RNchat Transcript June 30, 2010

rnchat: Attention Twitter Nurses! Remember to join us tonight at 9 PM EST for our weekly #RNchat where nurses share ideas about different topics! 6/30/2010 02:19 nursekama: @RNchat I'll b there! RT @RNchat: Join us tonight at 9 PM EST for our weekly #RNchat where nurses share ideas about different topics! 6/30/2010 03:17 EllenRichter: Twitter #Nurses! Mark your calendars! Tonight @ 9 PM EST join us for our weekly health care chat & share ideas with other RNs! #RNchat 6/30/2010 04:04 JoeCascio: @EllenRichter Hi there. Thanks for the reminder. #Nurses #RNchat 6/30/2010 04:07 EllenRichter: Attention Twitter Nurses! Remember to join us tonight at 9 PM EST for our weekly #RNchat where nurses share ideas about different topics! 6/30/2010 06:07 nursingpins: RT @rnchat: RT @daily_briefing: Nearly 2,000 Texas nurses voted to unionize, despite state's anti-union climate | http://bit.ly/bF8hGr #RNchat 6/30/2010 10:35 EdieBrous: RT @EllenRichter: Twitter RNs! Please RT & spread the word--tonight at 9 PM EST will be our weekly #RNchat hour where nurses meet online to share ideas! 6/30/2010 11:47 cerner: Survey: EHR Adoption Among Top 3 Concerns for Medical Practices http://bit.ly/aSLG1s #RNchat #HCSM 6/30/2010 12:42 EllenRichter: Don't forget! Tonight @ 9 PM EST I will moderate this week's session of #RNchat so come & join us! Lets hear what U have to say! :) 6/30/2010 13:11 LaurenWolfe: RT @cerner: RT @EAHolzhauer: Workplace Wellness Programs for Waistlines and Bottom Lines http://bit.ly/aKNoKP #RNchat #HCSM 6/30/2010 14:05 SaraRC1: RT @EllenRichter: Attention Twitter RNs! Spread the word! Two more hours until #RNchat tonight (Wednesday) at 9 PM EST ~Pull up a keyboard & join us! :) 6/30/2010 16:03 Aggiern95: RT @EllenRichter: Attention twttr RNs! Spread the wrd! 2 more hrs until #RNchat 2nite (Wednesday) at 9 PM EST (cont) http://tl.gd/27s0ad 6/30/2010 16:06 onlinenursing: RT @EllenRichter Don't forget!Tonight @ 9 PM EST I will moderate this week's session of #RNchat come & join us!Lets hear what U have to say! 6/30/2010 16:15 NUR3563: RT @EllenRichter Don't forget!Tonight @ 9 PM EST I will moderate this week's session of #RNchat come & join us!Lets hear what U have to say! 6/30/2010 16:15 EllenRichter: I'm finishing shift report & getting ready to drive home from the hospital now! Looking forward to joining our weekly #RNchat in 1 hour! :)

