Showing posts relating to: The Rounds: Clinical Considerations

Is Dictation or Typing the Most Efficient Documentation Method?

If there's one thing we can agree on as nurse practitioners, it's that time is a commodity. We're constantly pressured by the clock. Completing documentation can fall by the wayside as we move from patient to patient. I have a strict rule for myself - I must complete a patient's chart before I move on to the next visit. But, even so, I still find myself falling behind and scrambling to identify documentation shortcuts. Many of my coworkers dictate rather than type. Is dictating a better bet for charting efficiency?

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Are You Following These 4 Practical Prescribing Principles?

Most often, when I read research articles, I find them interesting, but not directly applicable to my practice. Or, the article presents an interesting perspective, however the research is young and not widely tested. Recently, however, a journal article was recommended to me that proved to be practical and directly applicable to my work as a nurse practitioner. The article? Principles of Conservative Prescribing published in the Archives of Internal Medicine

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F.A.Q About Signing Death Certificates as a NP

The first time a death certificate appears on your desk as a nurse practitioner is a nerve wracking moment. Are you allowed to sign death certificates as an NP? If so, what if you are unsure of the cause of death? What's the liability involved with signing a death certificate? Naturally, there's a lot of confusion and concern among nurse practitioners when it comes to signing death certificates so today we're addressing some F.A.Q. to clear up the confusion. 

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What's Up With Tramadol Falling Out of Favor?

Confession: I didn't quite get as far as I wanted to in the opioid blog series this summer. Planning for our epic MMU kickoff got in the way (and it was totally worth it!). But, I'm back on the bandwagon when it comes to talking about this hot topic - in a practical manner. One topic that come up at the kickoff of our residency-like program was Tramadol. I've prescribed Tramadol often for patients in the past as a non-opioid(ish) pain medication option. And, it works (sometimes).

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The Lidocaine Shortage: An End in Sight?

If you're a nurse practitioner who does a lot of procedures or works in the inpatient hospital setting, you're probably aware of the national lidocaine shortage. As an emergency NP, I've been receiving emails about the shortage for awhile now. Just how bad is the shortage and when will it end? I'm not interested in resorting to performing procedures without anesthesia. 

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How to Tell a Patient "I Don't Know"

How do you react when you don't know the answer to a patient's question? Does your face flush? Do you reply with an answer that doesn't directly address the question asked? Do you abruptly end the conversation? Experts say that the words "I don't know" might be some of the hardest to say, even more so than "I love you". Admitting uncertainty or lack of knowledge isn't easy - just ask children and Alzheimer's patients who confabulate rather an utter a simple "I'm not sure". As nurse practitioners, however, we inevitably find ourselves in situations where we don't have the answers. 

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Clinical Decision Tools to Help Detect Blood Clots

I love a good algorithm. Evidence-backed decision trees and clear-cut clinical calculation tools help guide my practice as a nurse practitioner. They take the guesswork out of decision making so I can act with confidence, in the best interest of my patients. As I have become a more experienced NP, my toolkit of clinical decision making tools has expanded. Among my favorite go-to resources are two clinical calculators for detecting the likelihood of blood clots. 

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Drug Interactions: Top 5 High Alert Medications

By Guest Author Eric Christianson, PharmD, BCGP, BCPS

Drug interactions are everywhere. They are particularly everywhere if you have chosen to work in geriatrics. Determining clinical significance and risk mitigation is what is really challenging. I primarily practice as a clinical pharmacist in geriatrics and have pulled together a list of medications so that when you see them, you'll be aware of the potential for drug interactions.  

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How the Vicious Cycle of Drug Shortages Happens

Have you run into problems getting your hands on lidocaine or other meds recently? From IV fluids to injectable opioid analgesics, the shortage on critical medications have emergency and operating rooms across the country functioning in a constant state of despair. On nearly a daily basis, healthcare providers are often scrambling to find a way to work around its facilities’ crippling supply of essential drugs. The situation is so dire that in the event of a natural or man-made disaster, many providers are fearful of whether they’d be prepared to handle such a demanding event when they’re already drowning in the day-to-day as it is.

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Cheat Sheet: Normal Physical Exam Template

Documentation serves two very important purposes. First, it keeps you out of jail. Okay, okay, incarceration might not be totally realistic, but there are plenty of scenarios in which your actions as a healthcare provider might be called into question.

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Decoding OTC Cough & Cold Medication Ingredients

Sure, it's only August but subtle signs of fall are here. The air's a bit crisper in the morning. The evenings are getting shorter. And, a sprinkling of crispy leaves has made its way to my lawn. What does this mean for nurse practitioners? Cough, cold and flu season is coming! 

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Tylenol vs. Ibuprofen: Which is Better for Fever?

Ahh, the age-old dilemma. When it comes to fever reduction, which works better - acetaminophen (Tylenol) or ibuprofen? I treat a lot of patients in the emergency department for fever-causing illnesses and recommend OTC medications on a daily (or more like hourly!) basis. But, when it comes to the exact stats for these medications, it can be difficult to remember to answer patients' F.A.Q. Which is better for fever reduction - acetaminophen or ibuprofen? And, how long does each medication take to kick in?

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