Best Kept Secrets of the OR #12- What is on back order now?

Your OR life will be spent tracking down instruments and supplies. Some of these supplies are of the urgent nature. This may be a disposable piece that goes to an equipment to a package of sterile towels. This may be the suture that is needed after you, or the surgeon, puts a giant hole in someone to fix their problem.

We have supplies that are by themselves. We will call these one thing.

We have supplies that might come in a pair. We will call these two thing.

We have red supply. We will call these red thing.

We have blue supply. We will call these blue thing.

Now that I am done Dr. Seuss-ing up the post (I hope you got it), we have lots of supplies.

Like lots of supplies.

So many supplies.

You never think we’d run out amount of supplies.

But the thing is that each surgery needs these supplies.

99.999999% of surgeries require supplies. I made that number up but the vast majority of cases need supplies.

These are special supplies that need to come sterile. You know, so that we don’t kill the patient by using a supply that will send them into sepsis. And we might not have the capability to render them sterile on site.

The point is the OR is a supply heavy place. And the supplies need to be sterile.

I would hazard a guess that the OR is the most heavily supplied place in the hospital.

You know what other place is heavily supplied and supplies the rest of the hospital.

The pharmacy.

100% of patients in the hospital require medications at some point during their time with us.

Many of those patients require some form of IV therapy. This is fluids/medications that are delivered to a patient via an intravenous catheter. Straight into the blood stream. And these fluids/medications need to be sterile as well. Same reason.

Hurricanes Helene and Milton did a number on two factories that supply IV fluids. One in Western North Carolina and one in Florida. Guess where many hospitals/surgery centers/doctor’s offices/free standing ERs get their fluids? From these factories.

Immediatly after the hurricanes my hospital put out the bat signal to all of its employees reassuring them that the corporation had IV fluids to continue to operate and reminding us to conserve IV fluids and bags.

The hurricanes were not even been a month ago and some surgeries are being cancelled due to lack of IV fluids.

This is disappointing to patients and providers alike.

Let me tell you about the model that hospitals et al. get their supplies through. It is called just in time ordering. The hospitals et al. can’t have millions of dollars of supplies on their shelves, including IV fluids. For one thing, that is a LOT of money to have in backstock. For another, especially when it comes to IV fluids and medications, there is an expiration date where the sterility of the packaging or the stuff inside the packaging can no longer be guaranteed.

Many hospitals et al. are in trouble with IV fluid supply levels. We in the business call this kind of thing back order. As in we need the supply/IV fluid and the supplier would like to give us the thing but is unable to because of glitches like hurricanes. We’ve had a LOT of backorder for as long as I’ve been a nurse and I don’t see that changing.

Is this model sound? Maybe. Does it hit the fan when it there is a bump? Absolutely.

Does it put patients at risk? Yep.

Tuesday Top of Mind 10/29/24- 50 years ago today, women could open credit cards and own a house

I knew this was the year when the world of credit opened up to women. But I had no idea that today, October 29, 1973, was the day.

I don’t think you understand exactly what that means.

We, as women, have been clawing our way out of the shadows for a very long time. Or should I say from under a man’s thumb for a very long time.

I like the thumb metaphor better than shadows.

I know, I know. I’ve written about it before. But it is important to acknowledge that it has only been FIFTY years here in the US that a woman has been allowed to sign for a mortgage or a credit card.

Oh, wait, I forgot the qualifier.

It has only been FIFTY years that a woman has been allowed to sign for a mortgage or a credit card WITHOUT A MAN.

That’s better and a more complete sentence.

I had a conversation with a guy this weekend and he was shocked when I was mad when he said that men make sure that society runs smoothly.

After my brain stopped smoking from the rage, I asked what he meant.

He said that it was the men who made sure the rules were followed.

After I was able to unfist my hands, I reminded him that men had had control of the reins of power since time immemorial, especially in this country, and that women were, in fact, police officers who enforced the laws. And there were women in the government who made sure these “rules” were enacted. Not as many as there should be considering we are more than half of the population, but women have to start somewhere.

We left the conversation there and I left the place where we had had this conversation.

It was either that or haul off and punch him. Yes, punch. With a closed-finger fist.

What I wish I’d said, “Well, Chris, maybe if we hadn’t only had real power and real representation in the US Congress, or on the Supreme Court before the last 45 years, women might’ve had a chance to do something about the gross interference of men.”

To which he’d reply, “Women could never.”

And I would say, “Well, if men would get out of our way we could.” And I would watch him turn red and bluster and walk away.

Now, that would be satisfying.

But, yay, for us women who’ve had the ability to take on debt, in our own name, for 50 years today.

Let’s get to work on the rest of it.

First thing to do is vote in this year’s general election.

Especially after that blatant dog whistle of a rally at Madison Square Garden on Sunday, 10/27/24.

The last thing I will write is that a person for the campaign noted after all the gross “joke” about Puerto Rico that the people didn’t seem to mind.

No, of course not, Jan. They wouldn’t.

Post-it Sunday 10/27/24-true words from a retired surgeon

The gown card reads “I’d rather be working here than being worked on here.”

A retired orthopedic surgeon said this to another orthopedic surgeon.