6/30/2010 17:01 incentive1: RT @cerner: RT @EAHolzhauer: Workplace Wellness Programs for Waistlines and Bottom Lines http://bit.ly/aKNoKP #RNchat #HCSM 6/30/2010 17:36 EllenRichter: Oooooh...I got home late from work! I must walk my dogs before #RNchat so bear with me! See you in 20 minutes! :) 6/30/2010 17:37 chemosabe: I'm ready when y'all are #rnchat 6/30/2010 17:49 nursingpins: I Found #RNchat but Will I Find a Nursing Position http://www.youtube.com/watch? v=Q15J8BlGKSQ #rnchat 6/30/2010 17:52 rnchat: Signing onto TweetGrid so that I can dust the room for tonite's #RNchat ....whew, boy was I rushing to make it JUST in time! :) 6/30/2010 17:55 rnchat: @chemosabe Hi out there, my friend! You at work again? :) #RNchat 6/30/2010 17:56 chemosabe: r we on yet #rnchat 6/30/2010 17:59 rnchat: LOL thank goodness I had enough time to make a fresh pot of coffee. I've been up 17 hrs & need a little boost! Looking forward to #RNchat 6/30/2010 17:59 rnchat: For those who may think this is @PhilBaumann tonite, its not! Its @EllenRichter filling in while Phil is busy being Phil! :) #RNchat 6/30/2010 18:01 rnchat: OK yes, @chemosabe we are on now. Its 9 PM & thats my start time tonight! :) Hi folks & welcome to our weekly #RNchat session! 6/30/2010 18:03 onlinenursing: Hey #RNChat friends. Terri here from MO (NP, Faculty, Student myself) 6/30/2010 18:03 nursekama: @rnchat Hello @EllenRichter, its been awhile since I've participated in #RNchat, looking forward to it this evening! #rnchat 6/30/2010 18:03 nursingpins: Hi Terri #rnchat 6/30/2010 18:03 rnchat: #RNchat is a way for nurses & all others in health care to meet, tweet & share feelings, thoughts & ideas~ We welcome silent lurkers! 6/30/2010 18:04 onlinenursing: Hi Ellen, Vernon, and @nursekama ....; @chemosabe... nice to meet you! #RNChat 6/30/2010 18:04 rnchat: I see all of you who joined us! Hi & welcome. Too hard to tweet each of your names now!

:) #RNchat 6/30/2010 18:05 rnchat: Seems like everyone knows the routine...but for anyone new, say hello & tell us a little about yourself! #RNchat 6/30/2010 18:05 chemosabe: Sorry Ellen and all, tyring to use work pc with old ie, having to do this via twitter it's self #rnchat 6/30/2010 18:06 rnchat: My name is Ellen & like Vernon, I'm a critical care nurse. I am in south Florida. I also work w/ lawyers as a Legal Nurse Consultant #RNchat 6/30/2010 18:06 rnchat: @chemosabe Hang in there. Try Twitterfall.com It works ok on the old systems (in my humble opinion) #RNchat 6/30/2010 18:07 chemosabe: hi i'm glen and the international participant at mo, @ work in Brisbane down under in day onc unit #rnchat 6/30/2010 18:07 rnchat: The topics will be labeled T1, T2, etc. Please remember to add topic label & hashtag #RNchat to ea tweet so we can track your responses! 6/30/2010 18:08 nursekama: My name is Kama and I'm an advanced practice nurse working in tertiary mental health care in southwestern Ontario. :) #rnchat 6/30/2010 18:09 rnchat: OK lets start with the first topic T1 #RNchat 6/30/2010 18:09 rnchat: T1 How do we educate pts, families & other health care professionals about end-of-life options that are more humane? #RNchat 6/30/2010 18:11 onlinenursing: @rnchat T1- great question. I try to do it, by laying out the options & discussing pain and QoL #RNChat. 6/30/2010 18:12 chemosabe: T1 oncology nurses could be accused of this frequently, particularly when haematologists are involved #rnchat 6/30/2010 18:14 rnchat: T1 I see end-stage pts get hospitalized with well-worded living wills yet DNR status is withheld by reluctant families #RNchat 6/30/2010 18:14 nursingpins: T1 Hospitals should offer ongoing EOL programs (Emps. and familys) but for the time being we must edu each family one at a time. #rnchat 6/30/2010 18:14 onlinenursing: T1 also love hospice. recently had pt. w/no health insurance,dying of CA. Could not get hospice-Very sad.Hospice RN's great eductrs #RNChat 6/30/2010 18:15

