INFORMATION ABOUT YOUR CLIENT
ON YOUR ACTIVITY SHEET.

SO YOU CAN WALK AROUND
WITHOUT HAVING TO HAVE

THE CHART ATTACHED TO
YOU AT ALL TIMES,

BECAUSE WE CAN'T,
OTHER PEOPLE NEED IT.

SO YOU'VE GOT TO HAVE A
MECHANISM OF GATHERING
INFORMATION.

AND WHEN YOU GATHERED
INFORMATION ABOUT MEDICATIONS,

YOU WENT TO THE MEDICATION
ADMINISTRATION RECORD

TO SEE WHEN THOSE
MEDICATIONS WERE DUE.

SO YOU HOPEFULLY, FOUND THEM
IN THE MED BOOK.

YOU SAW THAT THESE
PARTICULAR MEDS,

THE ROUTINE MEDS, WERE DUE
AT EIGHT AND AT TWO.

WE'RE GOING TO BE GIVING
THE EIGHT O'CLOCK MEDS
FOR OUR ACTIVITY.

SO WHETHER YOU COME IN AT 10:30
OR 9:15, YOU'RE GIVING
EIGHT O'CLOCK MEDS.

SO, DRAMA CLASS, IT'S
EIGHT O'CLOCK WHEN YOU ARRIVE.

ALRIGHT. SO WE HAVE A PLAN.
IT'S EIGHT O'CLOCK AND
WE'RE GETTING READY.

RIGHT NOW I'M IN THE MED ROOM.

YOU ARE GOING TO BE IN
YOUR LOWER PREP ROOM
OVER HERE IN 182,

GETTING ALL OF YOUR
SUPPLIES READY.

IN FACT, I'M NOT GOING TO CHECK
YOU OFF ON GETTING READY.

YOU'RE GOING TO GET
YOUR STUFF READY,

I'M GOING TO CHECK YOU OFF
AS TO WHAT YOU HAVE.

AND THAT'S WHAT HAPPENS PRETTY
MUCH IN THE NURSING FLOORS.

YOUR INSTRUCTORS WILL SAY,
"GO GET YOUR MEDS,
GO GET YOUR MAR."

AND THEN THEY CHECK IT
WHEN YOU COME BACK WITH IT,

BECAUSE WE DON'T HAVE TIME
TO WATCH EVERYBODY DO
EVERY LITTLE THING.

ALRIGHT, WHEN YOU GET READY
TO GIVE MEDS, WE WANT TO
KEEP THREE THINGS IN MIND.

YOUR SIX RIGHTS,
YOU ALREADY KNOW THEM.

SO WE'LL BE CHECKING OUR ORDER
TO MAKE SURE THAT WE HAVE
ALL THE INFORMATION,

AND WE'RE COMPLIANT
WITH THE SIX RIGHTS.

BUT WE ALSO WANT TO DO ONE
OTHER THING, AND THAT'S
THE THREE CHECKS.

WE'RE GOING TO CHECK OUR
MEDICATION THREE TIMES,

TO MAKE SURE WE'VE GOT
THE RIGHT ONE.

OUR GOAL HERE IS TO
HELP THE CLIENT,

AND NOT TO GIVE THEM ANYTHING
WRONG, AND NOT TO MAKE ANY
MEDICATION ERRORS.

SO WE GET A LITTLE
ANAL-ATTENTIVE, IF
YOU WILL, ON THIS.

BUT IT'S IMPORTANT SO THAT
WE DON'T MAKE ERRORS.

AND THAT'S WHAT WE'RE
GOING TO DO.

SO, WHEN YOU GET YOUR
MEDICATION ADMINISTRATION
RECORD, IT LOOKS JUST LIKE THIS.

THIS IS ST AGNES', BELIEVE.

YOU CAN TAKE IT OUT
OF THE CHART.

JUST THE SHEET YOU NEED, DON'T
TAKE A BUNCH OF EXTRA STUFF.

AND WHAT YOU WANT TO DO
IS YOU WANT TO START

SYSTEMATICALLY LOOKING AT
YOUR SHEET AND CHECKING IT.

ALWAYS START FROM THE TOP AND GO
DOWN LOOKING AT THE TIMES

TO MAKE SURE THAT YOU'VE GOT ALL
THE MEDS YOU THINK YOU WERE
SUPPOSED TO HAVE.

THINGS COULD HAVE BEEN ADDED OR
YOU MAY HAVE MISSED A TIME WHEN
YOU DID YOUR LITTLE SHEET.

SO WE ALWAYS JUST CHECK FROM
THE TOP TO THE BOTTOM.

PRETTY STRAIGHT FORWARD, WE ONLY
HAVE TWO MEDS AND TWO ON HERE.

BUT I'M GOING TO START HERE
AND REALIZE THAT I HAVE
CONRAD CURRY.

DR. I AM SMART, I WANT TO NOTE
THAT THIS CLIENT HAS ALLERGIES

BEFORE I EVER REALLY GET GOING
TO MAKE SURE THAT ANYTHING
I AM GIVING

IS OKAY WITH HIS
ALLERGY SITUATION.

AND I'M KIND OF CAUTIONED
STRAIGHTAWAY WHEN LOOK AT LASIX.

BECAUSE WE KNOW THAT LASIX HAS A
CONTRAINDICATION RELATED TO --

- SULFA.
- SULFONAMIDES.

SO IF THAT WERE THE CASE,
THERE'S TWO THINGS I WANT TO DO.

FIRST IS, I WANT TO CHECK WITH
MY CLIENT TO SEE WHAT HE
THINKS AN ALLERGY IS.

THERE ARE SIDE EFFECTS
AND THERE ARE ALLERGIES,

AND THEY ARE TWO
DIFFERENT THINGS.

FOR EXAMPLE, I MIGHT SAY ON MY
RECORD I'M ALLERGIC TO CODEINE.

I'M REALLY NOT.

IT MAKES ME THROW UP,

BUT I'M NOT ALLERGIC TO IT.

I JUST DON'T TAKE IT WELL.

THE SAME THING MAY BE FOR LASIX.

I NEED TO FIND OUT WHAT HAPPENS
WHEN YOU TAKE IT.

OH, I GET A RASH,
I HAVE SHORTNESS OF BREATH,

I GET THIS BUTTERFLY
REDNESS ACROSS MY NOSE.

OH, THAT'S NOT GOOD.
YOU'RE ALLERGIC TO IT.

SO YOU'RE LOOKING AT THINGS THAT
ARE DISTINGUISHABLE

BETWEEN AN ALLERGIC REACTION AND
JUST A SIDE EFFECT OF THE DRUG,

BECAUSE WE CAN GIVE SOMETHING
FOR NAUSEA, IF THEY
NEED THE DRUG.

BUT ALLERGY, THAT'S NOT
A GOOD THING.

WE DON'T WANT TO MAKE IT WORSE,
AND SOMETIMES, THE MORE MEDS YOU
GIVE, THE WORSE IT CAN GET,

AND WE DON'T WANT ANY
ANAPHYLAXIS HAPPENING, WHICH IS?

- STOP BREATHING.
- STOP BREATHING. BAD SHAPE.

ALRIGHT, SO WE GO ASK HIM.
ONCE WE'VE VERIFIED THAT
IT IS AN ALLERGY

OR WE'RE PRETTY SURE WE'RE NOT
COMFORTABLE GIVING IT,

THAT'S WHEN I WOULD
CALL THE DOCTOR.

BUT YOU DON'T WANT TO -- EVEN
WHEN YOU'RE TEST TAKING,

ALWAYS PICK THAT ANSWER THAT
SAYS, "CALL THE DOCTOR."

YOU DO WHAT YOU COULD DO FIRST.

AND THEN YOU DECIDE WHEN THE
DOCTOR NEEDS TO BE CALLED.

SO OUR FIRST THING IS TO
MAKE AN ASSESSMENT,

WHAT HAPPENS WHEN YOU TAKE IT?

ALRIGHT, SO MY CLIENT SAYS,
HE GETS NAUSEATED,
AND WE'RE OKAY.

SO I'M LOOKING AT MY DRUGS
HERE. I NEED TO GIVE LASIX
AT EIGHT O'CLOCK.

MY DRUG ORDER IS COMPLETE. WHAT
DO YOU NEED IN A DRUG ORDER?

A DRUG. SO WE NEED TO BE LOOKING
TO SEE WE HAVE THE RIGHT DRUG.

WE NEED A DOSE, YOU
CAN'T JUST MAKE IT UP.

YOU HAVE TO HAVE A ROUTE,
AND WE WANT TO BE COMPLIANT
WITH THE ROUTE,

AND WE HAVE TO HAVE A TIME.

AND THAT'S MINIMUM FROM WHAT THE
DOCTOR HAS TO ORDER FOR US.

WE'RE GOING TO MAKE SURE THAT
ALL THOSE THINGS HAPPEN RIGHTLY,

AS WELL AS IDENTIFYING OUR
CLIENT WHEN WE GET IN THERE,

GIVING IT CORRECTLY
AND THEN DOCUMENTING IT
CORRECTLY WHEN WE'RE THERE.

SO MY ORDERS ARE COMPLETE.
I'M PLEASED WITH THAT.

THE NEXT THING I WANT TO DO IS
SIMPLY GO TO MY MEDICATION CART.

WE'RE GOING TO BE SIMULATING
A UNIT DOSE SCENARIO

WHICH IS SIMILAR TO
THE HOSPITALS.

AND THE TRICK ABOUT TEACHING
MEDICATIONS IS,

I NEED TO TEACH YOU THEORY,
BUT EVERY HOSPITAL DOES IT
A DIFFERENT WAY.

FOR EXAMPLE, THOSE OF YOU
THAT ARE AT THE V.A.,

THEY USE BARCODE SYSTEMS TO
GET INTO THEIR DRUGS.

AND THEY HAVE A LITTLE WAND
HERE ON THE MED CART.

AND THEY WAND THE DRAWER AND GET
THEIR DRUGS OUT,

AND THEY WAND THE DRUGS,
AND EVERYTHING READING
THOSE BARCODES.

LIKE THEY HAVE IN THE
SUPERMARKET THAT TELLS
THEM THAT IT'S THE RIGHT DRUG.

AND IT ELECTRONICALLY
DOCUMENTS IT,

AND THEN WHEN THEY GO IN TO
THE CLIENT, THEY WAND
THEIR NAME BAND

BECAUSE THEIR NAME BAND HAS
A BARCODE, AND THEN THEY
WAND THE DRUG.

AND WHEN IT ALL MATCHES,
YOU GET TO GIVE THE MED.

WE'RE DOING THE
SAME THING MANUALLY.

MOST OF THE SYSTEMS IN THE
HOSPITALS HAVE A PICSYS SYSTEM

WHICH IS AN ELECTRONIC SYSTEM,
BUT IT'S STILL A HARD COPY
PAPER SYSTEM.

SO YOU STILL HAVE TO GET IN,
AND IT'S A UNIT DOSE SYSTEM
INTO DRAWERS.

BUT IT'S ELECTRONICALLY
CALCULATED, IF YOU WILL.

AND THE DRAWERS ARE
ELECTRONICALLY MANAGED.

SO WHATEVER THEIR SYSTEM IS,
THEY'RE STILL DOING
THE SAME THINGS.

THEY HAVE TO HAVE COMPLETE
ORDERS, AND YOU HAVE TO CHECK IT
THREE TIMES,

EVEN ELECTRONICALLY TO
GIVE THE RIGHT MEDS.

SO, WE'RE GOING TO JUST DO IT
MANUALLY, BECAUSE I DON'T
HAVE ALL THOSE SYSTEMS.

BUT YOU'LL SEE THAT IT
ALL PLAYS OUT THE SAME,
WHEREVER YOU'RE WORKING.

ALRIGHT, THE FIRST THING I WANT
TO DO, I WANT TO EXPLAIN
THE MED DRAWERS HERE.

WHEN YOU SEE CARTS LIKE THIS,

JOINT COMMISSION REQUIRES THAT
WE KEEP THE MED CARTS LOCKED.

THEY CAN'T JUST BE SITTING OUT
IN THE HOSPITAL, IN THE
HALLWAY LIKE THIS.

- THERE'S SOMETHING ON IT.
- UH-HUH. AND THEY'RE NOT
SUPPOSED TO BE IN IT.

IF OSHA CAME THROUGH, AND IF
THE JOINT COMMISSION AND THE
REGULATING BODIES COME THROUGH,

THEY GET FINED OR THEY GET
CITED, BECAUSE IT'S
NOT SAFE PRACTICE.

ANYONE COULD GRAB INTO
A DRAWER AND CAN GET
WHATEVER THEY WANTED.

I MEAN, MOST PEOPLE DON'T,
BUT YOU KNOW WHAT I'M SAYING.

AND SO FROM A SAFETY POINT OF
VIEW, THESE NEED TO BE LOCKED.

SO THIS ONE IS LOCKED
BY A KEY ON THE SIDE.

AND THEN MY NARCOTICS CABINET,
I REALLY DO HAVE LOCKED.

OKAY, AND WE'RE GOING TO
GET TO NARCOTICS LATER.

BUT RIGHT NOW, THIS IS OUR MED
DRAWER AND I'M NOT GOING TO KEEP
IT LOCKED,

FOR ONE, IT'S JUST THE KEYS GET
ALL DISCOMBOBULATED AROUND HERE.

SO THIS NEEDS TO BE LOCKED
BETWEEN MED ADMINISTRATIONS,

AND IT NEEDS TO BE
LOCKED IN THE ROOMS.

NOW IF THE NURSE IS GIVING
MEDS, AND SHE'S GIVING
A WHOLE BUNCH OF THEM,

SHE USUALLY DOESN'T LOCK IT
BETWEEN EVERY SINGLE ONE,

BUT AFTER MED ADMINISTRATION,
THEN SHE LOCKS IT.