This is the cure for all the people who are bellyaching about working.

Let us put it more simply. Would you rather work on the patient or be the patient that the team is being worked on?

Can’t put it any simpler than that.

I know, I know, you’d rather be at home with your children/spouse/significant other/pet.

However, if you had to choose which would you choose?

Because none of us are getting out of here alive, or intact.

I would definitely be working than the one on the table. But then you all knew that because I am the workaholic here.

It strikes me this can be analogous to learning as an adult. And this could have probably waited for a School Me Saturday.

Which would you rather do?

School Me Saturday 10/26/24-Study Music: yes or no?

This past Wednesday I titled the post “Mister, are you tall?”

This was about one of the songs that I used to listen to at Creighton and my first nursing program. Dr. Demento’s songs made me smile and I found them easy to listen to while learning.

When I was writing the post (which was about height differences in the operating room), I vaguely remembered that there was a height reference in one of the Dr. Demento songs. I was pretty sure the song was “Existential Blues” by Tom “T-Bone” Stankus but I had to relisten to make sure.

This led me down memory lane. So many silly songs. So many not very politically correct songs. It was a great afternoon and I listen to a lot of songs while I was folding laundry. What a great afternoon. I finished folding the laundry and cleaned the kitchen while tripping down memory lane. I remembered some of the songs that I listened to while writing a presentation on 1993 Rawanda or learning anatomy.

The point of this post is to encourage all adult learners to find what inspires them to focus and learn.

There has been interest in recent years about listening. I am writing, of course, of ASMR. Which is defined as autonomous sensory meridian response. If you Google the term lots of information pops up. Some people find it relaxing and stress relieving to listen to.

Those people aren’t me. I find most ASMR content mildly infuriating. Kind of like how I find all stress balls infuriating. So ASMR is not for me.

It might be for you, which is okay.

As an adult I confess I don’t listen to music when I write or study. I am not sure when it got away from me.

On Thursday as I was preparing for a presentation I had to give Friday, I decided to listen to Dvorak. Specifically Symphony No. 9 “From the New World”. I wanted to see if it would work as presentatin preparing music. It is one of my favorites after all.

I found it distracting. I wanted to conduct.

I tried a different classical music, one that was recommended by a writing group member.

No go. My brain kept picking out the repeating parts and it would be jarring when the music didn’t follow pattern.

More evidence that working through a global pandemic and working in ORs for 23 years with its music has changed my brain.

The overall point of this post is to find something that calms your brain and lets you think and learn and write.

This might be silence.

This might be ASMR.

This might be classical.

This might be old TV shows on repeat.

Listen to whatever speaks to you in that moment.

As with so much of being an adult learner you get to choose what works best for you.

I’ll be over here in the office, writing in silence, listening to the taps on the keyboard.

I guess that might be a form of ASMR. And I found a playlist that was entirely cats’ purring. I bet that might work for some people too.

Keep exploring until you find what works for you. It might be dusty CDs from your own high school years.

Best kept secrets of the OR #11- mister, are you tall?

Best kept secrets of the OR #11- Mister, are you tall?

This is a reference to the parody song “Existential Blues” by Tom “T-Bone” Stankus. If you haven’t listened, this is your sign. I’ll wait.

The OR team comes in all shapes and sizes. From small to tall, from large to not, all are welcome and represented.

But what if there is a very tall tech and a short surgeon? I put forth in evidence the 6 foot 5 inch tech and the 5-foot tall surgeon I worked with for years.

You see, you don’t get to choose your team when you are the surgeon, it is the middle of the night, and we are on call. There will be a height discrepancy.

What do we do? Saw off the techs legs or make them kneel?

Nope.

This very real problem has a lo-fi solution.

Boxes.

Not the soap boxes where the surgeon/tech can expound at length on a variety of topics.

These are more risers, to give the one lacking in height a 3-6 inches boost.

I write 3-6 inches because the risers are about 3 inches tall and they are stackable.

This kind of cuts into the discrepancy.

But one thing is for certain. The taller one will have a crick in their neck after surgery from looking down and the shorter one will have a crick in their neck after surgery from looking up.

Them’s the breaks as we don’t have a lot of variety to choose from. There isn’t a special stash of scrub techs or surgeons in the back if the one on display doesn’t suit.

This is not Goldilocks and there is no perfect fit.

Someone is gonna have to stoop or look up.

I do caution the ones on the riser to be careful. Because that can be a big fall if you aren’t paying attention.

Tuesday Top of Mind 10/22/24-the pregnant woman “owes” the state her progeny because they will be taxpayers someday-WTAF

The truth comes with a complaint in TX before the 5th Circuit Court of Appeals Court (of course). This is yet another attack on mifepristone by mail. Reminder, of the varying bans that politicians and states have placed on women’s bodies and their access to healthcare. Okay, it is really the abortion bans that have been ramrodded through state legislatures. And 63% of all abortions in the US are self-administered through medication such as mifepristone and misoprostol. Even before the Dobbs decision, the rule from the FDA allowed these medications to be distributed by mail.

Some people don’t appreciate that and they are throwing anything and everything at the rule and the FDA to stop it.