nursekama: @rnchat Interesting question for mental health areas...we sometimes have trouble bringing up end-of-life care w/ pts & family period #rnchat 6/30/2010 18:15 philbaumann: Hi #rnchat - I'm in SF and @doctoranonymous just took a compromising pic of me. ...Wait for et ;) 6/30/2010 18:15 rnchat: @nursingpins T1 Yes seems like its an uphill battle to be dealt with 1 family @ a time. We must make EOL care universally understood #RNchat 6/30/2010 18:16 rnchat: @philbaumann LOL ut oh...hope its not censored! :) Howdy in SF! Having fun, eh? #RNchat 6/30/2010 18:17 rnchat: @onlinenursing T1 Yes I love hospice philosophy too. It makes such sense. Shame that pt couldn't get it. Should be universal too! #RNchat 6/30/2010 18:18 chemosabe: T1 "why do they nail coffins shut?" #rnchat 6/30/2010 18:18 nursingpins: T1 EOL discussions must be started by med. team - still not discussed by most families - most have not even chosen a funeral home. #rnchat 6/30/2010 18:18 chemosabe: T1 "to keep the haematologists out" #rnchat 6/30/2010 18:18 rnchat: @nursingpins T1 We had a case last week where hospice consult written 6 days before family would consent. They just didnt understand #RNchat 6/30/2010 18:19 rnchat: @chemosabe We love all humor, no matter where it originates ;) #RNchat 6/30/2010 18:19 chemosabe: T1 saw a consumer post about this just today on macmillan.co.uk #rnchat 6/30/2010 18:20 onlinenursing: @chemosabe Or-why do wecontinue 2 torture terminal pts w/surg,tests,chemo?send me home,feed me chocolate/wine,let me be with my fam #RNChat 6/30/2010 18:20 rnchat: T1 Its very disheartening for a health care professional to keep doing interventions like bloodwork when its unnecessary & painful #RNchat 6/30/2010 18:21 chemosabe: actually that should be www.macmillan.org.uk #rnchat 6/30/2010 18:21 chemosabe: T1 sometimes family and patient r not ready to accept that there is nothing more to b done #rnchat 6/30/2010 18:22 onlinenursing: @rnchat I meant that last answer 4U.Hate 2 B moribid but death rate is 100%, 1 per person.We can either make it good death or not #RNChat 6/30/2010 18:22

nursingpins: T1 Hospice is in the position and most knowledgeable about EOL events - they could standardize the edu program? #rnchat 6/30/2010 18:23 onlinenursing: @chemosabe So true! #RNChat (not ready) 6/30/2010 18:23 rnchat: @nursekama T1 But suicidal thoughts doesnt mean terminal or end stage illness. Is EOL discussion appropriate with those patients? #RNchat 6/30/2010 18:23 pheroumenos: Daniel. hospice nurse. Relationships/education must be developed w/ community, referrers over time and must advocate in the now. #rnchat 6/30/2010 18:24 onlinenursing: RT @nursingpins: T1 Hospice is in the position and most knowledgeable about EOL events - they could standardize the edu program? #rnchat 6/30/2010 18:24 NUR3563: RT @nursingpins: T1 Hospice is in the position and most knowledgeable about EOL events - they could standardize the edu program? #rnchat 6/30/2010 18:24 rnchat: @onlinenursing T1 Oh I think we all understand what it means to want to go home, eat chocolate & drink wine if we are terminally ill #RNchat 6/30/2010 18:25 nursekama: @rnchat T1 No exactly, that was my point. But most hospitals mandate ALL clients must have EOL options documented in case of crisis. #rnchat 6/30/2010 18:25 chemosabe: T1 we used model of "shared care" so pt did not feel they were being dropped and txing team stayed involved #rnchat 6/30/2010 18:26 rnchat: @nursekama T1 Ohhh....ok I see. So its NOT appropriate with that diagnosis, but its mandated #RNchat 6/30/2010 18:26 rnchat: @chemosabe T1 Even in US hospitals, there are units that let hospice care write orders & the same staff cares for the patient #RNchat 6/30/2010 18:27 nursekama: @rnchat T1 With the increase of physical comorbidities within the mental health population I work w/, EOL options must be discussed. #rnchat 6/30/2010 18:27 rnchat: Ok 2 minutes til topic 2 (T2) :) #RNchat 6/30/2010 18:27 chemosabe: T1 again tho this started as not withdrawing agg tx in eol. cood b down to Dr or RN not willing to say no more #rnchat 6/30/2010 18:28 rnchat: T1 When was the "hospice concept" in health care first started....anyone know....just curious? #RNchat

