Peripheral Dopamine Order Now Requires SQ Option Per The Joint Commission.

Oakbrook Terrace, IL--  In an effort to enforce more accurate documentation,  The Joint Commission began mandating this month that all  peripheral IV dopamine orders contain a dual IV/SQ route of administration.  Previously, The Joint Commission only required hospital dopamine orders  to be administered through a stable and acceptable intravenous access site.
 Dopamine

Dopamine is a medicine frequently used by medical practitioners to support blood pressure or heart rate in the critically ill patient.  The Joint Commission says they have been made aware of thousands of incidents where physicians have ordered intravenous dopamine  through a dangling 25 gauge IV on the dorsum of the left 4th metatarsal with a blood pressure of  50/10 knowing very well that the IV is going to infiltrate into a fluid filled wheel of necrotic pus... and they order it anyway.

"All physicians know peripheral IV dopamine will eventually infiltrate into a subcutaneous route of administration.  We just want them to be honest with their documentation.  Providing an order for subcutaneous dopamine satisfies our requirement for accurate documentation and certification," said Mark Chassin, President and Chief Executive Officer of The Joint Commission.

While documentation accuracy may improve, some doctors worry giving subcutaneous dopamine may do more harm than good.  When given subcutaneously, dopamine can cause surrounding tissues to lose blood flow and rapidly die.

"I can understand The Joint Commission's desire for more accurate documentation but this policy just gives doctors an excuse for not putting in a central line and being a doctor," said Dan Stefbaum, lead author of The New York Time's Best Seller In Medicine, Shit Always Flows Downhill.

When confronted with concerns from patient advocacy groups, Mark said, "We know giving dopamine only through central invtravenous access is impractical and unrealistic and we would never expect any doctor working in an ER to place a central line against their best judgment.  As an organization that prides ourself on patient safety, finding middle ground in this policy was the only rational solution we could envision."

Some hospitalist groups have already responded with their own safety protocols to protect patients from this dangerous new policy.  "We have implemented an order for bedside 24 hour 1:1 monitoring with a care tech to watch the IV and notify the hospitalist stat when the IV infiltrates," said Devon Fenwick,  a hospitalist at the bottom of the hill.

Next week, The Joint Commission will discuss whether or not to allow surgeons to order antibiotics. 



Hospitalist Breaks Record For Ordering Most Consults in a Day

Los Angeles, CA -  Good Samaritan Hospitalist Ray Benford broke a world record Tuesday by ordering the  most hospital consults in a single day.  Guinness World Records was able to confirm Ray's 14 consults took out the old record of 12 consults in a single day that has stood untouched for 72 years.

"What do you mean?  I'm a Hospitalist," Ray said when asked to explain why a board certified internist would need so much help with one patient.

The  record breaking patient arrived as a transfer from an outside hospital with 457 pages of nursing notes, vital signs, a complete list of as needed bowel medications and no discharge summary, the normal train-wreck transfer protocol.

"I was pissed when the patient arrived right at my lunch time so I ordered a stat R.A.P.ER.S. evaluation to clear out the doctor's lounge."

The R.A.P.ER.S. acronym stands for Radiology, Anesthesiology, Pathology, Emergency and Surgery.  These  subspecialty physician species are notoriously known  for stripping bare the buffet line in the physician lounge minutes after opening, to the disgruntlement of all other specialties.

After eating lunch, Ray says he took a second helping to his office and entered consult orders for Gastroenterology, Infectious Disease, Nephrology, Cardiology, Pulmonology, Neurology and Dermatology to see for medical management. 

Rounding out the last two consults a  Rheumatology request and a second opinion Rheumatology request  was ordered at the same time to confirm the patient really didn't have Lupus.

"Technically, I only had 13 consults because the Dermatologist couldn't find the hospital, but they gave it to me anyway."



Clean Catch Urine Samples Now Automatically Relabeled To NOT CLEAN CATCH.

Roswell, NM -  Lovelace Regional Hospital changed the labeling guidelines for clean catch urine samples to halt inaccurate reporting of the most hated lab specimen ever, Director of Laboratory Services Erin Colico announced Friday.

Erin called this policy change the single most successful laboratory initiative in the history of urine methodology, where 98.7% of all clean catch urinary specimens failed to achieve national clean urine standards.

"The clean catch urine had become the laughing stock of lab samples.  It's even worse than the third year medical student's cervical smear samples we get.  We actually had one female ER urine specimen sent to use with multiple hairs we later identified as likely of male thigh origin," Jan told reporters.

"Once we realized nurses were never going to obtain  appropriate samples from wheelchair-bound 92 year old non-English speaking hearing impaired demented women and doctors were never going to stop ordering them, we just decided to change the definition [of a clean catch urine].  All clean catch urine specimens are now automatically relabeled NOT CLEAN CATCH.  There are no exceptions."

