An End to "First Doses", doing ECGs and bladder scans, and portering?

Jane5

http://www.imo.ie/news-media/press-releases/2013/imo-calls-for-a-national-/index.xml

The IMO appears to finally be calling for a national policy on NCHD inappropriate tasks, and a redefinition of NCHD duties and responsibilities.

If they actually manage to do this, and get a national policy, available for viewing in every hospital, it would almost be worth it to me to find a job as a locum intern, for just one night, to say a firm, loud and emphatic "No, that's ridiculous!" to every single bleep where I am, sometimes rudely, ordered to come and administer a "first dose", often despite the patient having had that drug on multiple previous admissions.

Please. please please let this happen! :pac:

take everything

Jane5 wrote: »

The IMO appears to finally be calling for a national policy on NCHD inappropriate tasks, and a redefinition of NCHD duties and responsibilities.

If they actually manage to do this, and get a national policy, available for viewing in every hospital, it would almost be worth it to me to find a job as a locum intern, for just one night, to say a firm, loud and emphatic "No, that's ridiculous!" to every single bleep where I am, sometimes rudely, ordered to come and administer a "first dose", often despite the patient having had that drug on multiple previous admissions.
:

LOL
Brilliant.

take everything

An actual shift limit of 24 hrs and paying Living Out Allowance would be a nice next step.

pc11

Jane5 wrote: »

http://www.imo.ie/news-media/press-releases/2013/imo-calls-for-a-national-/index.xml

The IMO appears to finally be calling for a national policy on NCHD inappropriate tasks, and a redefinition of NCHD duties and responsibilities.

If they actually manage to do this, and get a national policy, available for viewing in every hospital, it would almost be worth it to me to find a job as a locum intern, for just one night, to say a firm, loud and emphatic "No, that's ridiculous!" to every single bleep where I am, sometimes rudely, ordered to come and administer a "first dose", often despite the patient having had that drug on multiple previous admissions.

Please. please please let this happen! :pac:

I would love to see what would happen if NCHDs said a firm 'no' to quite a few things, like the insane shifts.

So, what would actually happen in a junior doc refused to work more than rostered? They couldn't be fired I'm pretty sure?

MrCreosote

pc11 wrote: »

I would love to see what would happen if NCHDs said a firm 'no' to quite a few things, like the insane shifts.

So, what would actually happen in a junior doc refused to work more than rostered? They couldn't be fired I'm pretty sure?

They would never work in Ireland again!

And as a result, would live happily ever after...

Dozen Wicked Words

Didn't realise Dr's still give first doses in some Irish hospitals, haven't done where I work for at least 5 years. I thought there was evidence that reactions were much more likely to occur 2nd dose onward (although I am too lazy to find out if this is fact or fiction)

Jane5

Dozen Wicked Words wrote: »

Didn't realise Dr's still give first doses in some Irish hospitals, haven't done where I work for at least 5 years. I thought there was evidence that reactions were much more likely to occur 2nd dose onward (although I am too lazy to find out if this is fact or fiction)

DWW, you are quite right. The first dose, if you have really never had the drug, is likely the one that sensitises you to it. The next dose, or maybe the dose after that, or MAYBE the dose after that.....or maybe twenty doses later, you may develop your allergic reaction. While you obviously can be allergic to something having never had it before, the above is immunologically more likely.

Additionally, I never in all the years I was on the wards came across one single person or heard of it happening, that had anaphylactic shock from an IV drug being administered. The odds of it happening are vanishingly small.

The first dose policy is based on, and I am sorry if this is unPC, but it is based on cretinism. Absolute moronism and utter bollox. Of all the inappropriate NCHD tasks, it annoys me the most precisely because it is so insanely, embarrassingly stupid. And I know it annoyed a lot of the GOOD nurses beyond measure, because it slowed up getting patients treated, and then they got flack from them and their families.

I mean, looking at it logically, every dose of every drug has an equal chance of causing an allergic reaction. The first dose (probably) less of a chance than the subsequent doses. Either get NCHDs to give EVERY DOSE OF EVERYTHING (probably in this country!) all the time ad infinitum and completely empty the A&Es, theatres etc of doctors-or give what is prescribed (hell, anything does happen and the doctor is the one going down anyway, not the administering nurse!) and in the incredibly unlikely event of anaphylaxis, PUT OUT AN ARREST CALL!

I'm here all week.

Jane5

Oh, and trust me, the "First Dose" policy is alive, and well, and kicking in pretty much 98% of all Irish hospitals right now. Right now, as we speak, interns and SHOs are making up IV medications despite never having received training to do so, and attempting to connect them up through the IV machines that really only nurses know how to use properly, because they were trained to and NCHDs weren't. Right now some house officer who has been on duty for 20, or 30 or 40 hours straight is staring at a syringe of something they've just made up and wondering "do I give this as a push? or dilute it and make it go in over a few hours? Where do they keep the IV instructions on this ward anyway?" Ah, patient safety, such a priority in our hospitals. If this policy is no longer in the hospital where you work, you are to be commended, because it's pretty much the only hospital we've heard of where it's been axed. You guys must rock.

Icemancometh

Jane5 wrote: »

Oh, and trust me, the "First Dose" policy is alive, and well, and kicking in pretty much 98% of all Irish hospitals right now. Right now, as we speak, interns and SHOs are making up IV medications despite never having received training to do so, and attempting to connect them up through the IV machines that really only nurses know how to use properly, because they were trained to and NCHDs weren't. Right now some house officer who has been on duty for 20, or 30 or 40 hours straight is staring at a syringe of something they've just made up and wondering "do I give this as a push? or dilute it and make it go in over a few hours? Where do they keep the IV instructions on this ward anyway?" Ah, patient safety, such a priority in our hospitals. If this policy is no longer in the hospital where you work, you are to be commended, because it's pretty much the only hospital we've heard of where it's been axed. You guys must rock.

Nurses give first doses in WRH. Fantastic stuff.

his_dudeness

Icemancometh wrote: »

Nurses give first doses in WRH. Fantastic stuff.

Same in Limerick (except in ED) and they were brining it in Galway when I was leaving.