systolic blood pressure, looking at the calculated percentage being  ≥ 7.5%who are at risk of ASCVD, heart attack and stroke (Yancy, Harrington, & Robinson, 2014). Evaluating the need of how likely one is to benefit from statin therapy (statin are a class of medications that are used to lower blood cholesterol levels).

The debate is the risk assessment calculator can over estimate a person’s risk assessment from 75% – 100%.

According to the risk assessment guidelines patients who are 20-79 years of age who do not have clinical ASCVD  and who’s 10 year risk percentage is less then 7.5%, those individuals risk factors should be assessed every four to six years (Rosenburg, 2014). Therefore recommending statin therapy for a broader group of patients that may not benefit?

The ACC/AHA they make a good “Switzerland” “neutral” statement. In a separate comment ACC/AHA joint statement went something along the lines of these guidelines are not meant to replace sound judgement. These guidelines are to encourage the discussion between a patient and their health care provider about the best methods prevention of a stroke or heart attack based on the patients personal preferences and health history (Stone, Robinson, Lichtenstein, & Bairey Merz, 2013).

If there is such a risk of over estimate where the guidelines can recommend statin therapy to a broader group that may not be beneficial, is this a useful tool? What do you think? Please leave your feedback in the comment section. If you enjoyed this posting please subscribe. Thank you.

I will  conclude by adding a link to the American Heat Association guidelines for additional information  2013 CV Risk Calculator and I will include a link to the American Heart Association clinical vignettes, so you can use to practice using the tool.

References:

Kolata, G. (2013, November 17). The New York Times. Retrieved February 1, 2014, from Risk Calculator for Cholesterol Appears Flawed: http://www.nytimes.com/2013/11/18/health/risk-calculator-for-cholesterol-appears-flawed.html?pagewanted=1&_r=2&

New York Times. (November, 19 2013). Cardio Source. Retrieved February 1, 2014, from New Risk Assessment and Cholesterol Guidelines Spark Debate: http://www.cardiosource.org/News-Media/Publications/Cardiology-Magazine /2013/11/New-Risk-Assessment-and-Cholesterol-Guidelines-Spark-Debate.aspx

O’Riordan, M. (2013, November 13). How Good Is the New ACC/AHA Risk Calculator? Retrieved February 1, 2014, from Medscape: http://www.medscape.com/viewarticle/814579

Rosenburg, K. (2014). New AHA-ACC Guidelines Could Lead to Major Changes in Clinical Practice. American Journal of Nursing, 13.

Stone, N. G., Robinson, J., Lichtenstein, A. H., & Bairey Merz, N. C. (2013). 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation Journal of the American Heart Association, 23,24.

Yancy, C. W., Harrington, R. A., & Robinson, J. G. (2014, January 29). American Heart Association (AHA) 2013 Scientific Sessions. New Cholesterol Guidelines and CV Risk Calculator: Controversy Clarified. Dallas, TX: Medscape.

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A Trip to the ER

With my dad, ED visit, prior to tele leads and O2.

With my dad, ED visit, prior to tele leads and O2.

So as well as a nurse, I am a daughter, sister, niece, granddaughter, and one of the go-to health care experts in my family. All of you in health care, I’m sure can relate.

As a health care provider, you get a new patient. You go in as a nurse/physician/PA/NP (and whoever else I’m forgetting), and you need to get the patient’s health history (hx).  But they are too stressed out to even remember specific medication dosages, history and anything else pertinent to what the physician needs to know in order to care for the patient properly. But I can attest to this, as a nurse, and most importantly as the family member of of patient, medication dosages is the last thing on your mind when your in the ER. Allow me to share a story with you.

This is a story about my father, and no I am not violating HIPPA, since I’m a family member in this situation. Well if anyone knows my father, he’s in his mid 50’s but he has stopped counting in his 3o’s. His medical health history includes cardiac disease, coronary artery disease,  hypertension and other ailments.  So he is actually on quite a few of medications, OTC meds and vitamin supplements (yet he does not consider the OTC meds and vitamins in the medication category). So he’s been in and out of the hospital primarily for cardiac reasons (he’s doing great now), by hospital I mean the Emergency Room. Earlier in the day he was complaining of chest pain, so my mother had an ambulance take him to the ER nearby, and not for a pleasure stroll. I don’t remember where I exactly was at the time, but I ended up meeting them there. So by the time they took him into a room, one of the nurses came in and started getting some additional information from my mother regarding the occurrence. Then the nurse started asking my parents for additional information regarding my dad’s medications (that he is currently taking), health, procedure and surgical history. But all my parents could tell the nurse  (after all they were both in a stressful situation, the added anxiety doesn’t help patients or family members) was my dad was on heart medicine, something for his blood pressure, and she or my father couldn’t remember the rest. So that was about as good as the history could be given. So then the nurse turned to me and requested that I get a copy of all his medications as soon as I was able to. Of course, at that time I felt guilty that I didn’t have a complete detailed record of both my parents health history, after all I am a nurse. It’s in my profession and honestly all health care to be prepared. I should be prepared, I should of had my family prepared for such an emergency. But because of my absolutely guilt trip I felt like the absolute worst daughter and the worst nurse possible. So then I had to run home and get all his medications. Well to make a long story short, I gave them the medications. They ruled out a heart attack, and attributed it to a panic attack. So he came home with a clear bill of health (but still had a follow up with his primary).

Screen Shot 2014-01-31 at 10.15.33 PMBut here is the thing, even as healthcare providers we can’t possibly be prepared for everything from tsunamis, earthquakes, terrorist biological invasion to having a family member in the ER. We can do what we can, learn and go forward from there.

So after that occurrence, it gave me an idea. Why don’t I make my parents each a wallet sized card? A card that contains all the pertinent medical information that a healthcare giver would need, in case of an emergency? So I made them each wallet sized laminated emergency cards-so they can each have in their wallet, and so I can have a copy in my own wallet.

Here are samples of what I made (excuse the blurriness), along with a rough copy of two cards in this blog (the cards available for purchase have been updated). When you have a family member in the Emergency Room, who may have more of a complex health history, it will be difficult enough to remain calm, much less remember all of their medical information. The reason I am sharing this with you is because the situation is already stressful, why not try to eliminate the stress of your loved one’s health history.

Which is why I am including an optional PDF template  that you could purchase via Etsy. Or you could create a similar template that fits your individual needs. If you choose to go with my template, I will also add a link to the laminates that would fit this template. Or you could use your own page laminate and individually cut each card apart. I will give you a short step by step:

***Sample template below***

Screen Shot 2014-01-31 at 10.07.20 PM

Instructions with template

  1. Purchase template
  2. Fill in text boxes with medical information
  3. Print
  4. Cut out the cards that you printed out to fit the laminate business cards
  5. **I purchase the laminate that does not require a laminate machine**
  6. There are two parts to the card, you have the front that will have the name on the top left and drug allergies on the top right, then an MD which I chose for my parents sake as their primary MD-with the office phone number. With the medications below. Then you have the back of the card with the history portion. Get both sides of the card and put them back to back.
  7. Press down laminate
  8. Insert in wallet

***Template is $1.20,  and all purchases are non-refundable. Template is a INSTANT PDF downloadable file. I will be donating 50% of all ER Medical Wallet card profits to the American Heart Association on behalf of my dad…Thank you .***

If you are interested in purchasing a emergency medical wallet card template please go to the link below.

Emergency Medical Wallet Template Cards

Scotch Self-Sealing Laminating Pouches, 25-Pack (LS851G), Business Card Size

You can never be to prepared. Especially, for me finding out the hard way, when it comes to your loved ones.