We have been living this for 2 years. They utilized much of the same constant approaches against Roe v Wade and we all know that sometimes shit sticks.

This last filing is a doozy and apparently pregnant teenagers are the “property of the state”. This is from the state of Texas. And the state of Missouri, as a second complainant, thinks it is the duty of a pregnant woman in Missouri to have the baby. You know, to make more taxpayers.

As I’ve been writing about it is about money and control.

But from the complaint itself being able to obtain abortion drugs “has caused abortions for women in the Plaintiff Stats and decreased births in Plaintiff States. This is a sovereign injury to the state itself… a loss of potential population causes further injuries as well: the States’ subsequent “diminishment of political representation” and “loss of federal funds” such as potentially “losing a seat in Congress or qualifying for less federal funding if their populations are” reduced or their increase diminished.”

What the actual fuck!

They’ve tipped their hand.

This is it; the entire reason for this bullshit. For the stripping of bodily rights from the women.

Men see women as nothing more than possessions. This includes the output of our uteruses. To their mind, they OWN us and any output our uteri might supply. And how dare we have a sense of our own and thoughts and aspirations of our own! To think that we are people.

After all, the ENTIRE reason for being a woman is to make a man’s job/life easier.

Or, so they think.

I saw this mentioned in an Esquire article and confirmed it with a CNN article and I am appalled. And disgusted. And unsurprised

Everyone needs to know about this.

Women need to know about this.

As a reminder, Missouri has a state constitutional amendment about the Right to Reproductive Freedom on the ballot in 15 days.

Just saying.

Post-it Sunday 10/20/14-hoarding

The gown card reads “Hoarding is not a good look and leads to panic.”

Yes, this is an operating room topic that I’ve written about before.

Yes, this is something that is happening in the real world right now because of hurricanes.

Yes, I am a bit late covering this for the hurricanes. Gee, Kate, Helene, and Milton were like TEN days ago. What? I live in North Carolina and I’ve been busy.

To be explicit, I’ve been busy with school, not with horrific water damage.

Hoarding is what happens when the OR fears that there won’t be a piece of equipment, a surgical supply, or a certain instrument(s) available for their case.

Instead of considering the entire picture of the surgery schedule and the fact that the case that needs X isn’t until late afternoon, with plenty of time to turn it over, they take X and hide it.

I am talking about any number of things in the operating room. An irrigation machine, a video tower, everyone’s FAVORITE C-arm, a battery, it can be any number of things. Most egregious is when the room doesn’t even need it for any of their cases but squirrels it away so 1) no one else can have it or 2) they can look like a hero to their doctor who might (emphasis on might) need it.

This is problematic for a variety of reasons.

It breaks trust in the department.

It makes it look like the department urgently needs a supply. It doesn’t, the supply is in a drawer in a room, location known only to the person who put it there. And maybe their work bestie. You now, for days they are not there.

The team members in question are greedy and desperate to be the hero when THEIR surgeon needs X and they abra cadabra produce it.

This is just as big of a problem as it is in the real world.

In the real world, I am talking about toilet paper.

Of course, I am.

The same reasons apply.

People are afraid that they won’t have it in case of emergency. Or what they think is an emergency or because Debbie Down the Street has it and I need it. ‘ll buy it ALL up and I will have it all. I will corner the market in tissue paper.

Just don’t. You have enough toilet paper, water, canned goods, etc. Leave some for people who really need it.

Did covid hoarding teach us nothing?

School Me Saturday- Poll me once?

In today’s special edition of school me Saturday I want to talk about polls.

Not poll numbers.

But poll questions.

Last semester one of my classes was about measurement. How to take it, and, more importantly, how to make sure the tools and questions were of quality.

Because there are such things as validity and reliability.

For this school me Saturday we are going to take validity: does the question really ask what you think it is asking.

The loose definition of validity is how well the question reflects a true finding among those asked. They use this to correlate with those outside of the poll.

The loose definition of reliability is how well the poll question reflects what can be replicated with another person taking the poll.

What prompted this topic was the ONE time I participated in a poll about this 2024 general election and how poorly written the questions were.

They asked me general questions about who I anticipated voting for and my general feeling about the election.

And then, after they found out I was not playing about voting straight party Democrat ticket, they threw some BS information out about the Democratic candidate and asked if I was still going to vote for them. When I said that I would rather vote for the Democrat, they pushed me, hard. I stated that bodily autonomy was so important to me that I didn’t care what crap they bought up about the candidate.

And they hung up on me.

Frankly, the entire encounter left me with such a bad taste in my mouth that I’ve declined all calls since.

It has been a LONG time since I was in journalism class but even I can spot when they are leading the interviewee the answer in the way that they wanted me to answer.

Obviously, they don’t know me.

The takeaway is that if you do answer the phone and talk to a pollster be honest. But also pay attention to their questions and how they are given.

And make sure that you get the name of the company taking the poll. A lot can be figured out by a quick Google.

If you do the quick Google, consider if you even want to talk to the pollster.

If you do talk to them pay very close attention to the questions and how they make you feel.

Before you ask, I do believe in polling.

Just not in answering my phone.