Clinical mistakes.....

[ventana]

using more LET (lido eppi tetra) on a guaze pad and soak for up to 30 min prior to suture..... really does work

BUT you have to wait till the skin blanches (30+Min) but the amount of pain free pain relief is great!

[DogLovingPA]

If that was the biggest "mistake" you made all day - that's still a good day.  As others have said, nothing to sweat over. 

 

Our UC will also do an initial evaluation on anyone that checks in.  Rarely we no charge them, but sometimes it is worth doing a couple things on someone who still clearly needs the ER.  For example, 2 days ago I had a 75 yo check in for chest tightness, arm tingling, diaphoresis and nausea.  He thought it was from being outside in the heat.  After a very quick H&P and exam - I told him that I was going to call 911, get an EKG and put an IV in his arm.  EKG showed an inferior STEMI.  I called the ER and ER doc had cardiologist paged and cath lab notified while EMS was still packaging the guy.  Sure... maybe only made a 10 minute difference.... but I'm not going to sit there and twiddle my thumbs while I wait for medics to show up. 

[GetMeOuttaThisMess]

I found it more effective if placed into the wound and not on the surface. Talking lacs and not I&D obviously.

[BruceBanner]

Very minor error. The important thing is you caught it. Always good to tell your SP too; it shows accountability and doesn't look like you are trying to cover it up, which would be 10 x worse.

 

Even the sharpest providers will make mistakes if enough pressure is applied. You can only juggle so many things at once.

[medic25]

using more LET (lido eppi tetra) on a guaze pad and soak for up to 30 min prior to suture..... really does work

BUT you have to wait till the skin blanches (30+Min) but the amount of pain free pain relief is great!

 

LET is great for an open wound; I'll typically paint the inside of the wound with a cotton swab then insert a saturated cotton ball (seems to wick less than gauze).  After 15 minutes, I remove it and repeat.  The second application really seems to have upped the efficacy for me (YMMV).

 

For intact skin such as an abscess, EMLA or LMX cream are an option to topicalize things a little.  If very painful I'll sometimes give a couple of percocet beforehand, then try and apply a good field block before injecting anything directly over the abscess.

[Reality Check 2]

Very minor error. The important thing is you caught it. Always good to tell your SP too; it shows accountability and doesn't look like you are trying to cover it up, which would be 10 x worse.

 

Even the sharpest providers will make mistakes if enough pressure is applied. You can only juggle so many things at once.

 

My thoughts to new grads along this line would also be - DO NOT BECOME RELIANT ON THE EMR.

I always ask patients about allergies myself because I have found consistent inconsistencies in the EMR.

I would never want to use something on the patient that makes the situation worse such as a topical betadine reaction or a true NSAID allergy/reaction to Toradol or Percocet. Not much really happening with lidocaine in my experience but I always try to verbalize and confirm with the patient that "nothing has ever reacted when put on your skin, correct?"

 

I have put small wipe off boards on the outside of exam doors - no protected info on them - but I use them as a checklist of what needs to be done and to keep others informed of what is happening. I know they get put in EMRs as orders but I am old and like visual reminders......

 

Such as - Peak Flow (PF) x 3, duoneb, repeat PF and O2 sat

or

Local at 09:20

Plan 4-0 Ethilon after irrigation

or

xray

tdap

wound care

 

It doesn't reveal anything protected about the patient and ours are where only the staff can see them with patients going out the other door of the room. So, it works.

[cbrsmurf]

Back on topic...

 

That's a policy that has "we want to maximize profit" written all over it.  I'm all in favor of evaluating and treating in cases where it's questionable whether any care can be effectively rendered at the current level of care, but let's not forget that holding on to patients who belong elsewhere... kills them.

 

http://archsurg.jamanetwork.com/article.aspx?articleid=1828520&resultclick=1

 

You should take in most emergent pts in a UC and have a provider assess.  If it was like to SOB case OP had, OP needs to assess.  The clinic should be able to charge for patient since OP is the one making the triage and immediate management decision he is trained to do.