6/30/2010 18:28 chemosabe: t1 some hlth pros too "soft" to b the villain & say "no more" #rnchat 6/30/2010 18:29 pheroumenos: Nursekama. T1. Seems determinant would be the degree to which EOL discussions promoted/exaccerbated self harm. #rnchat 6/30/2010 18:30 MatthewBrowning: T1 Florence Wald was the "Mother of Hospice" a CT and I believe Yale nurse ;-) http://bit.ly/9jTa9d #RNChat 6/30/2010 18:30 chemosabe: T1 Hospice goes back to the knights of St john in the ?1300's #rnchat 6/30/2010 18:30 rnchat: T1 Sadly, we still have physicians that do not want to sign a DNR form, claiming they do not feel the patient is "ready" for it #RNchat 6/30/2010 18:31 nursingpins: T1 I think hospice is the best thing adopted by w. medicine - it is still early for us and needs to be fine tuned. #rnchat 6/30/2010 18:31 rnchat: T1 I just recently read about (I think Montana) has the ability for doctors to write a lethal prescription for terminal patients #RNchat 6/30/2010 18:32 nursekama: @kidpsychnurse Just saw your message now: Tertiary health care defined http://bit.ly/92Xeq9 We're specialized mental health care #RNChat 6/30/2010 18:33 rnchat: @MatthewBrowning Nice link! Thanks! :) #RNchat 6/30/2010 18:33 MatthewBrowning: Actually a Dean of #Yale 's School of Nursing for a long time #RNChat 6/30/2010 18:34 nursingpins: T1 @rnchat I have seen many reluctant team members too - all members need more hospice education - many emotional blocks. #rnchat 6/30/2010 18:35 rnchat: Great contributions to T1....thanks everyone for good tweetin'---we could talk about this for hours! Moving on to T2 #RNchat 6/30/2010 18:35 rnchat: @physicianwriter Thanks for the link! Will read after the chat! Feeding pts with dementia via feeding tubes http://bit.ly/agw0Dv #RNchat 6/30/2010 18:37 rnchat: T2 Who can keep up with all the advances being made in pharma? What programs, tools, aids do you use @ work to get info on pt meds? #RNchat 6/30/2010 18:38 philbaumann: @onlinenursing @rnchat I'm having a good time. Definitely gotta get #rnchat out here! ;) 6/30/2010 18:38

rnchat: @philbaumann I'm trying! I think we need to have a Midnite EST chat to get the folks in Cali! :) #RNchat 6/30/2010 18:39 chemosabe: T2 diff downunda i'm sure, but, we rely on reps and participation in clin trials #rnchat 6/30/2010 18:40 MatthewBrowning: #rnchat LOL! RT @doctoranonymous: What happens in SF.... http://twitpic.com/21dd5f 6/30/2010 18:40 rnchat: T2 At my facility, our computer terminals all have Micromedex program which links us to 4 authoritative medication information sites #RNchat 6/30/2010 18:41 onlinenursing: @rnchat T2 -great question!!Pharm moving so fast.Better 2 know gen. drug classes than specifics. #RNCHat 6/30/2010 18:41 onlinenursing: RT @MatthewBrowning: #rnchat @doctoranonymous: What happens in SF.... http://twitpic.com/21dd5f BAW HA HA HA 6/30/2010 18:42 chemosabe: feeling paranoid, my line manager just emailled employers email and internet use policy #rnchat 6/30/2010 18:42 rnchat: T2 There isnt a day I work where I don't look up indications of a new drug or drug-drug IV compatibilities or side effects, etc #RNchat 6/30/2010 18:42 chemosabe: T2 my employer also has ckn (Clinical Knowledge Network), with jounral, monograph and pharma access #rnchat 6/30/2010 18:42 pheroumenos: T2. Use a drug guide for smart phone and Google. Hear girls waking, must go. Goodnight. #rnchat 6/30/2010 18:43 rnchat: @chemosabe The social media & internet use policy is circulating at my facility too. Dont get in trouble now!! #RNchat 6/30/2010 18:43 onlinenursing: #RNchat T2 - Also keep memberships 2 update with AANP, ANA, MONA, APNO, STTI (micromedex great idea! - any free software out there ?) 6/30/2010 18:43 nursingpins: T2 Hosp pharmacies are great help with existing orders - we need a quick ref. for major incomp. of new drug orders (standard ref. #rnchat 6/30/2010 18:43 rnchat: @PhilBaumann Love the picture!! Did you buy the shirt to match the phone case or visa versa!? :) #RNchat 6/30/2010 18:44 nursekama: T2 Hmm..we have Micromedex, Uptodate.com, Lexi-comp, eCPS with eTherapeutics, and a few others on our computers... #rnchat 6/30/2010 18:44