ALRIGHT, I NEED TO GET CONRAD
CURRY'S CARD OR DRUG DRAWER.

YOU CAN SEE THAT WE HAVE
THREE FOR EVERY CLIENT.

I HAVE SALLY SMITH, BETTY JONES,
ALAN SMITH AND SO FORTH.

SO, JUST GET A DRAWER THAT YOU
NEED. WE JUST MAKE DUPLICATES
COS WE GOT LOTS OF YOU.

AND THERE YOU HAVE IT.

ALRIGHT, ONCE I HAVE MY --

MY LITTLE DRAWER, I CAN
MOVE THIS STUFF ASIDE FOR NOW.

AND WHAT I WANT TO DO IS
GET MYSELF A TRAY.

AND I WANT TO GET MYSELF
A CUP SO THAT I CAN BEGIN
TO HUNT FOR MY MEDS,

AND PUT MY MEDS INTO
A MEDICATION CUP.

SO, THAT'S WHAT WE'RE GOING
TO DO, NOT TOO DIFFICULT.

I'M DIGGING THROUGH
MY DRAWER, I'M LOOKING
FOR LASIX 40 MILLIGRAMS,

I HAVE LASIX 40 MILLIGRAMS,
THIS IS MY FIRST CHECK.

LASIX 40, LASIX 40 PO, IT'S A
PILL. I PUT IT IN MY CUP.

ALRIGHT, THE NEXT THING I NEED,
I'M GOING TO GO ON DOWN MY LIST

IS POTASSIUM 10%,
40 MIL EQUIVALENTS PO.

SO I DIG AND I DIG AND I DIG,
AND THERE'S NO PILLS.

SO NOW MAYBE I SHOULD LOOK
AT THESE BOTTLES.

OH, I HAVE IT IN A LIQUID FORM.

OKAY, YOU DIDN'T KNOW THAT
WHEN YOU WERE GETTING
YOUR DRUG CARTS READY.

SO YOU'RE GOING TO HAVE A
LITTLE BIT MORE TO ADD
TO YOUR DRUG CARTS

BUT YOU KNOW ENOUGH
ABOUT POTASSIUM

THAT WE'LL BE ABLE TO DISCUSS
A LITTLE FURTHER HERE.

ALRIGHT, IT SAYS I NEED
POTASSIUM 10%, 40 MIL
EQUIVALENTS PO BID.

THIS SAYS, I HAVE POTASSIUM
10 MIL EQUIVALENTS 10%,

10 MIL EQUIVALENTS
PER 5 MILLILITERS.

HOW MUCH DO I NEED?

I NEED TO GET 40 MIL EQUIVALENTS
AND I HAVE 10 PER 5.

- 20 MILLILITERS.
- 20 MILLILITERS, OKAY.

NO TRICKS, BUT YOU GUYS NEED
TO GET INTO YOUR DRAWERS
AND MAKE SURE

THAT YOU'VE ALREADY
PRE-CALCULATED WHAT YOU
NEED TO GIVE THE RIGHT DOSE.

ALRIGHT, I'M GOING TO GO AHEAD
AND LOOK AT MY BOTTLE

AND MAKE SURE THAT THIS
HASN'T EXPIRED YET.

AND SO MY EXPIRATION DATE IS
GOOD, EVERYTHING LOOKS
FINE ABOUT THIS.

NOW I NEED A MEASURING CUP.

THESE MEASURING CUPS ARE ONLY
GOOD TO THE 5 CENTIMETERS.

CENTIMETERS, NO. 5 MILLILITERS
OR CUBIC CENTIMETERS.
THEY'RE THE SAME.

SO IF I HAD A DRUG THAT
WAS SEVEN OR EIGHT OR
TWELVE MILLILITERS,

THEN I'D HAVE TO GET A SYRINGE
TO DRAW IT UP AND THEN I COULD
SQUIRT IT INTO THE CUP.

BUT I'M OKAY WITH 20.

SO WHAT I WANT TO DO IS POUR IT
TO THE 20 MILLILITER LINE
ONCE I FIND IT.

WHEN YOU DO A LIQUID MED,
YOU WANT TO TAKE THE CUP
OR THE JAR,

AND YOU WANT TO HOLD IT WITH
THE LABEL IN YOUR HAND

SO THAT WHEN YOU POUR,
IF IT DRIBBLES DOWN,

IT DRIBBLES TO THE BACK OF
THE JAR AND IT DOESN'T
OBSCURE THE LABEL.

THEN YOU ALSO WANT TO GET DOWN
HERE AND BE AT EYE LEVEL
WITH THE 20 MILLILITERS.

ALRIGHT, AND THEN YOU JUST POUR
IT IN TO THE 20 MILLILITER LINE.

ONE OTHER LITTLE THING IS
HAPPENING WHILE I'M POURING,

AND THAT IS, I'M CREATING
A LITTLE BIT OF A MENISCUS.
WHAT'S A MENISCUS?

- BASICALLY THAT...
- OTHER WAY.

THE LITTLE -- THE LITTLE DIP
THAT GOES THIS WAY
IN YOUR LIQUIDS.

IT'S HOW IT HOLDS ON TO
THE CONTAINERS.

AND SO WHEN YOU'RE MEASURING
THAT DIP THAT HAPPENS,

YOU WANT TO MEASURE YOUR DRUG
TO THE BOTTOM OF THE DIP NOT
TO THE SIDES OF THE EDGES.

BUT IT'S NOT MUCH, IT'S NOT VERY
PRONOUNCED IN THERE

ESPECIALLY WITH THIS
PARTICULAR VOLUME.

BUT SOMETIMES YOU CAN SEE IT A
LITTLE MORE PRONOUNCED WITH
CERTAIN VISCOSITIES OF DRUGS,

AND SO YOU WANT TO MEASURE
RIGHT TO THE BASE OF THAT.

ALRIGHT, WELL,
THERE WE HAVE IT.

I HAVE SOME LASIX AND I HAVE
SOME POTASSIUM, I BELIEVE.

SO NOW I WANT TO MAKE
MY SECOND CHECK.

NOW THAT THEY'RE OUT OF THE
DRAWER AND READY AND I
WANT TO LOOK AT THEM,

AND I'M GOING TO BE MAKING
MY SECOND CHECK.

AND I'M GOING TO BE THINKING
IS THIS DOSE SAFE,
40 MILLIGRAMS?

YES, IT IS LASIX AND IT
DOES MEET THE PARAMETERS
OF ADMINISTRATION FOR LASIX.

I'M HAPPY ABOUT THAT.
THIS IS POTASSIUM.

AND NO ONE WOULD KNOW
IT'S POTASSIUM, EXCEPT
IF I TOLD THEM, RIGHT?

BECAUSE IT'S IN AN
UNLABELED CONTAINER.

SO I THINK I BETTER
DO SOMETHING ABOUT THIS.

SO I HAVE A LITTLE
PAPER TAPE HERE.

AND I'M GOING TO TAKE A LITTLE
PIECE OF PAPER TAPE
AND MY PEN.

AND I'M JUST GOING TO
WRITE THAT I HAVE KCL
10% 40 MIL EQUIVALENTS.

I'M NOT GOING TO WRITE 20
MILLILITERS COS I CAN
READ THAT ON THERE.

BUT AT LEAST IT TELLS ME
WHAT I'VE GOT GOING IN THIS
PARTICULAR JAR OR LITTLE CUP.

ALRIGHT, I'M GOING TO DOUBLE
CHECK AGAINST MY LABEL
THAT THIS IS INDEED

POTASSIUM CHLORIDE 10% 40 MIL
EQUIVALENTS IS WHAT I NEED.

10 MIL EQUIVALENTS IS PER 5,
I MIGHT REDO MY MATH

AND MOST OF THE TIME PHARMACY
WRITES ON THERE,

AND YOU NEED 20 MILLILITERS,
THEY'RE NICE TO US.

BUT I WANT TO DOUBLE CHECK
EVERYTHING. AND THEN I'M HAPPY.

ALRIGHT, I WANT TO BE THINKING
ABOUT MY DOSE ON THIS ONE.

WHAT DO YOU THINK ABOUT THIS
40 MIL EQUIVALENT DOSE,

ACCORDING TO YOUR READING,
AND YOUR DRUG CARTS?

A LITTLE HEFTY, RIGHT?

WHAT DID THEY SAY THAT YOU
SHOULD GIVE FOR A SINGLE DOSE?
NO MORE THAN 20 MIL EQUIVALENTS.

YOU COULD GIVE UP TO 100 MIL
EQUIVALENTS PER DAY RELATED
TO DEPLETION,

BUT 20 MIL EQUIVALENTS IS WHAT'S
RECOMMENDED PER DOSE.

SO WHAT WOULD YOU DO
AT THIS POINT?

- BRING IT TO THE
PHYSICIAN'S ATTENTION.

- NOT FIRST. I DO A LOT OF
THINGS BEFORE I CALL A DOCTOR.

I'VE BEEN YELLED AT ENOUGH IN MY
LIFE. I'VE LOOKED STUPID,
I'VE FELT STUPID.

SO THAT I DO A LOT
OF OTHER THINGS FIRST.
SO, ALWAYS ENTERTAIN.

IS THERE ANYONE ELSE YOU COULD
CALL BEFORE YOU CALL
A PHYSICIAN?

- THE PHARMACY.
- CALL THE PHARMACY?

THEY'RE NICER,
I DON'T KNOW WHY.

BUT CALL THE PHARMACIST AND
SAY, "I SENSE A LITTLE
DISCREPANCY HERE.

MY BOOK SAYS THAT YOU SHOULD
ONLY GIVE 20 MIL EQUIVALENTS
AND THE DOCTOR'S ORDERED 40.

THE CLIENT COMPLAINS OF STOMACH
BEING UPSET. AND WHAT DO YOU
KNOW ABOUT THIS?"

AND THEY'LL SAY, "WELL, THE BOOK
RECOMMENDS THAT YOU ACTUALLY
CAN GIVE UP TO 40

ACCORDING TO MY LITERATURE,
AND MY STUDY.

YOU MIGHT WANT TO CALL THE
DOCTOR AND ASK HIM

IF HE'D LOWER IT TO 20 AND
GIVE IT WITH FOOD BECAUSE
OF THE GI DISTRESS."

OKAY, NOW I'VE GOT SUPPORT
AND I'VE GOT A LITTLE MORE
INFORMATION AND MY BOOK.

WHAT YOU WANT TO DO AT
THAT POINT IS, IN YOUR
NURSE'S NOTES SAY,

"CONTACTED DR. SMITH, PHARMACIST
AND DISCUSSED KCL DOSE.

RECOMMENDS LOWER DOSE FOR CLIENT
RELATED TO GI DISTRESS AND
RECOMMENDED DOSING."

THEN DR. I AM SMART WAS CALLED.

SO DO SOMETHING FIRST IF YOU
CAN, THEN CALL THE PHYSICIAN.

SO NOW, YOU ARE INFORMED
AND YOU DON'T FEEL SO DULL.

BECAUSE IT'S JUST EMBARRASSING
TO GET BEAT UP ABOUT STUFF
LIKE THAT ALL THE TIME.

ALRIGHT, SO, WE'RE GOING TO GO
AHEAD AND GIVE IT AS ORDERED,

JUST BECAUSE THAT'S THE
DRILL AND WE POURED IT,
BUT PROCESS THROUGH.

THROUGHOUT ALL OF MY MED
ADMINISTRATIONS,

I FREQUENTLY MIX IN
SOME DRUGS THAT ARE OFF.

SO DON'T JUST ACCEPT THAT
BECAUSE IT WAS WRITTEN,
IT IS RIGHT.

IT'S NOT THAT WAY OUT IN THE
FIELD, AND IT'S NOT
THAT WAY IN HERE.

SO BE DISCERNING NURSES AND
COMPARE AND HAVE SOME LITERATURE

TO SUPPORT THE DECISION
THAT YOU'RE GOING TO MAKE.

WE'LL DISCUSS IT AT THE BEDSIDE
AND GO, "YOU KNOW, I'D PREFER TO
GIVE 20 MIL EQUIVALENTS."

I'LL CALL THE PHARMACIST,
I'LL CALL THE PHYSICIAN,
AND I'LL GO, "GOOD, GIVE IT."

YOU KNOW, BECAUSE WE WANT
TO GO THROUGH THE OTHER
STEPS AT THE END.

ALRIGHT, AFTER -- UH-HUH?
- WHAT DO YOU DO IF YOU POUR
TOO MUCH OF IT?

- IF YOU POUR TOO MUCH, YOU'RE
NOT SUPPOSED TO POUR IT BACK
INTO THE BOTTLE.

YOU'RE SUPPOSED TO JUST POUR
IT OUT. SO THAT CAN GET
A LITTLE MESSY.

SO IT'S BETTER TO POUR LESS
IF YOU CAN AND THEN UP --
AND THEN WORK IT UP,

AND THEN IF YOU NEED TO POUR
OUT, POUR OUT IN THE SINK.

OKAY, I HAVE THE TWO DRUGS I
NEED. I THINK I'M READY TO GO.

I'M GOING TO PUT THIS BACK HERE.

AND THIS IS WHAT YOU NEED TO
DO AS YOU DO THIS.

AS A NURSE, I WOULD GO GET IT --
I'M GOING TO DO MY THIRD CHECK
AT THE BEDSIDE.

BUT AS A NURSE, YOU WANT TO HAVE
YOUR INSTRUCTOR CHECK IT AND
THEY HAVE TO GO WITH YOU.

