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Pediatric Emergency Drug Calculator: Great Idea, Not Ready For Prime Time

Photo Jun 12, 10 15 47 PM Pediatric Emergency Drugs is designed to be a quick med list calculator for pediatric emergencies. For folks who deal with pediatric emergencies have the challenge of not only determining the proper drugs to use, but also to get the dosage right by age.

At the first page you are met with a screen to enter the age of the child and either allow the program to pick the estimated weight or put your own weight in. This is a nice feature as often in pediatric emergencies patients arrive through the door needing immediate care and a weight is unavailable. The estimated weight it appears to pick is the 50% for a boy of the selected age. Allowing you to pick the gender of the child would be helpful in narrowing down the weight a little further since girls of a given age would weigh a little less.  Another option would be to allow the use of Broselow colors. These days the standard for most ERs is the Broselow tape which is a plastic foldable tape that doses based on length.

Once you select your patient you have a section of drugs broken down into: cardiac arrest meds, infusions, and bolus drugs. The cardiac arrest meds are short a few drugs. There are no drugs for treating ventricular fibrillation (amiodarone)  and they do not make mention of the dose of electricity for synchronized cardioversion (only for defibrillation). The infusion list assumes you are mixing all drugs in 50mL bags which is not usually the case. (we usually use 100 or 250mL bags for drips). Also, in America thanks to JCAHO regs medicated infusions need to be have standardized concentrations and not use the “rule of 6” employed by this program. The list of bolus drugs is missing a few key drugs as well such as midazolam and hydrocortisone for sepsis. Read more »

*This blog post was originally published at iMedicalApps*

Hospitals Planning To Punish Docs Who Don’t Help Them Get Paid

Over at the WSJ Health Blog, some academic docs, such as hospitalist Dr. Wachter are suggesting just that.

Punishments such as revoking privileges for a chunk of time tend to be used for administrative infractions that cost the hospital money – things like failing to sign the discharge summaries that insurance companies require to pay the hospital bill. By contrast, hospital administrators may just shrug their shoulders when it comes to doctors who fail or refuse to follow rules like a “time out” before surgery to avoid operating on the wrong body part.

Docs and nurses who fail to follow rules about hand hygiene or patient handoffs should lose their privileges for a week, Pronovost and Wachter suggest. They recommend loss of privileges for two weeks for surgeons who who fail to perform a “time-out” before surgery or don’t mark the surgical site to prevent wrong-site surgery.

This couldn’t have come at a better time.  At Happy’s hospital there is a massive witch hunt to crack down on not signing off verbal orders within 48 hours.  This has nothing to do with patient safety.  It has everything to do with meeting the requirements of CMS  so the hospital does not lose their funding. Read more »

*This blog post was originally published at A Happy Hospitalist*

Why Is Food and Drink Prohibited At The Nurse’s Station?

Over the last several weeks I have received numerous emails dictating the enforcement of work place rules regarding eating and drinking in nursing areas and other areas with patient charts. It seems everyone, from the Chief of Staff to the CEO to the Head Nurse In Charge has been making it very clear that drinking in work areas won’t be tolerated. I have at times been confronted by dutiful staff doing their jobs with a robust sense of confidence to enforce this potentially dangerous patient safety issue.

Or so I thought. Whilst speaking with one of Happy’s friendly colleagues, I learned that the issue of food and drink in the work place has nothing to do with patient safety. Like my colleague stated so eloquently, if there is data that can be presented to me that shows my action of drinking coffee at the work stations would some how harm my patient, I will gladly stop immediately. Discussion finished.

But as I learned from my colleague, the issue of food and drink at the nurse’s station or anywhere near patient charts has nothing to do with patient safety. In fact, the regulations are in place to protect ME from myself.

That’s right, the coffee Nazis are cruising the halls with reckless abandonment searching for violators of the hospital wide coffee ban on rounds not because patients could be harmed, but because I could harm myself.

You see, it turns out my distinguished colleague was told these regulations were not CMS or JCAHO regulations, but rather OSHA regulations.

So I looked it up

“OSHA does not have a general prohibition against the consumption of beverages at hospital nursing stations. However, OSHA’s bloodborne pathogens standard prohibits the consumption of food and drink in areas in which work involving exposure or potential exposure to blood or other potentially infectious material takes place, or where the potential for contamination of work surfaces exists 29 CFR 1910.1030(d)(2)(ix). Also, under 29 CFR 1910.141(g)(2), employees shall not be allowed to consume food or beverages in any area exposed to a toxic material. While you state that beverages at the nursing station might have a lid or cover, the container may also become contaminated, resulting in unsuspected contamination of the hands.

Here are the actual OSHA regulations


Eating, drinking, smoking, applying cosmetics or lip balm, and handling contact lenses are prohibited in work areas where there is a reasonable likelihood of occupational exposure.


Eating and drinking areas. No employee shall be allowed to consume food or beverages in a toilet room nor in any area exposed to a toxic material.

In other words this is not a patient safety issue, but rather an employee safety issue. The Joint Commission has no specific standard on the issue other than for hospitals to comply with OSHA regulations.

So with that in mind, I have two comments regarding the issue:

  1. As a private practice physician who is not employed by the hospital, I would suggest that these OSHA rules do not apply to me and therefore the hospital risks no retribution for noncompliance from the accreditation arm of the Joint Commission, which is why I suspect the issue comes center stage for hospitals everywhere. If necessary, I will gladly sign a waiver to relinquish my rights to compensation should I ever contract a blood born pathogen or other communicable disease from drinking my coffee.
  2. If the hospital believes this is a patient safety issue and wishes to make their regulations stronger than those of OSHA and apply them to ALL people in areas with patient pathogens, I will gladly relinquish my daily fluids when I am shown the data regarding patient harm AND the hospital also bans all patient guests from bringing food or drink into the patient’s room. If this is a patient safety issue, it must apply to everyone should they wish to make their rules stronger than OSHA guidelines.

Until this is resolved with rational thought, perhaps over a round of coffee, I’m going to carry one of these around:

It always seems to work for patients.

*This blog post was originally published at A Happy Hospitalist*

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