This wasn't always the case.  Hospital officials spent fourteen years attending biweekly meetings with representatives from 27 different departments trying to solve the problem.

"I remember seven years ago when we had that four page exclusion criteria we had to fill out for every clean catch urine order," said Jesse Durang, the nurse who likes to tell stories about how things used to be.

With the introduction of computerized physician order entry (CPOE) in 2011, the job of risk stratifying patients as appropriate clean catch urine sample candidates was shifted to physicians.  As expected physician compliance was only 2%.  "Some physicians actually had the gall to give a verbal order for a nurse to fill out their CPOE urine sample protocol," Erin told reporters.

The physicians who did attempt to comply did not fair any better.  "Most of the time we found  physicians would speed click through the pop up boxes until they somehow managed to log themselves out and then give up or they would enter an order for an ANA instead of a urinalysis and they didn't even notice,"  Erin told reporters.

This proactive policy was met with praise from the Joint Commission  "We are confident this policy will lead to more policies we can investigate and comment on."

"What if I told you demented people have no business giving us a clean catch urine sample."

What if I told you demented people have no business giving us a clean catch urine sample photo dementedurine_zpsec513e73.jpg



Alzheimer's Patient Sent to the ER For Normal Mental Status.

Trenton, NJ -  An Alzheimer's patient at Lakeside Memory Care was sent to the emergency department at 3:00 a.m. last Sunday morning after staff noticed normal mental status.

Responding to a frantic 911 call, emergency officials  arrived to find an elderly woman in a wheelchair trying to sleep.  "I'm sleeping.  Please don't sternal rub me again," said Lonnie Bester, a 92 year-old resident who's baseline function involves a series of erratic clicks,  grunts and moans.

"I tried to give her a sleeping pill and she told me she was already sleeping.  That's when I knew something was wrong and I called 911," said Lisa Blazen, the night nurse  responsible for saving Lonnie's life.

Even emergency crews were surprised at the severity of her normal mental status.  "When I went to check her blood pressure, she politely handed me her arm.  No kicking.  No punching.  No cussing.  That's when I made the decision to turn on the sirens,"  said Jim Denton,  the EMT who arrived first on the scene.

Shortly after leaving Lakeside, Mr. Denton, called report to ER doctors and nurses in anticipation of the patient's imminent arrival.

"Usually when I hear an Alzheimer's patient coming in at 3:00 a.m., I start cursing out loud during their report.  But not this time.  She sounded really sick," said ER physician Ben Jasper.

Doctors and nurses searched diligently for a cause of her normal mental status.  But one negative head CT and a contaminated clean catch urine later left the team intellectually dissatisfied.  Ms. Bester was ultimately admitted to the Hospitalist physician after Lakeside refused to take her back on a Sunday.


"Prepare yourself. Demented patient with altered mental status coming to the ER. At 3 am."

Prepare yourself.  Demeneted patient with altered mental status coming to the ER.  At 3 am humor meme photo.




Fibromyalgia Allergy List Crashes EMR at Local Hospital

Arlington, VA -  Officials at Saint Vincent Hospital are searching for answers after a fibromyalgia patient with 57 allergies crashed their electronic medical record  less than two hours after going live.

"We were not prepared for the destructive forces fibro[myalgia] had to our IT infrastructure," said CEO Lance Bestow.  "We spent eighty million dollars and hired fourteen consulting firms and it still found a way to ruin our day."

Pharmacist Jim Detter was working data entry duty when the malicious fibromyalgia attack occurred.  "Everything was fine at first.  Then I hit a string of allergies to cardboard, the color red, Washington State, and country music.  I could literally feel my keyboard heating up."

A Department of Health and Human Services official, who wished to remain anonymous because they were not authorized to speak to the public, has confirmed a rash of similar attacks around the country. "We have talked with numerous  fibro-terrorism experts and none of them  seemed optimistic for a rapid solution."

Department of Homeland Security representatives are currently working with congressional leaders to craft legislation that requires all fibromyalgia patients to only report their top ten preferred allergies, none of which can include gluten, abstract thoughts or colors of any kind.

Reports of proposed government allergy restrictions quickly spread to  Fibromyallergia, the internet's number one fibromyalgia forum. One anonymous member, who goes by the moniker I-Drive-A-Hurts, was convinced they had an allergic reaction to the news.  "As soon as I heard this, I felt funny and added it to my list that I keep with me at all times.  By the way, I have fibromyalgia."

Until such legislation becomes law, public health officials are asking fibromyalgia patients to error on the side of caution and only tell their physicians and nurses about their top three allergies.  The AMA and ANA are loudly applauding these proposed changes.