SO, YOU'RE GOING TO GET YOUR
MEDS READY IN YOUR --

IN THE THE LITTLE STUDENT ROOM.
THERE'S STILL A COUPLE OF
THINGS, I NEED TO DO.

AND THEN YOU'RE GOING TO COME
LET US AND CHECK IT
FOR A THIRD CHECK.

SO BEFORE YOU COME TO ME,
THERE'S A COUPLE OF THINGS YOU
MIGHT WANT TO DO FOR YOURSELF.

AND THAT IS, I KNOW THAT BECAUSE
I'VE DONE ALL MY READING
ON THESE DRUGS,

THERE ARE SOME THINGS I WANT TO
CHECK ABOUT MY CLIENT, BEFORE I
GIVE THE DRUG, RIGHT?

THERE ARE SOME THINGS YOU WANT
TO KNOW ABOUT YOUR CLIENT
BEFORE YOU GIVE LASIX.

WHAT WERE THOSE THINGS?

WE CHECKED FOR SULFA ALLERGY.

- ELECTROLYTE.
- ELECTROLYTES.

SO, YOU MIGHT CHECK THAT
WITH THE CHART. WHAT ELSE?

- HYDRATION.
- HYDRATION, HYPOTENSION.

- HYPO-BULIMIA.
- THAT'S LAB STILL,
SO WE CAN CHECK THE LABS.

THE CLIENT, WE WANT PULSE
AND BLOOD PRESSURE BEFORE
WE GIVE THIS DRUG.

HOW LONG DOES IT TAKE
THIS DRUG TO WORK?

ABOUT 45 MINUTES,
THAT'S WHAT IT'S --

LOOK IN YOUR BOOK FOR THE ONSET
PEAK AND DURATION OF YOUR DRUGS.

I DIDN'T HAVE YOU DO
THAT QUITE YET

AND YOU'RE GOING TO REALLY HONE
IN ON THAT A LITTLE MORE
IN PHARMACOLOGY,

BUT IT TAKES ABOUT 45 MINUTES
FOR A PO MED TO START WORKING
TO UP TO AN HOUR.

SO, WE HAVE A LITTLE TIME.

BUT WE WANT TO GET VITAL SIGNS
BEFORE AND THEN TELL OUR CLIENT
WHAT TO EXPECT FROM THIS DRUG.

SO ONE OF THE THINGS I'VE
DISCOVERED, WHEN I GO
INTO A CLIENT'S ROOM

IS THAT THEY JUST ARE READY
FOR A NURSE TO COME IN.

AND AS SOON AS YOU GET THERE,
THEY HAVE A MILLION QUESTIONS.

"GET ME THE TV, HELP ME TO THE
BATHROOM, CAN YOU GET ME A
BLANKET, I'D LIKE SOME JUICE."

AND THEN THEY JUST START HITTING
ME WITH ALL THESE QUESTIONS.

AND IT'S VERY EASY TO GET
DISTRACTED WHEN YOU'RE
IN THE ROOM.

SO IF YOU GIVE YOURSELF SOME
CUES ON YOUR LITTLE CUP,
IT WILL REMIND YOU

THAT I NEED TO GET A PULSE AND
I NEED TO GET A BP BEFORE
I GIVE THIS DRUG.

SO GIVE YOURSELVES SOME
CUES SO THAT YOU DON'T
GET DISTRACTED.

WITH POTASSIUM, IS THERE
ANYTHING I WANT TO DO
REALLY BEFORE?

WHY AM I GIVING
POTASSIUM ANYWAYS?

- COMPENSATING FOR THE LIQUID
WE'VE LOST FROM [INDISTINCT].

- YES. IS THERE ANYTHING I NEED
TO CHECK IN PARTICULAR
WITH THE CLIENT?

I MEAN, I'M GOING TO
CHECK LAB WORK.

NOT REALLY. BUT WHAT DO YOU
THINK ABOUT GIVING THESE MEDS?

DID YOU NOTICE THAT WHEN
YOU GIVE THEM, THAT THERE'S
CRITERIA FOR HOW TO GIVE THEM.

DO YOU GIVE THIS ON
AN EMPTY STOMACH OR WITH FOOD?

- WITH FOOD.
- THIS ONE WAS WITH FOOD.

YOU DIDN'T HAVE MUCH CRITERIA
FOR YOUR POTASSIUM, YOU DIDN'T
KNOW IT WAS LIQUID.

HOW DO YOU GIVE A LIQUID?
DO YOU JUST TAKE IT STRAIGHT?

DO YOU DILUTE IT?
WITH FOOD OR WITHOUT?

- MIX IT AND PUT IT IN
SOME KIND OF JUICE.

- YES, PUT IT IN JUICE.
THIS STUFF IS JUST NOT TASTY.

IT'S PRETTY STRONG AND SO
WE'RE GOING TO WANT
TO DILUTE IT.

SO, I'VE SET MYSELF A LITTLE CUP
HERE. I THOUGHT I DID.

A CUP. AND BEFORE I GO
TO THE CLIENT'S ROOM,

I MIGHT ASK THEM OR I'LL GO IN
AND ASK THEM" WHAT KIND OF JUICE
DO YOU WANT ME TO PUT THIS IN?"

A LOT OF THEM LIKE CRANBERRY
JUICE COS THIS IS A
LITTLE BITTER

AND SO IF YOU PUT IT IN BITTER
DOESN'T SEEM SO BAD.

A LOT LIKE APPLE JUICE BECAUSE
THEN IT'S A LITTLE SWEETER
COS THAT'S SOUR.

SO WHATEVER, DOESN'T MATTER.
ORANGE JUICE, FINE, WHATEVER.

AS LONG AS IT COMPLIES
WITH THEIR DIET.

ALRIGHT, WHAT WAS OUR DIET?
THE CLIENT'S DIET?

- LOW SODIUM.
- REGULAR, LOW SODIUM.

SO THEN YOU NEED TO BE CAREFUL
ABOUT SOME OF YOUR JUICES
LIKE TOMATO JUICE.

THAT'S TOO SALTY, BUT PICK
SOMETHING APPROPRIATE.

AND THEN WE'LL BE READY
TO POUR IT IN.

ALRIGHT, I BELIEVE FINALLY,
I'M READY TO GO.

SO, I SHOULD HAVE MENTIONED --
DARN, JUST TAKE A POINT OFF --

THAT I WASHED MY HANDS PRIOR TO
GETTING MY MEDS READY.

YOU WOULDN'T WANT TO DO THIS
WITH DIRTY HANDS.

AND THEN I'LL DO MY HIGH FIVE
WHEN I GET INTO THE ROOM.

THEN NEXT THING YOU WANT TO DO
IS CHECK WITH YOUR INSTRUCTOR.

SO YOU GOT ALL YOUR MEDS READY,
YOU HAVE EVERYTHING READY TO
COME CHECK WITH YOUR INSTRUCTOR.

AND THIS IS WHAT YOUR
TRAY SHOULD LOOK LIKE.

YOU HAVE A CUP THAT'S GOT YOUR
PARAMETERS MARKED ON IT.

YOU HAVE YOUR DRUG,
DON'T UNWRAP IT.

WHY WOULD YOU NOT UNWRAP IT?

- BECAUSE, YOU MIGHT
FORGET WHAT IT IS.

- YOU MIGHT FORGET WHAT IT IS.

- SOMEONE ELSE MIGHT NOT KNOW.
- SOMEONE ELSE MIGHT NOT KNOW.

- IF YOU HAVE MORE THAN ONE --

- HE MIGHT REFUSE IT, THEN WHAT
DO YOU DO WITH THE DRUG?

AND THIS IS MY FAVORITE, I MIGHT
HAVE A SPAZ AND LOSE IT.

AND YOU JUST BE SURPRISED
WHERE A SPAZ - IT FALLS IN.

I WAS WALKING DOWN THE HALL ONE
DAY, I HAD ALL MY STUFF.

AND THIS DOCTOR CAME OUT OF
THIS DOOR THAT THEY WERE
NOT SUPPOSED TO COME OUT.

AND I RAN SMACK INTO THE DOOR,
AND HE LOOKED AT ME AND GOES,
"I'M REALLY SORRY."

ME TOO, WHOA! I FELT LIKE
I WAS IN A CARTOON.

YOU NEVER KNOW WHAT'S GOING TO
HAPPEN. SO, KEEP EVERYTHING
IN ITS CONTAINER.

AND FINALLY, HOW DO YOU DO YOUR
THIRD CHECK AT THE BEDSIDE IF
YOU DON'T KNOW WHAT IT IS.

SO, YOU KEEP EVERYTHING
WRAPPED UP AND YOU OPEN
IT AT THE BEDSIDE.

ALRIGHT, SO I GOT MY MEDS. THEN
YOU'RE GOING TO COME TO ME
WITH YOUR DRUGS.

AND I'M GOING TO TAKE YOUR
MAR AND I'M GOING TO TAKE
THE DRUGS, AND I'M GOING TO GO,

"OKAY, YOU HAVE LASIX 40,
LASIX 40 AND POTASSIUM."

I HAVE TO SEE THIS TO
KNOW THAT THIS IS OKAY.

SO DON'T JUST BRING ME A
CUP OF KOOL-AID HERE.

OKAY, IT'S GOT TO MATCH UP.
SO, I'LL COMPARE THESE
AND GO, "OKAY. OKAY."

AND THEN I WILL LOOK AT YOU
AND I'LL HAND YOU THIS.

AND YOU'LL HAVE YOUR MED CARDS,
AND YOUR ACTIVITY SHEET
AND I'LL GO,

"SO WHY IS YOUR CLIENT
GETTING LASIX?"

AND YOU'LL GO,
"BECAUSE HE'S GOT CHF."
"WHAT DOES IT DO?"

"WELL, IT HELPS THEM NOT ABSORB
THE SODIUM ANYMORE,

RETAIN IT AND SO THEY -- IT'S A
DIURETIC, AND THEY LOSE WATER."

"GOOD. ARE YOU GIVING
A SAFE DOSE?"

"YES, 40 TO 80 MILLIGRAMS IS
RECOMMENDED FOR THIS CONDITION,
UP TO 600 MILLIGRAMS.

AND I'M GIVING A 40 MILLIGRAM
DOSE AND IT'S ONLY TWICE A DAY.

"SO I NEVER GO ABOVE THE
80 MILLIGRAMS."

"GOOD . WHAT NURSING THINGS
ARE YOU GOING TO DO?"

"WELL, I'M GOING TO GO IN.
I'VE CHECKED THEIR LAB WORK
TO CHECK THE ELECTROLYTES.

THE DAILY WEIGHT WAS ORDERED

AND I'M GOING TO GO IN AND CHECK
THE VITAL SIGNS BEFORE
I GIVE THE MED,

SO THAT I KNOW HOW THEY'RE
DOING. AND THEN I'LL BE
TEACHING THE CLIENT

ABOUT CHANGING POSITIONS SLOWLY
IN ORTHOSTATIC CHANGES."

AND I'LL GO, "GOOD.
GO GIVE THE MEDS."

SO THOSE ARE THE QUESTIONS WE'RE
GOING TO ASK YOU EVER SINGLE
TIME FOR EVERY SINGLE DRUG.

AND I HOPE YOUR CLINICAL
INSTRUCTORS ARE DOING THE SAME
WHEN YOU GO TO GIVE A MED.

WHAT'S IT FOR?
WHY ARE YOU GIVING IT?

WE HAVE TO HAVE A CONNECTION
BETWEEN DRUG AND DIAGNOSIS.

DO YOU HAVE A SAFE DOSE?
WHAT NURSING THINGS ARE
YOU GOING TO DO?

OKAY, ALRIGHT,
SAME THING FOR POTASSIUM.

WE'VE DISCUSSED IT A LITTLE BIT.
WHAT'S IT FOR?

IT'S THE SUPPLEMENT BECAUSE
WE'RE GIVING A LOOP DIURETIC.

AND BECAUSE THEY'RE DIURESING,
AND LOSING A LOT OF FLUID,

WE'RE GOING TO SUPPLEMENT
THEIR POTASSIUM. IS IT
A SAFE DOSE? NO.

I WOULD CALL THE PHARMACIST,
AND THEN I'D CALL
THE PHYSICIAN.

HOW ARE YOU GOING
TO GIVE THE DRUG?

WELL, I'M GOING TO ASK THEM WHAT
KIND OF JUICE TO GIVE IT IN.

I'M GOING TO BE KEEPING TRACK
OF THEIR ELECTROLYTES
AND SO FORTH,

AND SO, THAT'S WHAT WE WANT
TO KNOW. DO YOU HAVE TO
HAVE IT ALL MEMORIZED?

NO, THAT'S WHY I MADE A MED
CARD. THAT'S WHY I WANT
YOU TO KNOW

EXACTLY WHAT YOU'RE GOING TO SAY
ON THE MED CARD,

AND I DIDN'T WANT YOU WRITING
THE WHOLE BOOK,

I JUST WANT YOU TO WRITE WHAT'S
PERTINENT FOR YOUR CLIENT

SO THAT YOU'RE ABLE TO RESPOND
TO THOSE QUESTIONS.

AND THAT'S WHAT YOU SHOULD KNOW
FOR EVERY CLIENT, FOR EVERY
MED YOU EVER GIVE.

OKAY. NOT TO MENTION, WHAT SIDE
EFFECTS WOULD YOU BE LOOKING
FOR, RELATED TO THIS DRUG.

ALRIGHT, ONCE YOU'VE BEEN
BLESSED BY YOUR INSTRUCTOR, THEN
YOU CAN GO AHEAD AND GIVE IT.

AND THAT'S WHAT
WE'RE GOING TO DO.

