The IHI held another conference call recently on “How Do I Communicate With My Team Effectively?” This time I dialed in. It was pretty cool. The call was a little heavy on theory (when I’m stuck in a communication problem, I’m not gonna think, “oh yeah: S-BAR!”), but it had a lot of really good tips. Get the audio or a transcript here.

They’ve got forums and stuff too. I think they’ve got a good thing going here and hope they get support to keep going; they’re moving in a good direction for helping students get a leg up with the trickier personal and interpersonal aspects of becoming a health care professional. Check it out.

The Joint Commission has released a sentinel event alert, Behaviors that undermine a culture of safety, that addresses issues near and dear to my heart, as regular readers will know. Effective January 2009, the Joint Commission has added two leadership initiatives that address “disruptive and inappropriate behavior.” Why? It leads to sentinel events (a sentinel event is “is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof”)! Not only does disruptive behavior ultimately expose health care institutions to lawsuits—

“Studies link patient complaints about unprofessional, disruptive behaviors and malpractice risk.”

but it also increases costs and decreases staff retention (relevant because, if you haven’t heard, there’s a nursing shortage):

“Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”

Basically, The Joint Commission is adding to our duties as health care providers to grow backbones and address bad behavior like adults instead of bitching about it to people who can’t do anything about it. They’re guilting us into it by reminding us that we really are all grownups and that patient safety and outcomes are at stake—as well they should!

It is interesting that bickering and back-stabbing in hospitals have reached a level critical enough to invite Joint Commission initiatives. My unit at work is emphasizing this lately, and oh boy does it need to. Our nursing director has even instituted a hand signal (a “talk to the hand” kind of dealio) that we should use when someone is gossiping or behaving inappropriately. We had a mandatory staff meeting on acting like adults.

Let us remember that it’s not just our egos and our comfort in the workplace at stake when folks aren’t getting along; miscommunication or noncommunication as a result of fear, anger, or simple pique could cause our next error that leads to patient harm. Yikes.

My friend L recently asked me what podcasts were, so since then I’ve been meaning to toss up a few pearls on the subject. Happily, there is a “Plain English” YouTube video that takes care of that for me:

My boyfriend even listens to podcasts on his (formerly my) iPod Shuffle. He fervently resisted the iPod and burned podcasts to a rewritable CD every morning for a long time, but finally he caved and can now be seen with the Shuffle clipped to his shirt pocket at all times. He listens to stuff like Air America. I should note that although almost all podcasts are free, occasionally content requires a subscription (I think Air America does).

I listen to mostly Mac and technology stuff: I know readers will be stunned by this. The point is that there are so many podcasts out there than pretty much anyone can find some that fulfill personal interests. I think the easiest way to listen to podcasts involves iTunes and an iPod (if you have a Shuffle, it won’t autodownload to your device; just drag the podcast over to the Shuffle icon). Just go to the iTunes store, go to podcasts, and browse. When you find one you like, subscribe to it, and iTunes will download the latest episodes automatically. Otherwise, there are giant podcast sites such as Podcast Alley and other cross-platform podcast aggregators such as Lemon. Podcast Alley has info and directions for various situations. Depending on your platform, desktop player, and portable player, instructions will vary, but for all situations the basics will include subscribing to a podcast and arranging for downloads, then, if you want it on a portable player, getting the podcast to the player. It is not complicated even though there are a few steps involved.

Podcasts rule. For once, I thought they sounded cool right from the beginning (normally I am dubious about revolutionary new things). You can even get video podcasts for, eg, National Geographic or the Comedy Channel.

I spend a lot of time looking at photos online: mostly in Flickr and Facebook. I spend so much time doing this that I have been bitter for a long time about the annoyingness of the interfaces. You have to page through little thumbnails, and if you want to look at a bigger picture you have to click and then wait. I’m not the only one annoyed by this because people have used the Flickr API, in particular, to create tools to get around it (see a comprehensive list at The Great Flickr Tools Collection). For the Mac in particular I have used Flickr Finder (free) and Photonic ($25). Both are an improvement over the Flickr Web interface, but they have serious drawbacks. Flickr Finder, for me, wasn’t all that intuitive for browsing, so I ended up rarely using it; Photonic is really impressive, but after any duration of use I noticed that the photos, well, flicker when they are loading. I felt the onset of epilepsy looming. Plus, those two tools, although worthy, did not conquer the Facebook problem, and that is significant because now a majority of my personal friends post their photos to Facebook rather than Flickr.