rnchat: T2 I find myself wishing I could dream up a better pharmacy program that totally integrated ALL the patients' drugs & medications #RNchat 6/30/2010 18:45 nursingpins: T2 hard to beat that (give a new med then go look it up rush) but many are given but few are looked up till too late. #rnchat 6/30/2010 18:46 nursekama: T2 Oh and I currently have Lexi-comp and Skyscape Apps on my iPhone... #rnchat 6/30/2010 18:46 rnchat: T2 I also love having Epocrates on my smart phone! And even having the web on my cell makes medication searches much easier! #RNchat 6/30/2010 18:48 nursingpins: T2 hopefully there will event be a standard drug program for all hospitals to use with latest info. #rnchat 6/30/2010 18:48 onlinenursing: Free andriod app - Physicians desk reference online T2 - #RNchat http://bit.ly/csnGSj 6/30/2010 18:49 MatthewBrowning: T2 I started teaching MDs & APRNs about ePocrates on Palm devices since 2000- was priceless in practice #rnchat 6/30/2010 18:49 rnchat: @nursingpins T2 Like for example, I had a pt on IV protonix, oral pepcid & NGT carafate. He needed only one. Nothing picked that up. #RNchat 6/30/2010 18:50 rnchat: Nice link!! Thanks! >> RT @onlinenursing: Free andriod app - Physicians desk reference online T2 - #RNchat http://bit.ly/csnGSj 6/30/2010 18:51 nursingpins: T2 @rnchat - good examp - I see that too. Some hospital pharm. pick that one up - some dont. Would be nice to run lists of meds. #rnchat 6/30/2010 18:52 onlinenursing: RT @MatthewBrowning started teachng MDs & APRNs about ePocrates in 2000/priceless in practice #rnchat http://bit.ly/6QRHNv Great resource 6/30/2010 18:53 rnchat: @nursingpins T2 I cant agree more about having standardized drug programs & other standardized care programs--no reinventing wheel! #RNchat 6/30/2010 18:53 onlinenursing: RT @ahier: Leapfrog report on safety of ePrescribing systems in hospitals (pdf) http://bit.ly/djnkFL #RNChat (good read T2) 6/30/2010 18:54 nursingpins: T2 so many meds interact with clotting agents -would be nice to run a list for flags - humans can no longer be expected to know all. #rnchat 6/30/2010 18:55 rnchat: T2 I like medication programs that have the ability to print up patient info handouts that pts can sign w/ nurse & put copy in chart #RNchat 6/30/2010 18:55

rnchat: Gosh where does the hour go, friends? I cant believe how fast it flew by! LOL, I didnt even finish my coffee! :) #RNchat 6/30/2010 18:57 rnchat: (Great link via @onlinenursing) RT @ahier Leapfrog report on safety of ePrescribing systems in hospitals http://bit.ly/djnkFL #RNchat 6/30/2010 18:58 nursekama: Good discussion tonight, thanks for the outstanding moderation @rnchat (Ellen)! I'm signing off...cheers! #rnchat 6/30/2010 19:00 rnchat: @nursingpins T2 Great point! The sheer # of available drugs is way to long for any human to keep track of! We need good programs! #RNchat 6/30/2010 19:01 nursingpins: T2 modern medicine can no longer be most effective without the help of stored information - we will just overlook too many things. #rnchat 6/30/2010 19:01 J_Bohlen: RT @nursingpins: T2 modern medicine can no longer be most effective without the help of stored information - we will just overlook too many things. #rnchat 6/30/2010 19:02 chemosabe: T2 NZ only has one drug of each class available on gov funded program #rnchat 6/30/2010 19:02 rnchat: I want to thank all those who diligently retweet the dates & times of our chats each week. Much appreciated! We have such good chat! #RNchat 6/30/2010 19:02 rnchat: @chemosabe T2 Well, having only 1 of each class of drug in the whole country surely makes it simpler for everyone. Less med errors? #RNchat 6/30/2010 19:04 chemosabe: @RNchat don't know the stats, would be interesting to sus out #rnchat 6/30/2010 19:05 wantnews: RT @rnchat: T2 Who can keep up with all the advances being made in pharma? What programs, tools, aids do you use @ work to get info on pt meds? #RNchat 6/30/2010 19:05 rnchat: Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 19:06 rnchat: Be on the look-out for the transcript of tonight's chat! Give @PhilBaumann a chance to have fun! Look for the link later this week! #RNchat 6/30/2010 19:07 nursingpins: Great job as always Ellen - thanks - nite all #rnchat 6/30/2010 19:08 wantnews: RT @rnchat: Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 19:08

