Author | Lightnews

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 12h

1. The pre-ACA healthcare world was bad.
2. We can't simply just return there. There's a near-universal boarding crisis now. States have made charity care laws stricter. COL has risen & wages haven't matched. Food banks have been hit hard...people are poorer & safety nets have holes.

Aaron Rupar @atrupar.com · 1d

Ron Johnson: "I don't think this is going to be any kind of gut-wrenching problem if these enhanced subsidies just go away. We'll probably have the weather the lies told by the Democrats. Democrats say all sorts of things that are untrue."

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 1d

Yes, we lost, but the Jays played good, are also the underdog & we didn't have to play the Yankees because of them which means a lot given our history...so yes, at this point, it's go Jays.

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 1d

The nomenclature for this has always been confusing...and why does the World Series only include one international team?

Shouldn't there be more?

This has puzzled me for quite some time.

Jerry Chen @jcsalterego.bsky.social · 1d

you're telling me the american league pennant is not even in america

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 1d

I get what you are saying because I've taken family members to get care at places where they've done this & I have *feelings* about it...but I think the point is more the patients who are really angry / scared we are keeping secrets when I have no idea what is going on / it's a prelim read.

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 1d

RE: AI in healthcare - what's the downtime plan?

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 1d

#MutualAidIsResistance

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

Ie fentanyl 25-100 mcg every hour for CPOT 3 or higher.

You start at 25mcg. 15-30 minutes later you document another score. If it hasn't gone down enough, you give another dose, and the next dose can be 50mcg.

So you titrate.

Provider can order starting lower or higher.

1 2

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

Scales like the CPOT or PAINAD.

You rate things like facial expression, restlessness, muscle tension, ventilator tolerance / crying out, consolability...the score is not necessarily equal to a 0-10 score, typically there is an order that is a dose range if the score is above a certain number

1 2

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

🫶

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

Yes, it is possible that our observational scales need to be revised. (We have to revise everything we do so it would be weird if we didn't have to revise these...just saying).

But I don't think that we can just not use them without not giving care / giving care based on vibes.

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

Do you have the links to the studies you are referencing?

There has been a recent push in nursing & medicine that humans are humans because part of our medical racism is to say that pain is different based on skin color.

So I'm wondering what is going on.

2

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

It looks like this tool is building off of validated scales like the CPOT and PAINAD which are not the same as each other for good reason and trying to make just one tool will probably be less accurate than the current ones used right.

(Also: is it being tested or just sold?)

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

My concern - I am an ICU RN - is that there are often situations when self-report is not an option.

It seems like this tool may be trying to take validated scales like CPOT and PAINAD and turn them into all one thing which would be less accurate than those scales used correctly (cont)

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

and that can turn into "I believe this number but not that number".

Yes, if somebody decides to use an observational pain scale instead of a self-report when the patient is capable of self-reporting, that can go really wrong. If that is your concern, I agree with you.

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 2d

What situation have those tools been used in? Are you talking about observational pain scales or another type of tool?

We can't get away from observational pain scales when caring for patients that cannot self-report pain. The other option is basing medication dosing on physiological numbers (cont)

1 1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

Yes.

Anything I say to explain is going to come across as trauma dumping or mean or inappropriate.

But yes.

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

Why you can't just enter the score in the EHR IDK.

This whole cloud trend thing sounds like it will go wrong.

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

It's not *meant* to FakeSpot and tbh doctors are doing that anyways "your blood pressure and heart rate aren't elevated, you must not be in pain".

And the intended scenario pt's wouldn't be masking.

And there's so much racism having something calculate a score might help.

Is the point.

4 3

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

The point of this is that there is so much variability between raters - and some providers don't believe us - and some pt's family members (I'm related to somebody who does this) take the idea & weaponize it for all sorts of purposes.

1 2

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

If you read OP's thread, this is for use in areas where we are already using observational pain scales because patient's can't report pain for one reason or another.
The CPOT works well for vented pt's & this would be a mess - vent tolerance isn't measured - but in the general population (cont)

2 2

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

Threatening to the theocracy project because this is a crowd of people breaking the purity culture rules as protest.

kamimagic @kamimagic.bsky.social · 7d

Umm, wasn't Mike Johnson at the Capitol on January 6th? Didn't he lead the objection to the certification of the election?

He thinks Portland, OR is the most threatening? WTH?

#ProudBlue
Video credit: The Oregonian/IG TikTok

1

Reposted by Jess 💛🤍💜🖤

Lauren-Ashley Arts @laurenashley087.bsky.social · 6d

You all will ONLY listen to each other.

We can make art, we can give speeches, but unless white liberals today are as down for the cause as Joan Trumpauer Mulholland, your disgust at this administration means nothing.

Your marches mean NOTHING if you don’t address white “supremacy.”

2 48 210

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

Read it. Rejoice. Grieve.

And...do what you want, what you can.

I'm not admin.

And my cooking is dreadful except for my pickles so I can't even try to bribe y'all.

#NurseSky #MedSky

1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

Read it. If you're like me it triggered a lot of bad memories. Reminded me of current badness.

There's even something that I do that I'd like to insist is common sense & decency after all these years...and nope. It's against the guidelines now.

1 1

Jess 💛🤍💜🖤 @gardenjess.bsky.social · 6d

digitalassets.jointcommission.org/api/public/c...

Y'all...the JC is redoing their certification process and next year's goals are not the same 10 things we've had for forever give or take.

digitalassets.jointcommission.org

1