I DO WANT TO MENTION BEFORE THE
THOUGHT LEAVES MY MIND,

THESE DRUGS WERE ORDERED
AT EIGHT O'CLOCK.

IF YOU HAVE SIX CLIENTS
AND THEY ALL HAVE SIX,
EIGHT O'CLOCK MEDS,

WHAT'S THE LIKELIHOOD
OF GETTING TO ALL SIX
PLACES AT EIGHT O'CLOCK?

- NOT VERY MUCH.
- SLIM AND NONE.

SO WHAT ARE YOUR PARAMETERS
FOR SAFE ADMINISTRATION?

- 30 MINUTES BEFORE AND AFTER.

- 30 MINUTES BEFORE THE ASSIGNED
TIME AND 30 MINUTES AFTER.

SO IF I HAVE A SLUG OF
EIGHT O'CLOCKS TO GIVE,

YOU BETTER BELIEVE,
I'M GETTING READY AROUND 7:15.

AND I'M STARTING TO PASS
THEM AROUND 7:30, 7:40

SO THAT I HAVE PLENTY
OF TIME TO GET THEM IN.

NOW IF I GOT -- LASIX WAS
ORDERED TWICE A DAY

AND LET'S SAY, I DON'T KNOW,
LIFE HAPPENED, AND I DIDN'T
GET IN THERE UNTIL NINE O'CLOCK.

WHAT DO I DO? WHAT HAPPENS?

- YOU WAIT UNTIL THE NEXT DOSE.
- YES.

OFFSET YOUR NEXT ONE.

- OKAY, THOSE ARE SOME
VERY GOOD RESPONSES.

YOU OFFSET YOUR NEXT ONE,
YOU GO TO THE NEXT DOSE,
SOMEONE SAID.

AND THERE WAS ANOTHER THING,
JUST DOCUMENT WHEN
YOU GAVE IT.

OKAY, I WANT TO EXPLAIN
A LITTLE BIT ABOUT HOW
THE DRUGS ARE ORDERED.

IF THE DRUG IS ORDERED
ONCE A DAY,

DOES IT MATTER WHEN IN
THE DAY YOU GIVE IT?

- DEPENDS ON THE DRUG.

- DEPENDS ON THE DRUG AND IT
DEPENDS IF IT WAS SPECIFIED.
IF THE DOCTOR SAYS,

"GIVE IT AT EIGHT O'CLOCK OR
BEFORE BREAKFAST." THEN YOU'RE
-- YOU'RE HELD TO THAT TIME.

BUT SOME DRUGS DON'T
MATTER VERY MUCH, LIKE
A LAXATIVE, FOR EXAMPLE.

IF YOU WERE TO GIVE
A LAXATIVE ONCE A DAY

AND YOU'RE AN HOUR OR TWO LATE
OR AHEAD, DOES IT REALLY MATTER?

NO, IT MET THE ONCE A DAY
CRITERIA. BE CAREFUL ABOUT THAT.

WHAT HAPPENS IN THE HOSPITALS
IS, WHEN WE HAVE A DRUG
ORDERED ONCE A DAY,

IT GETS AN ASSIGNED TIME, I
THINK I MENTIONED THIS
A LITTLE LAST WEEK.

IT GETS AN ASSIGNED TIME BY
THE HOSPITAL JUST SO THAT
WE STAY ORGANIZED.

AND SO, WE GIVE MOST OF OUR ONCE
A DAYS AT EIGHT O'CLOCK.

BUT WHAT IF THE CLIENT'S AN
EARLY RISER AND THEY WANT
THEIR LASIX AT 6:00?

- GIVE IT TO HIM AT 6:00.

- GIVE IT AT 6:00.
YOU STILL MEET THE CRITERIA.

IT'S NOT AN INCIDENT REPORT,
IT'S NOT AN ERROR, IT'S
A NURSING JUDGMENT.

YOU CAN DECIDE WHEN TO
GIVE A MED AS LONG AS IT'S
WITHIN THE SAFE PARAMETERS.

IF THE SECOND DOSE
WAS ORDERED AT 2:00

BECAUSE OUR LASIX TIMES ARE
NORMALLY 8:00 AND 2:00, BUT
OUR CLIENT GETS UP AT 6:00.

THEN WHY NOT GIVE IT
AT NOON WITH HIS LUNCH

COS ALL OF THIS STUFF'S
SUPPOSED TO BE WITH FOOD.

AND YOU CAN CHANGE
THE TIMES THAT ARE SET.

HOWEVER, IF A DOCTOR
ORDERS A DRUG TO BE
GIVEN EVERY SIX HOURS,

WE DON'T HAVE ANY CHOICE,
BUT WHEN WE GIVE IT.

AND WE HAVE TO STAY WITHIN
THOSE HALF HOUR PARAMETERS.

IF YOU GET OUTSIDE OF THE
PARAMETERS, FOR EXAMPLE
YOU HAVE AN ANTIBIOTIC.

AND WE WANT TO KEEP THE SAME
BLOOD LEVEL GOING ALL DAY LONG,

AND YOU WERE SUPPOSED TO
GIVE THE DRUG AT 6:00,

IT'S USUALLY LIKE 12:00, 6:00,
12.00 AND 6:00,

AND FOR WHATEVER REASON,
YOU COULDN'T GET THE
DRUG IN TILL 7:00.

THEN YOU CHANGE ALL THE TIMES.
YOU GIVE IT AT 7:00,

AND THEN YOU MOVE EVERYTHING
AROUND AN HOUR.

AND YOU JUST CHANGE
THE TIMES ON THE MAR.

SO NOW IT'S 7:00, 1:00, 7:00
1:00, SO THAT THEY KEEP THAT
BLOOD LEVEL GOING. OKAY?

- FOR HALF AN HOUR, YOU ALREADY
HAVE A HALF AN HOUR DELAY.

- YOU CAN. YOU COULD, IF YOU
WANTED TO GET IT BACK ON.

YOU COULD BUMP IT UP THAT HALF,

AND THEN BUMP IT UP
FINALLY TO THE RIGHT
TIME IN THE NEXT HALF

AND THEN GET IT BACK ON.
ESPECIALLY WHEN IT'S
JUST ONE HOUR.

BUT WHEN IT STARTS GETTING TO BE
TWO OR THREE COS THEY WERE OUT
AT A TEST OR PROCEDURE,

AND WE MISSED AND SO FORTH.
YOU USUALLY JUST GET THEM GOING,

GET THEM ON TO ANOTHER
TIME-FRAME OR YOU SKIP THE DOSE,

AND GO TO THE NEXT ONE,
DEPENDING ON WHAT THE DRUG IS.

- AND THEN WE CHANGE IT
ON THE MEDICAL, MAR.

- YES, UH-HUH I WOULD
JUST CROSS IT OUT,
I CAN SHOW YOU,

I WOULD JUST CROSS IT OUT,
AND WRITE IN NEW TIMES.

- DO WE NEED TO
INITIAL THAT OR --

- NO, AND THEN YOU CAN JUST SAY
AND REPORT WHY IT HAPPENED

AND THEN I'D JUST GO
BY THE NEXT SHEET.

I SEE THE TIME IT WAS GIVEN
AND I MAKE MY DECISION
FOR THE NEXT DRUG

BASED ON WHEN THE
LAST DOSE WAS GIVEN.

SO THAT'S WHY WE HAVE THE
WHOLE SHEET TO WORK ON.

OKAY, WE'RE READY TO GO.

I'VE OBVIOUSLY CHECKED
MY DOCTOR'S ORDERS,

I'VE OBVIOUSLY GATHERED
ALL MY EQUIPMENT, I'VE
WASHED MY HANDS AGAIN.

AND I NEED MY TABLE TO GO
NEXT TO THE CLIENT.

I AM GOING TO IDENTIFY MY CLIENT
AND PROVIDE PRIVACY,

BUT WE HAVE A NEW WAY
TO IDENTIFY OUR CLIENTS.

NOW THIS IS SERIOUS BUSINESS
OF IDENTIFYING AT THIS POINT.

GOOD MORNING, MR. CURRY,

I'M DIANE,
I AM YOUR NURSE TODAY.

AND I HAVE YOUR MORNING
MEDICATIONS FOR YOU.

COULD YOU TELL ME
YOUR WHOLE NAME?

I KNOW I CALLED YOU MR. CURRY,
BUT TELL ME YOUR WHOLE NAME.

CONRAD CURRY. ALRIGHT.

I JUST WANT TO CHECK
YOUR NAME BAND HERE.

AND THIS IS WHAT IT
SAYS ON YOUR SHEET.

AND I WILL NOT GIVE YOU POINTS
IF YOU DO NOT DO THIS.

YOUR MAR MUST GO TO THE NAME
BAND AND YOU'RE COMPARING
MAR TO NAME BAND.

YOU DON'T JUST SAY, "AND I
CHECKED MY DOCTOR'S ORDERS,
IDENTIFIED MY CLIENT,

AND I COMPARED MAR TO THE NAME
BAND AND I'LL...TRY TO PASS --"

AND I'LL GO, "MAR
IS NOT MOVING."

GOT TO GO DOWN HERE.

SO THIS IS WHAT I WANT TO
HEAR, CONRAD CURRY.

AND I WANT TO HEAR THEIR
IDENTIFICATION NUMBER.

333770000, WE HAVE A MATCH.

AND IT SAYS HERE THAT
YOU'RE ALLERGIC TO SULFA.

WHAT HAPPENS
WHEN YOU TAKE SULFA?

IT UPSETS YOUR STOMACH?

HAVE YOU EVER HAD ANY TROUBLE
WITH RASH, DIARRHEA, ANY
DIFFICULTY BREATHING?

HAVE YOU TAKEN LASIX BEFORE,
THE WATER PILL?

IT HAS A LITTLE BIT
OF SULFA IN IT.

YOU HAVE? YOU'VE BEEN TAKING
IT FOR FIVE YEARS.

ALRIGHT. PURSUE A LITTLE BIT
WHAT'S GOING ON.

OKAY.

SO ASK THEM THEIR NAME,
AND CHECK THEIR NAME BAND.

PROBLEM, NURSING HOMES,
NO NAME BANDS.

WHAT DO YOU DO?

HAVE THEY TALKED TO YOU
ABOUT THINGS TO DO IN
THE NURSING HOMES?

ONE OF THE NURSING HOMES IN
THE AREA HAS A PICTURE BOOK

AND IN THE NOTEBOOK,
THEY HAVE TAKEN ALL OF
THE RESIDENTS' PICTURES,

THEIR NAME AND IDENTITY
IS ON THE BOOK,

AND YOU TAKE THE BOOK,
YOU MATCH UP THE PICTURE,

ASK THEM THEIR NAME AND THEN YOU
MATCH IT THAT WAY,

SO THAT YOU KNOW YOU HAVE
THE RIGHT CLIENT.

ALWAYS ASK THEM THEIR NAME,

AND THEY SHOULD HAVE AT LEAST
PUT A NAME BAND ON THE BED
OR SOMETHING.

BUT THE PEOPLE CAN MOVE, YOU
KNOW, THEY'RE A MOVING GROUP.

SO FIND OUT WHAT THEIR
CRITERIA IS FOR CHECKING BANDS,

BECAUSE YOU HAVE TO IDENTIFY THE
CLIENT, ESPECIALLY IF, YOU KNOW,

YOU'RE IN AN ALZHEIMER'S UNIT
OR SOMETHING,

BOY, YOU GOT TO KNOW WHO
YOU'VE GOT FOR YOUR CLIENT.

SO PICTURE BOOKS WORK,
ASK TO STATE THEIR NAME,
AND GET THE RIGHT CLIENT.

OKAY, I HAVE TWO
PILLS FOR YOU.

I HAVE YOUR LASIX,
WHICH IS A WATER PILL.

IT'S TO HELP GET THE WATER OUT
OF YOUR SYSTEM BECAUSE OF YOUR
CONGESTIVE HEART FAILURE.

IT MAKES YOU GO TO THE
BATHROOM, YOU KNOW THAT

BECAUSE YOU'VE BEEN
TAKING IT FOR SO LONG.

DO YOU HAVE ANY TROUBLE GETTING
TO THE BATHROOM? GOOD.

THE OTHER THING IS
THAT IT CAN CAUSE SOME
ORTHOSTATIC CHANGES.

AND WHAT THAT MEANS IS THAT WHEN
YOU'RE LAYING DOWN AND THEN YOU
GO TO SITTING UP OR STANDING,

IT MAKES YOUR HEAD
A LITTLE DIZZY.

HAVE YOU EXPERIENCED
ANY OF THAT?

OH, YOU HAVE? IN FACT,
YOU'RE DIZZY RIGHT NOW.

I MEAN, TALK TO THEM ABOUT
IT A LITTLE ABOUT BIT AND SAY,

"I WANT TO JUST TELL YOU THAT
IT'S REAL IMPORTANT THAT YOU
CHANGE POSITIONS SLOWLY.

MAYBE DANGLE AT THE EDGE
OF THE BED FOR A FEW SECONDS

AND MAKE SURE THAT YOU ARE
NOT TOO DIZZY, SAME
WITH STANDING.

DON'T JUST JUMP OUT OF BED
AND START WALKING REAL FAST.

MAKE SURE THAT YOU
HAVE YOUR BEARINGS THERE
WITH THE WATER PILL.

WE'RE ALSO GOING TO
KEEP TRACK OF I&O,

WHILE YOU'RE ON THIS,
TO SEE THAT WHAT'S COMING --

GOING IN IS COMING OUT, AND
HOPEFULLY, MORE IS COMING
OUT RIGHT NOW.

AND THEN WE'LL BE GETTING YOUR
WEIGHTS EVERY MORNING.

