Abbreviations

Today's abbreviation is one of the hardest ones to recognize when dealing with medical records.  This is because like many of the difficult abbreviations it means something else outside of the medical records and it looks strange in the medical record.

Without further ado:



AKA - above the knee amputation.

It is a surgical procedure or an incident as well as a condition after the fact.  It normally is NOT something that people miss about clients, but sometimes they do, and having a nurse examine the medical record can note things like the patient coming back from a surgical procedure and the staff documenting a pulse in a non- existent leg.


Examples

Pt. with hx of AKA

Pt required AKA of left leg after traumatic injury.

Gendel Family Favorites: Turkey Cake

Today's recipe has been a Thanksgiving staple in our family since 1985.  I know the year, because I found the copy of the recipe that this is based off of.  The recipe is courtesy of Pillsbury and the little magazines that they have at the checkout counter.

This is a super simple Turkey Cake and lots of fun at a Thanksgiving Celebration. Although I've taken it out of the pan, many years, and in fact in the original recipe, you can just serve it in the pan, saving a step.

Turkey Cake

Cake
1 pkg cake mix - I use chocolate cause thats my favorite
1 c. water
1/3 c. vegetable oil
3 eggs

Frosting
1 container white frosting
2 drops red food coloring
2 drops yellow food coloring (or orange food gel instead of the above coloring)
Candy Corn
2 yellow and 1 red gumdrop
Chocolate Sprinkles
Mini Chocolate Chip
Sugar

1. Prepare the cake per the instructions on the package and allow to cool completely.
2. Reserve 2 tablespoons of the white frosting and frost the cake with the remaining frosting.
3. Using food coloring or gel color the remaining frosting and set aside.
4. Trace a turkey shape on the frosting. Usually we just draw an approximation, but for more artistic sorts email me and I'll send you a copy.
5. Frost the head with the remaining orange frosting.
6. Fill in the tail area and wing based on the picture with candy corn in overlapping layers to form the wing and tail.
7. Fill the body with chocolate sprinkles. This takes a little bit of patience but it's really not that difficult to get the sprinkles to stay in the line if you traced your turkey first. Pour them in the middle near the wing and tail and move them to the edge.
8. On a sugared surface roll out the red gumdrop in the shape of a tear drop and use for the snood. Roll out the yellow gumdrops and cut a little peace symbol out for the legs. Place both on the turkey.
9. Place the mini chocolate chip for the eye
10. ENJOY!!!

Falls- The final week.

The most serious thing that can happen after a patient falls is that they die as a direct result of the fall.

In my opinion the second most serious complication that a patient can suffer after a fall doesn't usually occur right after the fall, but in the months after the fall. This is the development of pressure ulcers, and the myriad of complications that may occur as a result of the development of pressure ulcers.

Sometimes the fall is an innocent non negligent cause, such as an normally ambulatory person falling because they tripped, or had a syncopal episode.  Now the person is bed ridden and dependent on staff for their care.  This is when the person is at increased risk for pressure ulcers.

The reasons for the development of pressure ulcers are different for each client and facility.  Sometimes they're as simple as a wet diaper left on a little too long, and they heal rather quickly without any damage, but sometimes they're more complex.

That's where it becomes necessary to read the medical records to understand why a pressure ulcer had formed in a particular client and whether or not the staff is negligent in the care.

Over the next couple of weeks we'll focus first on the general causes of pressure ulcers that are non-negligent and then we'll transition into how some of the various diseases that the clients are diagnosed with affect healing.

Abbreviations

Since I've been focusing on falls for my Tuesday disease process feature, I thought I'd focus on one of the few abbreviations that occur in the medical record that can be problematic when patients are at high risk for falls.

BRP - Bathroom Privileges

Bathroom privileges means that someone has determined that the patient is not at medical risk to ambulate to and from the bathroom to their bed, but should be in bed or the chair the rest of the time. It means they should NOT be up ambulating in the hall unassisted.

This particular order is really common in the prenatal care area and in the geriatric populations. In the geriatric populations as with the prenatal populations, the patient is usually very sick or hooked up to several machines so going any distance is difficult with out assistance.

