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Thursday, August 16, 2012

RT Cheat Sheets are illegal???

So the purpose of ISO and JAYCO is to make sure that quality is met and that the hospital meets a certain set of criteria.  While I'm not familiar with JAYCO, ISO has a policy that only forms approved by the institution may be available tot he staff in the hospital.

This is a policy that I have great exception to, as I believe the policy itself is the antithesis of good quality to patient care.  I believe that having cheat sheets available to clinicians if among the best methods of obtaining the best quality.

Especially under stressful situations it's nice to have a handy cheat sheet to use as reference.  One particular area I find a cheat sheet useful is when it comes to managing neonates who are in respiratory distress.

Considering we rarely get such patients, it's nice to have a reference to help one decide the following:

  • What size ETT is best
  • The best place to secure the ETT
  • The best pressure support
  • The ideal tidal volumes
So your humble RT created such a cheat sheet, and it has become readily available and used by the rest of the RT staff where I work.  I even have it on this blog here.

Yet recently I redid my cheat sheet so that it will be available in pocket size form.  My coworker and I were sitting around deciding what colors to use, when my boss came around.  He said, "Now, if you're going to use these they need to be approved by the forms committee."

I said, "We dont' plan on leaving it lying around, we're just going to have it in our pockets so we can be better therapists when we have a sick baby."

"It doesn't matter," he said, "If a baby dies and ISO finds that you used one of your cheat sheets, they could say that your cheat sheet wasn't approved and impacted the quality of the patient's care."

I rebutted this by saying, "Yes, but the situation you describe would never happen.  If anything, the opposite.  Not having the cheat sheet will decrease the quality of patient care and increase the risk of causing damage to the baby.  It's only common sense that you let us use these.  It's only common sense that ISO would want us to use these."

I have have carried a sample pocket sized cheat sheet in my pocket the past eight years, and so have many of my coworkers.  The boss said we can't. He said ISO officials can make us flip our pockets out.  I said, "If they do that I will refuse."  My coworkers agreed with me.  

Yet we lost the battle.  The cheat sheet probably won't pass forms committee because the information on my cheat sheet come from an variety of sources, I just put them together in a neat little package.  To find my sources and determine where they came from would be too much work and I'm not going to do it.

Despite this unfortunate situation, my coworker and I are proceeding with our efforts.  We will print out the new cheat sheets, laminate them and give them to all our coworkers as a nice little Christmas gift."

The irony of this entire situation is I gave this same boss a copy of my cheat sheet five different times over the past eight years to get it approved by forms committee so we could put a copy of it wherever we needed it:  in OB and ER.  Yet he ignored our requests every time.  

This is just more proof of the idiocy of ISO and what's wrong with the medical industry.


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