YOU'VE LOST A COUPLE OF POUNDS
THIS MORNING, THAT'S GREAT.
OKAY, SO, THIRD CHECK.

I AM NOW GOING TO TAKE
THIS AND GO,

"OH! BLOOD PRESSURE,
PULSE. YOU KNOW WHAT,
BEFORE I DO THIS,

I NEED TO GET YOUR VITAL SIGNS."

SEE WHAT A GOOD CUEING
SYSTEM THAT IS FOR YOU

BECAUSE YOU JUST KEPT TALKING
ABOUT STUFF, YOU DISTRACT
YOURSELF, I DO.

SO I GET MY VITAL SIGNS,
AND NOW I'M GOING TO DO
MY THIRD CHECK.

AND I HAVE LASIX 40 MILLIGRAMS,
LASIX 40 MILLIGRAMS, GREAT,
OPEN IT, AND PUT IT IN HERE.

AND THEN MY POTASSIUM, I'LL GET
GOING HERE IN A SECOND.

SO, THIS IS
MY DUPLICATE CUP HERE.

I HAVE YOUR LASIX FOR YOU,
IF YOU WANT TO WANT TO
GO AHEAD AND TAKE THAT

GIVE IT TO THE CLIENT,
AND HE CAN TAKE IT HIMSELF.

ALRIGHT, THEN YOU WANT TO
JUST WATCH, AND MAKE SURE
THAT THEY SWALLOWED THE PILL.

THE SECOND THING IS
I HAVE YOUR POTASSIUM.

IT SEEMS LIKE THEY WROTE
ON YOUR CHART

THAT YOU LIKE APPLE JUICE
WITH YOUR POTASSIUM. IS THAT
OKAY? IT'S WHAT I BROUGHT.

THAT'S OKAY.

SO, PUT THIS IN HERE.

THE POTASSIUM IS TO
GO ALONG WITH THE LASIX.

YOU KNOW, ANY TIME YOU
TAKE A LOOP DIURETIC,
WHICH IS WHAT THIS IS.

YOU NEED TO SUPPLEMENT YOUR DIET
OR SUPPLEMENT WITH MEDICINE

FOR YOUR POTASSIUM BECAUSE IT
PULLS OFF, POTASSIUM.

ALRIGHT, THERE YOU GO.

IT'S IN ABOUT
SIX OUNCES OF FLUID,

AND HE TAKES THAT,
AND WE'RE GOOD TO GO.

ALRIGHT, ANYTHING ELSE
I CAN GET FOR YOU?

YOU SWALLOWED BOTH OF THOSE,
YOU GOT IT DOWN OKAY? GOOD.

AND LOOK, SOMETIMES THAT
FEELS A LITTLE INSULTING.

BUT I HAVE TO TELL YOU,
I'VE GIVEN MANY A BED BATCH

AND I'VE FOUND MANY A GREEN PILL
AT THE BOTTOM OF THE BED.

YOU'VE GOT TO LOOK ON SOME OF
THESE CLIENTS

AND MAKE SURE
IT REALLY WENT DOWN,

AND THAT EVERYTHING
IS OKAY WITH THAT.

ALRIGHT, WELL, I HAVE SOME
MEDS TO GIVE YOU LATER,

SO IF YOU NEED ANYTHING,
GIVE ME A HOLLER,

YOUR CALL LIGHT'S WITHIN REACH,
AND I AM OFF THE ROOM.

OKAY. ALL OF THIS STUFF THEN
WILL GO BACK IN THE DRAWER.

PUT IT IN THE DRAWER
WHERE IT CAME FROM.

WE HAVE PLENTY OF DRUGS
IN ALL THE DRAWERS,

SO DON'T JUST TOSS THEM IN ANY
DRAWER, PUT THEM IN THE DRAWER
THAT YOU GOT THEM FROM.

- IS THERE ANY REASON WHY HE
COULDN'T SWALLOW THE LASIX WITH
THE POTASSIUM IN THE JUICE?

- NO, HE COULDN'T --
HE FELT SO LUCKY.

DON'T TAKE THIS,
AND POUR IT BACK
INTO THE BOTTLE.

WHAT A MESS, IT GETS OUR
LABELS ALL YUCKY.

IT'S JUST FOOD
COLORING IN WATER.

SO JUST TOSS IT IN THE SINK
AND THEN THROW THE STUFF AWAY,
OKAY, FOR YOUR CUPS.

ALRIGHT. FINALLY,
YOU'RE STILL NOT DONE,

WHEN THE MED HAS BEEN GIVEN,
WE DOCUMENT.

OKAY, SO I NEED TO
GO OVER DOCUMENTATION,
AND I'LL DO IT FROM HERE.

THEN I WASHED MY HANDS,
DID I SAY THAT?

I DON'T KNOW WHICH WAY. THEY
ALREADY PICKED UP ON
NOT WASHING AGAIN.

I'M AS BAD AS YOU.
I GO HOME, DREAM
ABOUT MY CHECKUPS.

OKAY.

A COUPLE OF THINGS
ON THE MAR.

THIS -- THIS COLOR RIGHT HERE,
WE ACTUALLY CHECKED IT
LAST WEEK,

BUT WHERE IT SAYS
THE LASIX ARE IN CHECK.

MY INITIALS IN HERE MEAN
THAT I CHECKED

THIS MAR TO THE DOCTOR'S ORDER,

AND I KNOW THAT IT WAS
WRITTEN CORRECTLY.

LASIX 40 MILLIGRAM BID,
POTASSIUM BID.

AND THAT'S ALL IT MEANS,
THAT THIS IS A CHART CHECK.

THIS DOES NOT MEAN
YOU GAVE THE DRUG.

IT MEANS THAT SOMEBODY CHECKED
THIS SHEET

WITH THE DOCTOR'S ORDER,
AND EVERYTHING'S RIGHT ON IT.

WHAT WE NEED TO DO IS
DOCUMENT WITHIN OUR SHIFT,

SORRY. THAT WE GAVE THE DRUG.

SO THIS IS A 7:00 TO 3:00 SHIFT,

AND WE GAVE
AN EIGHT O'CLOCK DRUG.

SO WE'RE GOING TO COME OVER
HERE

AND WRITE EIGHT O'CLOCK,
0800 AND OUR INITIALS.

0800, YOUR FIRST
AND LAST INITIAL.

THAT'S ALL
THERE IS TO THAT.

AT THE BOTTOM, WHEN
YOU SIGN YOUR NAME,

WHENEVER YOU SIGN INITIALS,
YOU HAVE TO SIGN WHAT THOSE
INITIALS STAND FOR.

SO YOU NEED TO PUT
YOUR INITIALS ON THERE,

AND THEN SIGN YOUR
COMPLETE FULL NAME,

AND LAST NAME,
AND YOUR CREDENTIALS.

AND YOUR CREDENTIALS, RIGHT NOW
ARE STUDENT NURSE, SN CSUF.

AND THAT MUST BE AT THE END OF
YOUR NAME EVERY SINGLE TIME.

THERE'S A LOT OF STUDENT
NURSES OUT THERE,

STUDENT NURSES FROM MADERA,
STUDENT NURSES FROM
CITY COLLEGE,

STUDENT NURSES FROM HERE,
SO WE HAVE TO HAVE

THE CREDENTIALS OF
OUR SCHOOL BY OUR NAME.

WE WANT THEM TO KNOW HOW
WONDERFUL WE ARE

BECAUSE, YOU KNOW,
IF THERE'S PROBLEMS,

THEY ALWAYS BLAME IT
ON THE STUDENTS.

AND SO WE'RE GOING TO
BE THE GOOD ONES OUT THERE.

SN CSUF. AND THAT'S IT.

ALRIGHT, YOU SHOULD
ALWAYS DOCUMENT AFTER YOU
GIVE THE MED, NOT BEFORE.

THINGS HAPPEN. YOU MIGHT HAVE
GONE IN TO GIVE YOUR MED --

LET'S SAY YOU WENT IN TO GIVE
LASIX AND WHEN YOU TOOK THE
BLOOD PRESSURE,

IT WAS 80 OVER 40.
WHAT ARE YOU GOING TO DO?

- CALL THE DOCTOR.
- HOLD THE LASIX.

CALL THE DOCTOR. IT'S TOO LOW.

YOU'RE NOT GOING
TO GIVE LASIX WITH A
BLOOD PRESSURE LIKE THAT.

SO YOU'RE GOING TO HOLD IT.
THEN WHAT DO YOU DO?

IF YOU DON'T GIVE A MED
THAT'S BEEN ORDERED, HOW
DO YOU DOCUMENT THAT?

WELL, ON THIS SHEET, YOU'RE
GOING TO CIRCLE THE
EIGHT O'CLOCK,

AND THAT MEANS NOT GIVEN,

AND IF I DIDN'T GIVE THE LASIX,
WELL, I'M NOT GOING TO GIVE
THE POTASSIUM EITHER.

SO I'M GOING TO
HOLD THEM BOTH,

I'M GOING TO CALL THE PHYSICIAN,
AND IN MY NURSE'S NOTES,
I'M GOING TO SAY,

BLOOD PRESSURE AT 0800,
80 OVER 60,

CLIENT COMPLAINING OF DIZZINESS,
VERTIGO, ON AMBULATION,

MEDICATION HELD,
DR. SMITH NOTIFIED.

AND DR. SMITH COMING IN TO
EXAM LATER, OR WHATEVER.

HE MAY NEED TO SEE THE DRUG,
HE MAY, WHATEVER YOU DO.

THAT'S -- YOU HAVE TO DOCUMENT
THAT YOU MADE AN ATTEMPT.

ANY TIME YOU DON'T GIVE
A DRUG, THEN YOU HOLD
IT, YOU CIRCLE IT.

SO THAT MEANS YOU KNEW IT WAS
TO BE GIVEN, BUT YOU JUST
DIDN'T GIVE IT.

YOU COULD EVEN, IF
YOU WANTED TO, WRITE THE
BLOOD PRESSURE IN THERE.

IN THAT SQUARE. SO
ALRIGHT, THAT'S IT.

OKAY AT THIS POINT, THE NURSING
CALL LIGHT GOES OFF.

"YES, MR. CURRY, WHAT'S GOING
ON, HOW CAN I HELP YOU?"

"MY KNEE IS HURTING SO BAD,
CAN I HAVE MY PAIN PILL?"

"WELL, SURE, YOU DIDN'T
HAVE ONE LAST NIGHT, DID YOU?

SO IT'S BEEN A WHILE
SINCE YOU'VE HAD IT.

DO YOU WANT TO TAKE
ONE PILL OR TWO?"

"WELL, I DON'T KNOW
WHAT DO YOU THINK?"

"WELL, HOW BAD IS YOUR PAIN
ON A SCALE OF ONE TO TEN?"

"WELL, IT'S A FIVE."

"WELL, HAVE YOU TAKEN
DARVOCET BEFORE?"

"NO." "YOU WANT TO TRY ONE,
AND SEE HOW IT WORKS?"

"OKAY, YOU WANT TO TRY TWO,
AND SEE HOW IT WORKS?"

IT'S TOTALLY UP TO YOU,
AND THE CLIENT.

IT DOESN'T MATTER REALLY,
IF THEY GET THE ONE OR THE TWO.

SO...

..SAY, "I'LL BRING IT RIGHT IN."

OKAY, SO YOU'RE GOING TO
RUN TWO SEPARATE DRILLS.

YOU'RE GOING TO GIVE
YOUR NARCOTIC AT ONE TIME

AND YOU'RE GOING TO GIVE
YOUR ROUTINE MED AT ANOTHER,

SO THAT YOU CAN GO THROUGH
THE CHECKS AND ALL THAT
KIND OF STUFF.

ALRIGHT, SO HERE'S OUR ORDER.
I GO TO THE NURSING, THE MAR,

AND I LOOK AT
MY DARVOCET ORDER,

AND IT SAYS THAT THEY COULD HAVE
ONE DARVOCET OR TWO.

HOW COME IT'S ON SEPARATE LINES?
DID YOU NOTICE THAT?

- IT'S ONE INTO ONE
AND ONE INTO TWO.

- UH-HUH, SO HOW WOULD I KNOW
IF YOU GAVE ONE OR TWO

IF YOU DIDN'T SEPARATE THEM?

SO I HAVE TO HAVE THE ONE,
ON ONE LINE OR THE TWO,
ON ONE LINE.

SO THAT I KNOW
WHICH THE NURSE GAVE.

IT'S JUST, THE WAY ABOUT HERE.
SO WHAT WE NEED TO DO BEFORE
WE GIVE DARVOCET,

ONE, IS TO FIGURE OUT WHEN
THE LAST DOSE WAS GIVEN,

BECAUSE WE CAN'T GIVE A DOSE
ANY SOONER THAN WHAT IT
WAS PRESCRIBED.

AND IT SAYS THEY CAN HAVE
IT EVERY SIX HOURS AS NEEDED.

SO IF IT'S AT EIGHT O'CLOCK,
THEY COULDN'T HAVE
HAD A DARVOCET

AT ANY TIME AFTER TWO O'CLOCK.

SO IT APPEARS THEY DIDN'T
HAVE ANYTHING, I'D HAVE TO
CHECK YESTERDAY'S SHEET,

THIS SHEET OBVIOUSLY HAS NOTHING
ON IT, TO FIND THE LAST DOSE.

AND THEN ONCE I'M OKAY THAT
THERE'S NO ALLERGIES
OR ANYTHING,

THEN I CAN GO AND GET MY MED.
SO, I THINK I'M OKAY.

- CAN I ASK YOU A QUESTION?
- UH-HUH.

- I KNOW THIS
SEEMS REALLY SILLY.

IF THEY'RE ALLOWED TO HAVE ONE
OR TWO EVERY SIX HOURS
AND THEY HAVE ONE.