As you can see, from both populations where this is common, it is likely that they're off balance for some reason and ambulating long distances is a bad idea.

Example

Activity Level: BRP

Pt has BRP, pt has been seen ambulating several times in the hall without assistance, able to be redirected.

Gendel Family Favorites: Barb's Mac and Cheese

This is a recipe that at least 3 generations have made now.  My Grandmother made this recipe, my Mom made this recipe and now I make this recipe.

When I was growing up my Mom would make this for me and my friends.  It became an oft requested recipe, and I know at least one of  my friends has made it for visitors and she will be making it for her own child when he's old enough. When my friend's would request it, they would request it as Barb's Mac and Cheese, which is how it got its name.

Without further ado- I present you:

Barb's Mac and Cheese

Ingredients

7 oz macaroni noodles (I like Cremette)
8 oz cheddar cheese
32 oz milk (1 quart)
1 egg
salt and pepper to taste
bread crumbs (optional)

1. Preheat oven to 350 degrees.
2. While the oven is preheating boil the noodles per package instructions to al dente and drain.
3. Grease a 13x9 pan
4. Combine milk, cheddar cheese, and egg in a large bowl.
5. Add the drained noodles to the bowl, mix well, and transfer to the pan.
6. Top with bread crumbs if using
7. Bake for 1 hour or until set.
8. Slice and enjoy.

Falls

Last week I focused on an unusual fall. This week, I'll focus on a more common cause of falls.

When reviewing a record it is more likely than not that a fall will occur shortly after admission, an illness, or a readmission because these mark changes in the routine.

It is common for patients who cannot to attempt to ambulate to be found a few times before they fall half off the bed, or sitting up, or even ambulating.  Many times a bed alarm is ordered and that is the last time that the bed alarm is mentioned. The patient then falls and the note reads as below:

Nurse heard patient calling out.  Nurse went to room and found patient on the floor. Patient unable to tell nurse how patient ended up on the floor. Pt. MAE. Pt assisted back to bed and physician notified. NNO at this time.

After this the incident report will frequently record that the patient had a bed alarm in place and it was functioning, but outside of the physicians order there will be no documentation of the bed alarm in place and functioning each shift. As you can see the date of the above fall the bed alarm was not in place and functioning.

Unfortunately without the assistance of a nurse it can be hard to see all the potential problems involved in a fall.

We will focus on falls for one additional week before we move on to pressure ulcers. 

Abbreviations

There are approximately  10 abbreviations that the Joint Commission calls DO NOT USE abbreviations.  They are abbreviations that can be confusing even within the medical community and result in over doses, under doses, and/or medication administered to the wrong body part.
However, such as this week there are a number of other abbreviations that should ALWAYS be written out and many hospitals require it.

mcg-- microgram. 

The Joint Commission does not officially list this on their abbreviation list as we've gone to more computer generated writing and the latin or greek letter (mu) is not an easily accessible keyboard option. However when things are handwritten, in orders especially, this can be confused for milligrams resulting in a dose that can be over 1000x what the order was written for.

There was a recent news piece about a child in Boston who received a deadly amount of his cancer drug because of a mistake like the one described above.  It is always best to be in the habit of fully writing out the word microgram and NEVER using the abbreviation.

Best practice is to write it out EVERY time which makes it harder to misinterpret. The FDA as well as other regulatory agencies have determined this to be best practice even in non-human medical areas including veterinary medicine.


Example:
Forteo 20mcg SQ QD -- Forteo 20 micrograms sub-q every day

Drug X to be administered at 50 micrograms/kg/day

Gendel Family Favorites: Blueberry Muffins

The first Gendel Family Favorite is a breakfast Recipe.  Next week we'll have a side, then a Thanksgiving themed dessert, and finally a holiday season drink.

This is my all time favorite recipe.  For those of you who don't know, I normally don't like blueberries. I don't know why I just don't like them. But I go out of my way for these. These muffins have been part of our Thanksgiving, Christmas, and New Year's Day breakfasts for all but a few years (when the cookbook went briefly missing) for most of my life.

