impressions and observations

Working in healthcare in the midst of a pandemic leads to many impressions and observations. Our number of COVID patients is slowly decreasing, but deaths are still rising. One bright spot is the 38 year old patient I mentioned in this post. Although many patients in similar situations haven't survived, it looks like this one might pull through! Then there's the patient who has been hospitalized since the beginning of April. He was on a ventilator for weeks, but finally began to recover. He was eventually moved out of critical care, but because of altered mental status and other complications was recently brought back to CCU. As lately as two days ago he'd been agitated and trying to climb out of bed. Today I heard he'd passed away. I don't have full access to patient information so I don't know what the actual cause of death was. To see someone near death fight for so long, gain ground, then regress, is disheartening. 

I mentioned in this post that we were using the anti-malarial drug hydroxychloroquine even though it hadn't been proven effective. President Trump has touted it as a cure for coronavirus and claims to be taking it. However, further studies have shown it to be ineffective against COVID-19 and because of potential harmful side effects, doctors are no longer recommending it. The most recent "miracle drug" for treating coronavirus is the antiviral Remdesivir. Currently the federal government controls which hospitals get this drug, based on data such as number of COVID cases and number of ventilated patients. We got our first supply last week, but it was only enough for one severely ill patient. Our hospital command center along with doctors involved in treating the sickest patients, decided who would get it. Again, this drug has not yet been proven effective although some studies have shown hopeful signs. The patient who received our first supply of Remdesivir did not improve or get worse for the first few days. He eventually began to further decline though, and passed away yesterday. In the meantime we received a larger shipment of drug and now have several patients on it. Time will tell if it actually works.

There was an incident in the ER on Sunday that made it into our local paper. A combative patient punched a nurse aide in the face, knocking him down and breaking his glasses. The patient was charged with assault, although the aide was not seriously injured. You can read the article here. I'm glad action was taken to protect the caregiver, because they often put up with abuse from patients. 

The weather has been delightful this week and I'm looking forward to being off all next week! We get two weeks of vacation every year, and I like to choose the end of May because it's one of the most beautiful times of the year in my opinion. I hope to spend lots of time outside, puttering around in my flowerbeds and soaking in the sunshine!

weekend work race

Today I nearly reached my breaking point. I was mentally prepared for a very intense weekend, but it still took a toll.

Last week one of the pharmacists who has been at St. Joe's over 20 years said he's never seen our IV room as busy as it's been the last while. During the week, a pharmacist and tech are in the clean room making IV's, but on the weekends it's just one tech. Yesterday and today it was my responsibility to make IV's for the entire hospital. The pharmacists helped by sending back drips before they were due so they'd be ready when the nurse requested them. We currently have 7 patients on a ventilator, and as I mentioned before, these patients are on multiple IV's for sedation. Some of them run at high rates so one bag might only last an hour or two. I have no idea how many drips I made over the last two days, but it was enough to give me blisters from manipulating a syringe! By lunchtime today I had almost more than I could take and a few tears were shed, but after a 30 minute break I was ready to tackle the rest of the day! When you're making drips as fast as you can but there's always more to do, it starts feeling like no matter how hard you try, you haven't accomplished anything. The second shift tech came in at 3:30 and helped out, and I stayed over an hour late. Finally I asked a pharmacist to take over so I could leave.

When making IV's, one thing that's very important is that no foreign objects or particles somehow get into the drug. One way this can happen is when you "core" a vial. Sometimes a small piece of the rubber stopper of a vial is sheared off as the needle passes through. These pieces can be very tiny and almost unnoticeable. The pharmacist who checks the final product may not see it. At two different times today I happened to notice a vial had been cored. Once it was after 200 milliliters of propofol had been injected into a bag. The way to fix this problem is to drain the entire contents through a filter needle. A drug flows very slowly through a filter needle and in the time it takes I could've probably made a whole new bag. Very likely I could have let it go and the pharmacist wouldn't have seen it. You simply cannot cut corners when a patient's safety is at risk, though.

Thankfully I'm off tomorrow so the weekend stress can be forgotten by the time I go back to work on Tuesday!

of drugs and dying

Things continue to be much the same with the COVID situation at work. Our IV room has experienced a huge surge in the amount of stat IV's made, and at times can hardly keep up with the demand for sedatives for vented patients. To make one bag of fentanyl, for example, nine 2 mL vials have to be opened and punctured. Just taking a guess, we probably make at least 25 bags in an 8 hour shift.

This is the type of vial we are currently using. Before the cap can be snapped off, the perforated top part of the wrapper has to be peeled off. Those little details are time consuming and slow down the process. The clean room workers appreciate when the ante room tech peels the stickers off before sending the drug back. Today I was the ante room tech, and at one time I peeled off the stickers on 108 vials to make 12 bags of fentanyl.

This is another type of vial, called an ampule, we had. They are also time-consuming to open and draw the drug from. The ampule is glass and since the tops are snapped off, there is potential for glass shards to be in the drug. We use a filter needle, which traps particles, when drawing out of an ampule. The needle is then changed before injecting the drug into an IV bag.

In the last week we've had several patients who work at the same local facility admitted with COVID. This is alarming and shows what can happen in workplaces once someone gets the virus. One of those patients, who was only 58, passed away today. Hearing that saddens everyone. We prepared many IV's for her in the short time she spent in critical care. I have full confidence in the elderly pulmonologist who is the intensivist (doctor who provides care for critical patients). I've seen respiratory therapists and nurses doing their jobs with their best ability. Yet all that effort can't save a life. There's another patient in critical care (employed by the same company) who is only 38 and in very grave condition. You can tell once certain drugs are being used that an all-out effort is being made to keep someone's body from shutting down. For example, when someone's kidneys are failing, they might be put on CRRT (continuous renal replacement therapy) a type of 24 hour dialysis which does the work of the kidneys. I can't remember anyone who recovered after being on CRRT.

The tone of this blog has been negative and I don't want it to end that way so I'll mention some more uplifting events. These things brighten a work atmosphere!

• Seeing a brand new baby on a trip to the birthing center
• Same baby announcing a set of strong, healthy lungs to anyone within earshot 
• Helping a patient get their meds quickly
• "Thank you" from a tired, hardworking nurse 
• Support from the community in the form of drive by's, donations, and food for healthcare workers