AND DECIDE THEY STILL HURT --
- WE'RE GOING TO TALK
ABOUT THAT LATER.

- YEAH, WE'LL TALK ABOUT THAT
AT THE END OF THIS

BECAUSE THERE ARE THINGS
WE CAN DO AND CAN'T DO
RELATED TO THIS.

WE'RE GOING TO GO WITH ONE,
FOR NOW, AND THAT WILL HELP
REMIND ME OF THAT SCENARIO.

OKAY, WHEN YOU COME
TO YOUR TEST,

DON'T BRING ALL OF YOUR SHEETS,
AND GO, "WHICH ONE ARE YOU?"

ONLY TAKE THE ONE THAT YOU
NEED AT THE TIME YOU'RE
DOING THE DRUG.

ALRIGHT, SO WE NOW HAVE
OUR PRN SHEET WHICH IS
A DIFFERENT COLOR.

AND WE HAVE OUR DARVOCET
AND OUR CLIENT HERE,

SULFA ALLERGIES,
AND MY HANDS ARE WASHED.

I AM GOING TO GO
TO THE MED CART,

THIS IS A WHOLE SEPARATE SHEET,
ON CHECKING OUT A NARCOTIC.

ON YOUR MEDICATION CHART,
YOU WANT TO GET YOUR MAR,

AND YOU WANT TO GO
TO THE NARCOTICS CABINET.

OUR NARCOTICS CABINET IS -- WE
HAVE A DRAWER IN THE LAB THAT
WE'LL OPEN UP FOR TESTING

BUT WE ALSO HAVE THIS
DRAWER FOR PRACTICE.

AND THEY'RE ALL LOCKED.

WHAT WE WANT TO DO IS
WE WANT TO GO GET THE DRUG.

WE KNOW THE TIME-FRAME IS OKAY.

WE KNOW THE ALLERGIES
ARE NO PROBLEM,

WE JUST NEED TO GET THE DRUG.

SO WHAT YOU WANT TO DO IS
YOU WANT TO COME

TO YOUR NARCOTICS CABINET
AND GET THE NARCOTIC LOG.

AND THEY ALWAYS KEEP TRACK OF
NARCOTICS, THEY'RE LOCKED UP.

AND WE HAVE TO MAKE SURE THAT
WHEN WE TAKE A DRUG OUT

THAT THE RIGHT NUMBER OF PILLS
WERE IN THERE. AND THAT WHEN
WE SIGNED IT OUT,

WE LEFT THEM WITH THE
RIGHT NUMBER OF PILLS.

SO I WANT TO COME
TO THIS NARCOTIC LOG,

AND I WANT TO COME ACROSS HERE
AND I WANT TO FIND DARVOCET,

AND IT SAYS, DARVOCET-N 100,

THERE ARE 36 TABS THAT
ARE SUPPOSED TO BE IN
THIS DRAWER. ALRIGHT?

SO I'M GOING TO GET THE KEY,
UNLOCK THE DRAWER...

..AND COME INTO
THE NARCOTICS CABINET.

I'M GOING TO LOOK THROUGH
ALL OF THIS STUFF HERE,

CHECK IN MY LITTLE SHEET,
AND FIND THE DARVOCET,

IT'S NOT IN ANY OF THIS STUFF,
WHICH IS ALL FAKE,

I GOT TYLENOL NUMBER THREE,
IT'S ALL A BUNCH OF FAKE STUFF.

AND THEN FINALLY,
I HAVE DARVOCET, AND WE'VE
PUT THEM IN AN EMESIS BASIN,

BECAUSE WE'VE RIPPED THEM APART
SO MANY TIMES THAT THEY HAVE
LOST ALL SENSE OF ORDER.

NORMALLY, YOUR NARCOTICS
COME IN SHEETS LIKE THIS.

AND THEY COME IN A ROLL,
IN A BOX AND THEY'RE NUMBERED.

SO IF THERE ARE 30 IN A BOX,
THIS WOULD BE 30,

THIS WOULD BE 29,
THIS WOULD BE 28.

AND SO AS YOU RIP THEM OFF,
THE NUMBER IS ON THERE.

WELL, WE'VE LOST ALL
SOPHISTICATION,

AND WE JUST HAVE THIS
HEAPING PILE OF DRUGS THAT
YOU'RE GOING TO HAVE TO COUNT.

OKAY, AND I HAVE ALREADY REALLY
PRE-COUNTED AND THERE'S 36,
AND I DID COUNT EVERY ONE.

SO THOSE OF YOU TUESDAY MORNING
AT EIGHT O'CLOCK WILL HAVE
A SLUG TO COUNT,

AND THOSE OF YOU TUESDAY
AT 11:15 WILL HAVE
VERY FEW TO COUNT.

ALL RIGHT, YOU WANT TO MAKE
YOUR COUNT,

MAKE SURE IT MATCHES,
36, 36.

AND THEN I NEED TO SIGN OUT
THAT I HAVE TAKEN A PILL.

YOU SIGN THESE OUT
BEFORE YOU GIVE THEM,

BECAUSE ONCE THEY'RE OUT OF
THE DRAWER, THEY'RE GONE,
THEY'RE TAKEN.

SO I COME OVER TO MY NARCOTICS
LOG AND I SAY, 0800.

MY PATIENT IS CONRAD CURRY.

NOT MUCH ROOM HERE.
ROOM NUMBER, BED NUMBER FIVE,

AND MY NURSE SIGNATURE,
IS HERE THAT I TOOK IT.

AND I'M GOING TO COME
ACROSS HERE TO THE NEXT LINE,

AND SAY DARVOCET-N 100,
THERE ARE NOW 35 IN THE DRAWER

BECAUSE I TOOK ONE.

NOW ONCE I FILLED OUT HOW MANY
ARE LEFT IN THE DRAWER,
WHO'S TAKEN IT,

THIS IS WHEN YOU, AS A
STUDENT, SAY TO THE RN

WHO HAS BEEN WATCHING YOU TAKE
THIS OUT OF THE DRAWER,

YOU SAY, "WILL YOU
CO-SIGN FOR ME?"

YOU HAVE TO HAVE A CO-SIGNATURE
AS A STUDENT TO TAKE OUT
A NARCOTIC.

YOU DON'T, AS AN RN,
BUT YOU DO, AS A STUDENT.

SO I'LL SAY, "SURE." AND
THEN I'LL CO-SIGN FOR YOU.

WHAT I WON'T DO IS
I WON'T SIGN A BLANK CHECK.

IF YOU HAVEN'T PUT THE NUMBER
IN HERE AND YOU ASK ME TO
CO-SIGN FOR MR. CURRY.

I WON'T. OH, I FORGOT TO
DO ONE OTHER THING.

I KNEW SOMETHING WAS
MISSING HERE.

WHERE IT SAYS DOSE,
YOU HAVE TO WRITE THE DOSE,

AND MY DOSE IS ONE PILL.
AND THAT'S ALL THERE IS TO IT.

SOMETIMES IT'S MILLIGRAMS,
BUT THIS IS A PILL.

- ARE THOSE COMING IN TWO -- ARE
THERE TWO PILLS TO ONE PACKET.

- NO, THERE'S ONE PER PACKET.
- ALRIGHT.

- SO IF THE DOSE WAS TWO,
THEN YOU WOULD COME OVER HERE

- AND GO TO PAGE TWO AND THEN --

- UH-HUH. AND THEN MY COUNT
WOULD GO FROM 36 TO 34.

ON THIS PARTICULAR LOG SHEET,
YOU DON'T HAVE TO SIGN OUT
FOR EVERY LINE.

SOMETIMES THEY HAVE
A SHEET PER DRUG,

AND THEN YOU HAVE TO
SIGN OUT FOR EVERY LINE,

BECAUSE EVERY LINE IS
THE NUMBER OF THE DRUG.

SO WHEN IN ROME DO
WHAT THEY WANT YOU TO DO.

BUT NEVERTHELESS YOU'RE STILL
ACCOUNTING FOR EVERY PILL.

OKAY, ONCE EVERYTHING'S SET,
I HAVE MY PILL, I WANT
TO DO A CHECK,

DARVOCET-N 100, DARVOCET-N 100,
I'M GOING TO PUT IT IN A CUP.

I'M GOING TO SHUT MY DRAWER
AND LOCK IT.

AND GIVE THE KEY BACK
TO THE NURSE.

YOU DON'T JUST LEAVE THE KEY
HANGING AROUND OUR POCKETS,

LIKE WE DO FOR PRACTICE.
BUT IT'S KEPT BACK.

ALRIGHT, DARVOCET N100,
I DID MY CHECKOUT OF THE
DRAWER, MY CHECK HERE,

I WANT TO DO ONE MORE CHECK.

IT'S GOT ACETAMINOPHEN,
650 MILLIGRAMS

AND PROPOXYPHENE NAPSYLATE,
100 MILLIGRAMS.

IT'S GOOD TO GO HERE.

ALRIGHT, I HAVE MY DRUG,
IT'S CHECKED OUT.

AND THAT'S REALLY
ALL THERE IS TO THAT, OKAY.

- IF THERE WAS A POSSIBILITY,
THERE ARE LESS THAN REALLY
THERE ARE --

- I'LL START
HUNTING THEM DOWN.

THIS IS A LITTLE TRICKY,
I MADE SITE VISITS AT THE
HOSPITALS RECENTLY,

AND BECAUSE OF ALL THESE
DIFFERENT ELECTRONIC SYSTEMS,

THEY'RE NOT CONSISTENT
IN THEIR CHECKING OF
THE NARCOTICS DRAWERS

BECAUSE THE NARCOTICS DRAWERS,
FOR EXAMPLE, IF THE VA SPIT OUT
THE DRUG ONE AT A TIME,

YOU JUST DIAL IN WHAT YOU NEED,
AND IT GIVES IT TO YOU. AND IT'S
KEEPING AN ELECTRONIC COUNT.

SO THEY'RE ONLY CHECKING THEIR
NARCOTICS, LIKE, ONCE A WEEK,
WHICH I DON'T THINK IS ENOUGH.

I'VE BEEN DOING SOME READING
ABOUT IT AND THEY REALLY
SAY, AT LEAST ONCE A DAY.

THAT YOU SHOULD MAKE SURE
EVERYTHING IS RIGHT
IN YOUR MACHINES.

BUT MOST OF THEM, WHEN YOU'RE
DOING A MANUAL TECHNIQUE,
LIKE THIS,

EACH SHIFT HAS TO COUNT.

SO IF I'M THE DAY SHIFT,
AND YOU'RE THE NIGHT SHIFT,

YOU COME ON WITH ME --
YOU COME HERE AND
YOU READ THE BOOK,

AND I, AS THE DAY SHIFT
COUNT, AND WE MAKE SURE
THE NUMBERS ARE ALRIGHT.

SO, IF LATER ON IN THE SHIFT,
YOU SEE THAT THERE IS NOT
A DRUG WRITTEN DOWN THERE

AND THE COUNT IS OFF, YOU START
HUNTING YOUR PEERS DOWN AND GO,

"OKAY, WHO GAVE DARVOCET?
THE COUNT IS OFF."

AND I CAN'T SIGN UNTIL
I KNOW WHERE IT IS.

YOU GOT TO FIND THEM.
SO I'LL SIGN UP MINE
AND I'LL GIVE IT,

BUT I START HUNTING FOR IT.
I CAN'T HELP THAT THE
COUNT IS OFF,

I'LL CIRCLE IT UNTIL
I CAN FIND OUT WHAT'S GOING ON.

SO MY PATIENT'S NOT WAITING
FOR OUR PROBLEMS, BUT WE
GOT TO HUNT IT DOWN,

AND WHAT USUALLY HAPPENS IS
THEY DON'T LET ANYONE GO HOME

ON THE NEXT SHIFT UNTIL THEY
FIND THE ERROR, SO.

- DOES THAT HAPPEN OFTEN?
- NO, THANK HEAVENS.

BUT WHEN IT DOES HAPPEN
A LITTLE MORE OFTEN,

IS WHEN YOU GOT A LOT OF
PEOPLE IN THE DRAWER.

SO WHEN YOU GOT STUDENTS AND
STAFF AND STUFF AND A LOT
OF COMMOTION GOING ON,

THEN SOMETIMES THE NURSE WILL
GRAB IT AND NOT SIGN IT UP.

THE STUDENTS TEND TO NOT DO IT,
BECAUSE WE'RE SO,

YOU KNOW,"OH, OH! SIGN FOR ME, I
DON'T WANT TO GET IN TROUBLE."

AND FACULTY, AND STAFF
ARE WATCHING YOU.

SO THEY USUALLY DO
GET SIGNED OUT.

SO IT JUST DEPENDS ON HOW
PEOPLE ARE GETTING HOLD
OF THE KEYS AND STUFF.

SO NO, NOT VERY OFTEN,
BUT IT DOES.

IF THERE IS A RUSH AND SOMEONE'S
RUSHED INTO SURGERY,

AND YOU NEEDED SOMETHING
QUICK OR WHATEVER,

YOU MIGHT GRAB YOUR MED
BEFORE YOU SIGN. SO, YEAH.

ALRIGHT, IT'S TIME TO GIVE OUR
MED.

WE'VE CHECKED TWICE,
WE HAVE THE RIGHT MED,

WE HAVE NO ALLERGY
PROBLEMS WITH THIS.

I THINK WE'RE OKAY TO GO.

I DO WANT TO DISCUSS ONE THING
THAT YOU DISCOVERED
ON YOUR DRUGS.

WHAT DO YOU THINK ABOUT THE DOSE
THAT THE DOCTOR ORDERED?

- IS IT A POSSIBILITY...
- IT SHOULD BE EIGHT HOURS.