Because these are so unique I had to take all the pictures.

 From Muffins by Elizabeth Alston
The Best Blueberry Muffin 

Elizabeth says- Bursting with berries, these are the best blueberry muffins of all. The secret is an extra half cup of blueberries which are mashed, and then added to the batter.

My mom and I were discussing these ahead of this post and we agreed. These are muffins that remind of us of Smurfs. Smurf muffins. A couple of things to know- we at our house to my knowledge have NEVER made these with fresh blueberries, we've always used frozen so we've always used the full amount of sugar.

Ingredients:

1/2 cup (1 stick) butter at room temperature
1 cup granulated sugar or slightly less depending on the tartness of the berries
2 large eggs
1 teaspoon vanilla extract
2 teaspoons baking powder
1/4 teaspoon salt
2 1/2 cups blueberries (mash 1/2 cup with a fork) Thaw the half cup- makes mashing easier. 
2 cups all purpose flour
1/2 cup milk
1 tablespoon sugar mixed with 1/4 teaspoon ground nutmeg we usually leave this part off but it can add a nice touch. 

Instructions:

1. Heat oven to 375 degrees. Grease 12 regular muffin cups, including the area between each cup, or use foil baking cups.

2.  In a medium size bowl, beat butter until creamy. Beat in the sugar until pale and fluffy. Beat in eggs, one at a time. Beat in vanilla, baking powder and salt.

3. Mix mashed berries into batter.

4. Fold in half the flour with a spatula then half the milk. Add the remaining flour and milk. Fold in remaining blueberries.

5. Scoop batter into muffin cups. Sprinkle with nutmeg sugar.

6. Bake 25 to 30 minutes, or until golden brown (They will turn golden brown). Let muffins cool at least 30 minutes in the pan before removing. Enjoy slightly warm.

Falls STILL (There's lots to say on this)

I could have written one very long blog post on falls, but I wasn't particularly interested in overwhelming you with all of the information rather I was interested in providing short bites about falls that can be processed each week.  

I was gonna take a break from falls but can't remember what I was going to talk about so we'll keep going on falls anyway. 

Today we're going to focus on falling out the window.  Another story that's stuck with me.  The woman suffered from a diagnosis of dementia.  She resided on a locked second floor unit of a local nursing home.  She had decided that she needed to go to the grocery store.  She couldn't get off the unit through the door, so she went to her room to attempt to open the window.  The window opened so she climbed out the window, falling to the bushes below. 

Thankfully she only suffered a broken arm. 

When the state investigated what happened they found that the unit was in disrepair.  The little device that stops the window from opening at 4 inches was missing.  It was found that the staff knew that the window opened wider than four inches and failed to repair the window to prevent the client from leaving via the window and harming herself. 

In this case the staff was very lucky that the client did not hurt herself more severely than a broken arm, but it is clear that they failed to provide a safe environment.  

This would have been a difficult case, except for the reporting to the state and the state doing a thorough investigation.  Because they did the investigation it was found that the cause of the fall was the window being in disrepair, and that the staff knew the window was in disrepair, yet failed to do anything about it. Further the nursing staff failed to report up the chain of command that the maintenance staff failed to fix the window. 

After the state came in the window was fixed the next day but the damage was done. 

This is an uncomplicated fall out the window.  Usually they are more complicated than that and a nurse is needed to investigate the whys of a fall out the window.  Was there psychosis due to medication errors prior to the fall, or was there suicidal ideations (the expression of the desire to commit suicide and a concrete plan) without close and appropriate medical supervision before the fall. What was the outcome?  Nursing helps with all of these. 

Abbreviations

Today we have an abbreviation that is very common in medicine and really saves a lot of time for medical professionals.

S/P 

S/P stands for status post.  It means after. The information after the s/p in note indicates what kind of thing the patient is is after.


Examples:

S/P ORIF on 9/22. (Status post open reduction internal fixation on 9/22).

S/P colonoscopy with complications.