rnchat: XOXO Thanks everyone! @EllenRichter signing out of this account! See you all later! :) #RNchat 6/30/2010 19:09 wantnews: RT @nursingpins: T2 modern medicine can no longer be most effective without the help of stored information - we will just overlook too many things. #rnchat 6/30/2010 19:11 wantnews: RT @rnchat: T2 I like medication programs that have the ability to print up patient info handouts that pts can sign w/ nurse & put copy in chart #RNchat 6/30/2010 19:18 EllenRichter: RT @RNchat Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 19:28 KPNurseRecruit: RT @onlinenursing: Free andriod app - Physicians desk reference online T2 - #RNchat http://bit.ly/csnGSj 6/30/2010 19:32 Tombolo_MN: Such an .mportant conversation! RT @EllenRichter: @Tombolo_MN Thanks for retweeting information about the date & time of this week's #RNchat 6/30/2010 19:46 KPNurseRecruit: Hated to miss the #RNChat again tonight. I was in Recruitment Intake meeting until 7 (CA time). Will read transcripts. Peace! 6/30/2010 19:47 wantnews: RT @EllenRichter: RT @RNchat Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 19:47 drjfpmd: nice #health talk RT @RNchat Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 19:52 PrescribedRxN: Workplace Wellness Programs for Waistlines and Bottom Lines http://bit.ly/aKNoKP #RNchat #HCSM 6/30/2010 21:11 holisticnurses: RT @drjfpmd: nice #health talk RT @RNchat Anyone who misses an #RNchat session can check out http://RNchat.org site for older transcripts! 6/30/2010 21:15 thibaudguymard: Workplace Wellness Programs for Waistlines and Bottom Lines http://bit.ly/aKNoKP #RNchat #HCSM via @PrescribedRxN 6/30/2010 22:54 andrewspong: How Nurses Use the Internet and Technology (abstract; Manhattan Research) http://ow.ly/25BOK | Anyone read this yet? #hcsmeu #hcsm #rnchat 6/30/2010 23:24 rnchat: @andrewspong Interesting work from @manhattanresear - er, uh, I like how they don't know about RNchat ;) #hcsmeu #hcsm #rnchat 6/30/2010 23:27 philbaumann: @andrewspong Interesting work from @manhattanresear - er, uh, I like how they don't

know about RNchat ;) #hcsmeu #hcsm #rnchat 6/30/2010 23:27 andrewspong: RT @philbaumann: @andrewspong Interesting work from @manhattanresear - er, uh, I like how they don't know about RNchat ;) #hcsmeu #hcsm #rnchat 6/30/2010 23:34 andrewspong: @PhilBaumann Not exactly credentialing the authoritative nature of the report there, I agree :D #hcsmeu #hcsm #rnchat 6/30/2010 23:35 anjelikadeo: RT @andrewspong: How Nurses Use the Internet and Technology (abstract; Manhattan Research) http://ow.ly/25BOK | Anyone read this yet? #hcsmeu #hcsm #rnchat 6/30/2010 23:47

RNchat Transcript June 30, 2010

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