- IT SHOULD BE EVERY EIGHT HOURS
AND NOT EVERY SIX HOURS.

AND WHAT IS
OUR PRIMARY PROBLEM?

- TOO MUCH, ON THE TWO PILLS.

- UH-HUH. WITH TWO PILLS,
WHAT'S THE MAXIMUM PROPOXYPHENE

WHICH IS THE NARCOTIC PIECE OF
THE DRUG, WHAT'S THE MAX
THAT YOU COULD HAVE?

- 600.
- 600 MILLIGRAMS.

SO IF WE'RE GIVING IT FOUR TIMES
A DAY AND WE GAVE TWO PILLS,

WE COULD THEORETICALLY BE
UP TO 800 MILLIGRAMS
WHICH IS TOO MUCH.

WHAT ABOUT THE
TYLENOL COMPONENT?

WHAT IF YOU GIVE TWO
PILLS A DAY, I MEAN,
TWO PILLS AT A TIME?

HOW MANY MILLIGRAMS IS
THAT OF TYLENOL?

THAT'S 1,300 MILLIGRAMS
A DOSE, AND THEN IF YOU GIVE
THAT FOUR TIMES, WHAT HAPPENS?

WE GO OVER 5 GRAMS.

WHAT WAS THE RECOMMENDED MAXIMUM
FOR TYLENOL IN A DAY?

- 4 GRAMS.
- 4 GRAMS.

YOU HAVE TO BE VERY
CAREFUL WITH SOME OF THESE
COMBINATION PRODUCTS,

LIKE DARVON, DARVOCET,
PERCODAN, PERCOCET

BECAUSE THEY'VE GOT AN
ASPIRIN OR TYLENOL
COMPONENT IN THEM.

YOUR CLIENT HAS A FEVER,

CAN YOU BE GIVING HIM TYLENOL,
AND DARVOCET FOR PAIN?

NO. YOU WOULD BE
LOADING THEM UP.

SO BE AWARE OF WHAT YOU'VE
GOT GOING IN YOUR PRODUCT.

YOU WOULD, HOPEFULLY, THINK THAT
THE PHARMACISTS WOULD GO,

THIS IS TOO OFF, AND THEN
CALL THE DOCTOR.

BUT WE TOO WOULD CALL,
AND SAY, THIS IS TOO MUCH.

NOW IF YOUR CLIENT DOESN'T TAKE
IT MORE THAN THREE TIMES A DAY
IT NEVER BECOMES AN ISSUE,

BUT IT DOES IF
THEY WANT IT EVERY SIX.

AND THEY WANT TWO PILLS.
SO, PROBLEM. ALRIGHT,
THE OTHER THING,

THAT'S NOTEWORTHY AND YOU'LL GET
MORE ABOUT IT IN PHARMACOLOGY
IS WITH THE TWO PRODUCTS.

WHY HAVE TWO PRODUCTS
IN ONE DRUG?

WHY NOT JUST GIVE
THEM ONE OF EACH OR
ONE WHEN THEY NEED IT?

THEY FOUND IN PHARMACOLOGY
AND IN PAIN MANAGEMENT THAT
IF YOU GIVE A NARCOTIC,

IT WORKS ON A CERTAIN KIND OF
PAIN, THE DEEP VISCERAL PAIN.

AND THEY FOUND OUT THAT
NON-NARCOTIC MEDICATIONS,
WORK ON MORE PERIPHERAL PAIN.

SO IF THEY PUT THE TWO TOGETHER
AND NOT EVEN AS HIGH A DOSE,
YOU GOT BETTER PAIN RELIEF

BECAUSE THEY WERE ACTING ON
TWO DIFFERENT NEURAL SYSTEMS,

AND THE MORE PERIPHERAL PAIN

AND THEY GOT BETTER
PAIN MANAGEMENT. THEY
WERE HAPPIER PEOPLE.

SO THEY STARTED MARKETING A
PRODUCT THAT GAVE A COMBINATION

TO ACT ON THOSE
TWO TYPES OF PAIN.

AND THAT'S WHAT WE'VE
GOT HERE. SO, IT'S NOT
REALLY A STRONG DRUG,

BUT IT IS A GOOD ONE.

ALRIGHT, WE'RE GOING TO GO
INTO OUR CLIENT'S ROOM.

GOOD MORNING, MR. CURRY,
I HAVE YOUR PAIN MED FOR YOU.

WHERE DID YOU SAY YOU WERE
HURTING? IN YOUR KNEE.

AND WHAT IS IT ON A SCALE OF
ONE TO TEN. FIVE, ALRIGHT.

WELL, IT TAKES ABOUT AN HOUR FOR
THIS PAIN MEDICATION TO WORK.

SO, LET ME KNOW HOW IT'S DOING
AND I'LL CHECK BACK WITH YOU.

BUT ONCE A PILL GETS IN YOUR
SYSTEM, IT LASTS A GOOD WHILE.

SO IT SHOULD LAST YOU WELL FOR
ABOUT SIX TO EIGHT HOURS.

SO WE'LL KIND OF KEEP TRACK OF
THAT AND DON'T LET YOUR PAIN
GET MUCH OVER FIVE,

BECAUSE IT'S HARDER TO
CATCH UP WITH.

YOU GET LIKE UP TO AN
EIGHT OR NINE IN THE
PAIN THRESHOLD,

AND IT'S A LITTLE HARD TO
MANAGE AT THAT POINT.

SO GIVE ME A CALL, I'M HAPPY TO
GET THAT PAIN MED FOR YOU.

CAN YOU TELL ME YOUR NAME?

I KNOW I JUST ASKED YOU,
BUT I NEED TO ASK YOU AGAIN

SO I GIVE THE
RIGHT MEDS TO EVERYONE.
YOU DON'T WANT ME MIXING UP.

I KNOW YOU DON'T WANT
MRS. JONES' STUFF.

NOW THEY'LL SAY THAT TO YOU,
WHY DO YOU KEEP ASKING ME?

AND THIS IS MY FAVORITE LINE
OF ALL, THE OTHER NURSES
DON'T DO THIS.

WELL, I DO. THAT'S THE WAY
I KEEP MY MEDS STRAIGHT.

SO, I DON'T BE NURSE BASHING.
IT'S THE WAY I DO IT AND
IT'S THE BEST WAY TO DO IT.

AND THAT'S ALL THERE IS TO IT,
AND THIS IS HOW I MAKE
NO MED ERRORS.

ALRIGHT SO, CONRAD CURRY,
CONRAD CURRY.

DR. I AM SMART, 333770000.
YOU'RE STILL ALLERGIC TO SULFA.

AND THAT SHOULDN'T BE A PROBLEM
WITH DARVOCET. HAVE YOU EVER
TAKEN DARVOCET BEFORE?

ALRIGHT, IT'S GOT A LITTLE
BIT OF A NARCOTIC IN IT,

AND IT'S GOT
A LITTLE TYLENOL IN IT.

AND THAT'S HOW IT WORKS
TO MANAGE THE PAIN.

IT MIGHT MAKE YOU
A LITTLE NAUSEATED,

SO IF YOU WANT SOMETHING TO EAT
WITH IT, THAT WOULD BE GOOD.

AND THE OTHER THING ABOUT
NARCOTICS THAT YOU MIGHT
WANT TO KNOW IS

THAT IF YOU TAKE THEM FOR
A WHILE IT CAN MAKE YOU
A LITTLE CONSTIPATED.

SO YOU WANT TO KEEP TRACK OF
THAT. WHEN WAS YOUR LAST BOWEL
MOVEMENT, BY THE WAY?

ASK EVERYBODY EVERYDAY. "HI,
HOW ARE YOU, WHEN WAS YOUR
LAST BOWEL MOVEMENT?"

AND SO TRY TO GET OVER
SOME OF THOSE PERSONAL
ISSUES STRAIGHTAWAY.

ALRIGHT, MY HANDS ARE WASHED,
I'VE PROVIDED PRIVACY, I HAVE
IDENTIFIED MY CLIENT,

I THINK I HAVE JUST DONE
ALL THERE IS TO DO.

YOU WANT TO GET SOME GOOD VITAL
SIGNS BEFORE. AND IN PARTICULAR,
WHEN YOU GIVE A NARCOTIC,

WHAT'S THE VITAL SIGN YOU'RE
MOST CONCERNED ABOUT?

- BLOOD PRESSURE.
-NO.

- PULSE.
- NO.

- RATE OF RESPIRATION.
- RESPIRATION.

IF I KNEW I'D GET THERE, THERE'S
ONLY FOUR. I'D LOVE TO HANG IN
THERE, RIGHT?

RESPIRATION. WITH
NARCOTICS, THEY SUPPRESS
THE RESPIRATORY SYSTEM.

SO WE'RE ALWAYS WATCHING
RESPIRATIONS RELATED
TO NARCOTICS.

SO FILE THAT LITTLE TIDBIT
INFORMATION AWAY.

AND SO, WE'LL KEEP
AN EYE ON HIM.

THIS IS A LOW DOSE AND IT'S NOT
VERY LIKELY, UNLESS HE HAD SOME
KIND OF ALLERGIC RESPONSE,

BUT NEVERTHELESS THAT'S
THE VITAL SIGNS. I'VE GOT
GOOD VITAL SIGNS.

I'VE CHECKED HIS PAIN,
I HAVE CHECKED EVERYTHING.

I AM NOW GOING TO DO MY
THIRD AND FINAL CHECK, MAYBE
FOURTH OR FIFTH BY NOW.

DARVOCET-N 100 1 PO,
YOU ARE CONRAD CURRY,

THE KEY IS THAT WE CHECK
THIS SHEET TO HIM,

AND THIS IS THE DRUG FOR HIM
AND THIS IS WHY WE NEED TO
MAKE OUR FINAL CHECK.

THIS IS HIM, THIS IS
OUR OFFICIAL DOCUMENT.

ALRIGHT, SO I'M GOING TO PUT IT
IN THE CUP, GIVE IT TO HIM,

GIVE HIM HIS GLASS OF WATER,
HE'S GOING TO SWIG IT DOWN.

DID YOU GET THAT DOWN? GOOD.

AND THAT'S ALL THERE IS TO THAT.

ALRIGHT, ANYTHING ELSE I CAN GET
FOR YOU? YOU HAVE YOUR CALL
LIGHT, GREAT.

I'LL COME BACK AND CHECK ON YOU
IN ABOUT AN HOUR, AND SEE HOW
THAT PILL WORKED FOR YOU.

AND SEE YOU IN A BIT.

- DO WE NEED TO TELL THEM --
- WASH YOUR HANDS.

- DO WE NEED TO TELL THEM TO
LIFT THEIR TONGUE AND --

DEPENDS ON THE CLIENT, I'VE HAD
SOME SWEET LITTLE CONFUSED
PEOPLE OUT THERE

THAT I SAY, "OPEN YOUR MOUTH.
YOU NEED TO LOOK IN THERE."

YOU KNOW, BECAUSE I'VE SEEN THE
GREEN PILL ON THE WHITE PILLOW
ON THE BASE OF THE BED.

BUT I MEAN, HONESTLY, IF YOU
GAVE ME A PILL, ARE YOU GOING TO
GIVE ME THE WHOLE MOUTH CHECK?

NO, RIGHT. YOU KNOW, BASED ON
ALERTNESS, AND SO FORTH.

JUST ASK THEM IF THEY
GOT IT DOWN OKAY.

YOU NEVER KNOW, MIGHT POCKET IT
AND SAY SOMETHING, RIGHT.

OKAY, SO WE NEED TO DOCUMENT.
SO LET'S GO DOCUMENT.

DID NOTICE THE DOCUMENTATION
IS ASTERISKED?

EVERY TIME, BECAUSE IT'S
CRITICAL, RIGHT.

IT'S OUR FIFTH RIGHT, OUR SIXTH
RIGHT. SO, WE GOT TO MAKE SURE
THE DOCUMENTATION IS RIGHT.

AND SO, AFTER WE GIVE THE PILL,
I DID CHECK THAT TO THE
DOCTOR'S ORDER.

I GAVE THIS, IT COULD BE EIGHT
O'CLOCK, I DON'T CARE
WHAT TIME IT IS.

AT EIGHT O'CLOCK,
I GAVE THE DARVOCET.

AND MY NAME IS...

THIS PEN IS KIND OF CRUMMY,
TURNING INTO A BIG BLUR.

I'LL TRY AND GET
THIS THERE SN CSUF.

AND THAT'S WHAT WE DO.

ANY TIME YOU GIVE A NARCOTIC
OR ANY PRN MED,

YOU HAVE TO FOLLOW UP ON THE
EFFECTIVENESS OF THAT MED

AND DOCUMENT ABOUT THAT
IN YOUR NURSE'S NOTES.

SO THAT'S WHY I SAID, "I'LL BE
BACK IN AN HOUR, TO SEE HOW IT
IS -- HOW IT'S WORKING FOR YOU."

AND THEN IN MY NURSE'S NOTES
I WILL SAY,

PAIN THREE AFTER ONE HOUR
OR ONE HOUR POST DARVOCET.

SO THAT I -- IT WORKED FOR HIM,

HE'S MORE COMFORTABLE OR IT
DIDN'T WORK, PAIN STILL FIVE.

OKAY, LET'S TALK ABOUT
PAIN STILL FIVE,

CLIENT NOT COMFORTABLE,
AND HE ONLY TOOK ONE PILL.

WHAT CAN YOU DO?

GIVE HIM ANOTHER ONE.

OKAY, NOW HERE'S THE TRICK.

THE ORDER IS ONE PILL
OR TWO PILLS.