Enter PicLens (subtitle: “Immersive Views Across the Web”). PicLens is an add-on for Firefox, IE, and Safari and does work with the new Firefox 3. It works with Windows and Mac, but I see no love for Linux as of yet. I was going to make a cool screencast, but there’s already one on the PicLens Web site here. Scroll to the bottom of the page to see the currently supported sites. They include Flickr, Facebook, Google image search, and YouTube, and those seem to be the big three, at least in the World According to Me.

PicLens finally allows me to easily browse photo pools and sets easily and within my browser so I don’t have to mess with external software. There are several viewing options, and if you don’t like one I suggest playing around with them. The super cool-looking 3D bouncy wall caused me to become vomitose with motion sickness, for example. I’m loving this plug-in and hope more Web sites start enabling it. And did I mention it’s free? Go get some PicLens love and enter the war against paging!

I know everyone is all jacked up about the iPhone 3G today, but (a) I have a BlackBerry, (b) no one can get their iPhone 3G to work right, and (c) Mobile Me is still behaving like my dog, meaning it works when it feels like it and at no other time. So I’m going to buck the trend and write about our new Wii (photo from CNET). In case you are living under a rock, as I evidently was until the last few weeks, you’ve heard that the Wii is the latest and greatest from Nintendo: it somehow has motion sensors in the Wii remote controller widget that allow you to steer and do stuff by moving the controller itself, as opposed to the old paradigm of pushing buttons on a controller. People were all abuzz on Twitter tweeting about the Wii Fit, which has a balance board and basically lets you work out with your Wii. That sounded pretty cool, so I investigated, and I finally told the boyfriend that we should get a Wii. He said no, but then he started thinking about it, and we set out to buy one.

They are sold out. EVERYWHERE. For real! Everyone wants a Wii! And they’re not even new. Weird. I signed up for wiialerts.com and that worked. I got a text message, immediately signed into Amazon, and got the last one still in stock. We got a Wii Fit bundle, and we rented Mario Kart from Family Video, so last night we had Wii Sports, Wii Fit, and Mario Kart to play with. Wicked cool!

The boyfriend is bored by Wii Sports, but I groove on the boxing. You can practice with a punching bag, and I like boxing so this is ideal. When I use a for-real punching bag, I immediately injure myself, but the virtual one is fab. The other sports are so-so fun. Wii Fit is wicked cool, as expected. You have to step through a bunch of boring introductory stuff, but it’s fun and I actually worked up a sweat and got out of breath, which surprised me because it looks like mamby-pamby stuff. But Mario Kart could destroy my life by causing me to do nothing else: you get a little steering wheel and use it to race around tracks. You can pick way more characters and cars/bikes than in previous versions, and it is soooooooo fun. I hypothesize the imminent purchase of this game and a spare Wii remote to allow a two-player game!

Soup bowl

Originally uploaded by notratched

I don’t think I’ve ever blogged about food before, exactly, but I’m so excited about this find that I had to share. I found these soup bowls at Target for $2.99 (yeah: expensive but I pay at least that much for junk food for lunch otherwise at work). Brand name is Annie Chun. These things are saving my life when I am so tired I can’t coordinate myself to cook. I’m so excited to find food that is actually healthy and can be prepared almost instantly…like 3 minutes tops. And did I mention they’re vegetarian? It’s so exciting!

Before and after a hip replacement

Originally uploaded by photocillin

LOL we should have this sign on my unit at work. What on earth would cause this combination of signs?

Just a quick entry before I enter back into the fray for another day. I woke up yesterday feeling RESTED for the first time since April—I’m not even exaggerating. I don’t feel that way today, but I have hope that eventually I will be rid of damn mono. The day was so busy it passed in a flash, and I saw the worst wounds I could have imagined…yikes. I would have probably had a terrible day except I was working with a super RN. I was taking mental notes all day on the topic of “how to work well with your aide.” After today, I have nearly 2 weeks off…finally, a mini vacation! I’m so excited!

This post is a follow-up to my previous post Witch Hunts in the Hospital. This morning I listened to an audio program from the Institute for Healthcare Improvement’s Open School for Health Professions; it is called “What is it like to be trapped in an error?” and you can download the audio or a transcript here. The IHI’s ideas are new to me (admit mistakes? encourage openness about mistakes? mistakes are GOING to happen? medical errors involve TWO victims—the patient and the provider?) and extremely eye opening. The entire thing rang true to me and lit a fire under me to wave the banner of stopping hospital witch hunts.

Currently, I rarely learn from other folks’ mistakes because everything is hushed up. No one learns from mine because as soon as the error is discovered it is hushed up. I’ve committed only one BAD error, but I don’t even have my license yet. I live in constant dread of the next one. I felt a little vindicated to hear the program mentioned above, because it emphasizes the systemic and human-related aspects of errors. I had no idea that there was actually a science of investigating and preventing health care errors. It is helpful to feel that a framework exists to help combat that constant fear of making a bad mistake.

In addition, I was gloomily happy to hear that other people, too, are horrified by their errors. The other people involved in “my” error appeared to blow it off, and outsiders who got the HIPAA-fied version of the story unilaterally said, “Learn from it and move on.” I was really upset: when I got home from work that day, I sat under a hot shower and cried for a long time, and after that I went to bed feeling that I was unsafe as a patient-care provider and had made a horrible choice for a career. I felt like a freak for being that upset when no one else appeared to be. However, the folks in this audio discussion admitted that they were also very upset when they made bad mistakes (the nurse says she felt like she was going to throw up), and this helps.

It would be so much easier to navigate errors and use them to improve patient care if we could somehow promote openness, remove punitive witch hunts and gossip, and be honest with each other. My one incident occurred a while back, and still no one has asked me a single question about what happened. I even went to my boss recently to volunteer the information because there are elements about it that could be easily used to prevent a repeat, and she didn’t want to discuss it. It’s just weird.

Anyone have any comments on this? Is this a top-down or bottom-up change? How can we start? What can one nurse do? Redoubling our efforts is good but ultimately leads to exhaustion. I don’t think it’s enough.

I am gimpy. I have included a scintillating photo of my badly infected little toe. My camera couldn’t really capture how bad it looks…without the flash, the toe is going blue with red on the edges. Still, readers with discerning eyes can see the line near the top of the toe where the infection is spreading. It has gone around the top of my foot and down the side. It hurts! I don’t mind admitting that I’m very nervous about this. I have seen folks in the hospital for IV antibiotics for stuff that starts exactly like this. I’m taking high-dose Bactrim for 10 days. How I’m going to work four shifts next week is beyond me, but I’m going to worry about that in a few days. This started as just a blister!

Meanwhile, in other news, my laptop returned good as new via overnight air FedEx the other day. I restored from my SuperDuper drive and was back the way I started. Apple breathed not a word regarding possible hypotheses for the strange and sudden failure of the old hard drive.

I keep thinking I should be feverishly studying for the NCLEX, but I can’t do it. I have to stand behind myself with a cattle prod just to go to work because I’m so burned out and tired (damn mono still hanging on)—the thought of a new semester and boards is insupportable. We’ve been really busy at work, so tempers have been running a little hot. It is difficult for me to work when I’m tired AND getting snapped at for no good reason, and it’s difficult to remember that my co-workers are probably feeling exactly the same. We have an IV therapist whose attitude I admire. He always has a smile and a cheerful quip no matter how busy and tired he is. Yesterday I told him so, and he told me that when he starts feeling tired and stressed out, he talks to a patient for just a few minutes to remind himself that he isn’t having that bad of a day after all. I wanna be just like him!