SO, IF YOU GAVE THE FIRST PILL,
AND HIS PAIN WASN'T RELIEVED,

AND YOU CHECKED WITH HIM IN TWO
HOURS OR THREE HOURS AND
IT HASN'T WORKED,

YOU CAN GIVE HIM
THE NEXT ONE PILL.

SO NOW HE'S GOT TWO PILLS ON
BOARD, BUT YOU NEED
TO EXPLAIN THIS.

I CAN'T GIVE YOU ONE PILL
ALTERNATING EVERY THREE HOURS,

THAT WASN'T WHAT
THE DOCTOR ORDERED.

THE DOCTOR SAID YOU CAN HAVE
ONE PILL OR TWO PILLS.

SO IF I GIVE YOU
THIS SECOND PILL,

IT WILL BE A FULL SIX HOURS
BEFORE YOU CAN TAKE TWO PILLS.

OR YOU CAN WAIT FIVE AND
A HALF HOURS AND YOU
CAN TAKE TWO PILLS.

YOU SEE WHAT I'M SAYING?

SO, ONE PILL, NOT WORKING,
YOU CAN GIVE A SECOND
ONE PILL IN THREE HOURS.

BUT THE SECOND PILL OR TWO PILLS
CAN'T HAPPEN FOR SIX HOURS.

AND THEN YOU FALL INTO A
ONE OR TWO PILL SCENARIO.

SO YOU COULD ONLY ONE TIME DO
THE DOUBLE BACKING THING.

DOES THAT MAKE SENSE? SO,
EXPLAIN TO THEM, WHICH
WOULD YOU RATHER DO?

WOULD YOU RATHER WAIT A COUPLE
MORE HOURS, AND TAKE TWO PILLS
OR DO YOU WANT TO TAKE ONE NOW

AND THEN YOU HAVE A FULL
SIX HOURS BEFORE YOU
CAN TAKE THE TWO,

BECAUSE THAT ISN'T THE ORDER.
ALTERNATE EVERY THREE AND
THAT'S WHAT YOU DO.

OKAY, ANY QUESTIONS ABOUT PILLS
AND DRUGS AND THINGS?

ALRIGHT, THAT'S ALL
YOU HAVE TO DO.

AMAZINGLY, IT TOOK AN HOUR
TO GIVE THREE PILLS.

ISN'T THAT JUST ASTOUNDING?

IT WON'T TAKE YOU AS LONG.

WHAT YOU NEED TO DO IS COME
INTO THE ROOM, GET YOUR
TWO PILLS READY,

OR YOUR LASIX AND YOUR
POTASSIUM. HAVE THEM --

HAVE YOUR CUPS LABELED, AND ALL
YOUR STUFF TOGETHER. YOU'LL
COME IN AND CHECK HIM.

AND WE'LL EITHER HAVE YOU GO TO
THE NARCOTICS STATION, DOESN'T
MATTER WHICH ONE YOU GET FIRST.

WE MAY SAY SET YOUR PILLS DOWN,
AND GET YOUR NARCOTIC FIRST.

SO WE'LL SEND YOU TO
GET YOUR NARCOTIC.

AND YOU GO GET YOUR NARCOTIC,
SO WE CAN ALTERNATE A LITTLE
ON THE BEDS.

DEPENDS ON HOW MANY
STAFF I HAVE.

AND SO FORTH. SO, EVERYONE
OKAY WITH THAT?

ALRIGHT, I WANT TO EXPLAIN
ONE OTHER LITTLE THING.

YOU'VE MADE THIS ACTIVITY SHEET,
AND SO WHAT IS THE POINT OF IT?

WELL, IT TOLD US TO GO GET MEDS
AT EIGHT O'CLOCK AND I DID.

SO WHAT DO I DO WITH MY SHEET?

AFTER I GIVE MY EIGHT O'CLOCK
MED, I PUT A LINE THROUGH IT.

AFTER I DOCUMENT MY EIGHT
O'CLOCK MED, I PUT A SECOND
LINE THROUGH IT. I'M DONE.

IT HELPS ME KEEP IN MY MIND,
KEEP STRAIGHT THAT MY TASK
HAS BEEN COMPLETED.

GIVING THE MED IS ONE PART OF
THE TASK, DOCUMENTING IT IS THE
SECOND PART OF THE TASK

AND I NEED TO KEEP MYSELF
TOGETHER BECAUSE YOU GET SO BUSY

THAT SOMETIMES YOU DON'T GET TO
ONE PIECE OF THE PUZZLE,
UNTIL LATER.

NOW THE DARVOCET, WHAT I LIKE
TO KEEP TRACK OF OVER HERE IS
NOTICE I WROTE, LAST DOSE.

WHEN I GOT REPORT, THEY TOLD ME
THAT THE LAST TIME THE CLIENT
TOOK DARVOCET

WAS AT TEN O'CLOCK AT NIGHT. SO
I KNOW THAT MY CLIENT IS OKAY
TO HAVE MORE DARVOCET.

AFTER I GET MY DARVOCET,
I'M GOING TO SAY, 08 O'CLOCK."

SO THAT IF THE CLIENT CALLS
ME AT 1:30 AND SAYS,

"YOU KNOW, MY KNEE IS STILL
HURTING, AM I STILL DUE
FOR MY PAIN MED?"

AND I LOOK AND GO, "YOU HAD IT
AT 8:00, IT'S 1:30,

THAT'S FIVE AND A HALF HOURS.
YEAH, THAT WOULD BE GREAT.

DOESN'T SEEM TO LAST YOU VERY
LONG. YOU WANT TO TRY TWO
THIS TIME?

YOU'RE UP AND ALONE, WE'RE
ACTIVE THIS AFTERNOON WITH
YOUR FAMILY, YOUR PT'S COMING.

WHY DON'T WE TRY TWO PILLS
THIS AFTERNOON?"

YOU KNOW, JUST NEGOTIATE WHAT
WOULD WORK BEST FOR YOUR CLIENT.

BUT THAT'S HOW I KEEP TRACK OF
IT ON MY LITTLE SHEET,

AND THEN ONCE I GIVE IT AND ONCE
I DOCUMENT, I MARK THROUGH.

I DO THE SAME THING AS I GATHER
INFORMATION THROUGHOUT THE DAY.

I'M WRITING DOWN VITAL SIGNS,
AND I'S AND O'S.

AND THEN WHEN I CHART, I EXIT
OUT. AND THAT MEANS, IT'S IN THE
CHART. I'VE DONE IT, I'M DONE.

THE HAPPIEST SIGHT AT THE END
OF MY DAY IS EXITS.

I DO EVERYTHING AND THEN I CHART
IT, I PUT A LINE THROUGH THE
WHOLE DEAL, DONE. DONE, DONE.

OKAY, SO, BRING YOUR
ACTIVITY SHEET,

YOU'LL HAVE TO GATHER UP YOUR
MARS AND YOUR MEDS AND
YOU'LL BE SET.

OKAY, LET'S TALK ABOUT
MED MATH A LITTLE BIT,

IF THERE'S NO MORE QUESTIONS
ABOUT MED ADMINISTRATION.

SO WE CAN GET READY FOR THAT

BECAUSE THERE'S A BIG
MED MATH TEST THIS NEXT WEEK.

SO, OH, PLEASE STUDY THIS WEEK.
THIS IS NO TIME TO NOT STUDY
AND THINK YOU GOT IT.

EVERYDAY, DRILL YOURSELVES
ON THOSE CONVERSIONS.

YOU JUST GOT TO KNOW THEM,
IT'S BY MEMORY.

AND PEOPLE FEEL SO BAD WHEN THEY
GO, "I JUST COULDN'T REMEMBER
WHAT A TABLESPOON WAS."

OH, IT'S SAD TO HAVE TO TAKE A
TEST OVER BECAUSE OF THE
TABLESPOON.

SO I WANT TO REVIEW WHAT
THOSE CONVERSIONS ARE

AND THEN I WANT TO GO THROUGH
ONE MORE PRACTICE TEST WITH YOU.

AND I WANT YOU TO APPRECIATE
THAT IN YOUR SYLLABUS, I GAVE
YOU A MED MATH PACKET.

IF YOU HAVEN'T SEEN IT YET,
THERE'S A BUNCH OF PROBLEMS
FINALLY TO JUST DO AGAIN.

YOU REVIEWED IT, YOU'VE DONE ALL
OF THESE PRACTICE TESTS, NOW
GET IN HERE AND DO THAT.

I'VE ALSO GIVEN YOU
PAGE ASSIGNMENTS WITH EXACT
PROBLEMS IN YOUR MATH BOOK.

IF YOU'LL DO THOSE, YOU GUYS
WILL BE IN GREAT SHAPE.

IF YOU DON'T AND YOU'RE JUST
DOING IT, OH, IT'S GOING
TO BE SAD.

- IN YOUR SYLLABUS, YOU HAVE
THESE LITTLE GRADES LIKE
ROMAN NUMERALS,

THAT'S JUST FOR OUR PRACTICE
TO MAKE SURE WE GOT IT.

- UH-HUH. ON EVERY TEST, THERE
IS A ROMAN NUMERAL, EVERY
SINGLE TEST.

SO YOU'RE NOT
GOING TO BY LUCK GET IT.

EVERY TEST HAS
A HOUSEHOLD MEASURE.

WHICH ONE IT IS, I DON'T KNOW.
THERE'S A BUNCH OF TESTS.

AND SO I JUST PULL TWO OR THREE
FOR EACH SECTION AND SO IT'S
JUST WHATEVER I PULL.

I ROTATE THEM FROM SEMESTER TO
SEMESTER AND SO FORTH.

- THERE'S 25 QUESTIONS ON THEM.
- NO, 10. 10, IT'S NOT THAT BAD.

THIS IS WHAT THE TEST
LOOKS LIKE.

ACTUALLY, THERE'S 20 AND
THIS IS -- ACTUALLY, 19.

THE FIRST 10 QUESTIONS
ARE MATCHING,

AND THEY ARE WORTH
ONE POINT EACH.

BUT ACTUALLY, THE FIRST FIVE
ARE MULTIPLE CHOICE.

AND SO IT SAYS, LIKE,
ON A DOCTOR'S ORDER,

LASIX PO BID, AND
WHATEVER IS IN BOLD FACE,

YOU HAVE TO PICK THE MULTIPLE
CHOICE OF WHAT IT IS.
SO, BID IS?

- TWICE A DAY.

- IT'LL DAY, ONCE A DAY, TWICE
A DAY, THREE TIMES A DAY,
FOUR TIMES A DAY

AND YOU PICK THE
MULTIPLE CHOICE.

AND SO IT'S TO DO YOUR
ABBREVIATIONS ON THOSE FIRST 10.

FIVE ARE MULTIPLE CHOICE,
AND FIVE ARE MATCHING.

SO, GO OVER YOUR ABBREVIATIONS
LIKE WE'VE DONE.

WHAT'S OU?
- BOTH EYES.

- BOTH EYES. OS?
- LEFT.

- LEFT EYE. PC?
- PUPILS?

- UH-UH. AFTER, AFTER.
P IS AFTER A. P IS AFTER A.

A IS BEFORE. P IS AFTER A. SO A
IS BEFORE, P IS AFTER, AC?

- AIR-CONDITIONING.

- THE FOUR MEALS -- I THINK WE
COULD USE SOME IN THIS WONDERFUL
SPRING WEATHER.

I WAS TALKING TO A FACULTY NOT
EVEN FROM OUR DEPARTMENT,
HE SAID,

"I HAVE SPRING FEVER SO BAD, I
GOT TO GET OUT OF HERE."

I SAID, "I KNOW, AND EASTER
BREAK IS NOT FOR A WHILE."

SO, WE GOT TO GET TO WORK.

LET'S SEE, WHAT
ELSE IS THERE? Q?

- HOURLY.

- QH?
- EVERY HOUR.

- HS?
- HOURS OF SLEEP.

- PRN?
- AS NEEDED.

- STAT?
- RIGHT AWAY.

- OKAY, JUST REVIEW THOSE AND
MAKE SURE YOU'RE FEELING PRETTY
GOOD ABOUT THOSE ABBREVIATIONS.

THAT'S THE FIRST 10. THOSE ARE
MY GIFT TO YOU, ONE POINT EACH.

OKAY, SO THAT'S 10 OUT OF 90.
THEN YOU HAVE NINE QUESTIONS.

EIGHT OF THEM ARE
STRAIGHTFORWARD CONVERSIONS.

THE DOCTOR ORDERED THIS,
YOU HAVE THAT.

NO, LET ME TAKE THAT BACK.

SIX OF THEM ARE THAT.

THEN ONE OF THEM IS THAT KIND
THAT SAYS, YOU'RE THE
CAMP NURSE,

AND YOU HAVE A PINT OF PEPTO
BISMOL AND A DOSE IS
A TABLESPOON.

OR YOU HAVE EIGHT OUNCES OF
KAOPECTATE AND ONE TEASPOON
IS THE DOSE.

HOW MANY DOSES PER CONTAINER?

OKAY. PUT EVERYTHING INTO
MILLILITERS AND DIVIDE YOUR
PART INTO YOUR WHOLE.

WE'RE GOING TO DO
ONE MORE HERE TODAY, OKAY?

AND THEN FINALLY, YOU HAVE
A QUESTION

THAT IS THE POUNDS, KILOGRAMS
KIND OF CONVERSION DEAL.

AND THAT'S IT. NO SURPRISES, NO
TRICKS, STRAIGHTFORWARD.

BUT IN THOSE, YOU'LL HAVE A
GRAIN, YOU'LL HAVE A MILLIGRAM,

YOU'LL HAVE A ROMAN NUMERAL AND
YOU'LL HAVE A HOUSEHOLD MEASURE.
IN EACH ONE. ALRIGHT.