Hospital supply restrictions/Calling nurses

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USA Sanitized for obvious reasons.

Recently has come to my attention that suppliers to hospitals (via VHA) have said they will only allow a 10% increase in orders from previous order histories. Also VHA has contract language which binds the hospitals to not using 'second sources' for supplies. (VHA is a large hosptial association which provides services and representation for their member hospitals)

Hospitals in general are in the midst of industry restructuring. This means that budgets are very tight and tightening more. Budget cycles typically take 4 months to negotiate internally. Contingency monies are possible but the hospital board typically must agree that the monies are needed (usually emergencies or the like).

Most hospitals use JIT to the max in order to keep money from being tied up in inventory (like manufacturers).

Read all of the above again. Add to this that most hospitals are not yet committing money to stockpiling necessities.

EQUALS = THIS (below)

In the USA hospitals in general will not have a sufficient stockpile of supplies to operate for more than a few days to a week without replentishments. There are alot of sole suppliers in the chain. Even if hospitals now started stockpiling they would only be able at most to accumulate 0.7 months (21 days) worth of supplies at normal usage. First, this will not happen because there is now no serious sense of urgency about stockpiling in the sector. Second, there is no warehouse space. Third, there is also no money to do this.

HEALTHCARE RATIONING

Which leads to healthcare rationing in Q1 2000. No elective surgeries. Only emergencies and only those for which they have supplies to provide care.

You need two things for the practice of modern medicine: drugs and blood/blood products. Without these you are back to 1900 in a heart beat. You also need sterile supply (gaze, instruments, etc). You need IV solutions in a very big way. You need IV 'sets' to administer the IV solutions.

CONCLUSION

Healthcare in the USA will be severely affected if there are disruptions in the supply chain which prevent delivery for whatever reason.

Check out the Weiss and Triaxsys reports. Healthcare and Pharmaceuticals are far, far behind the curve on this one. Even middling disruptions in the other sectors will have significant disruptive influence on healthcare.

Those employed in healthcare must seriously think about not working due to layoffs or 'frozen' work days due to the switchover to 'emergency only' admissions policies.

So, all you nurses, its time for you to start stockpiling from CVS, etc in anticipation of providing family practice in your neighborhoods. Also need to brush up on communicable diseases and herbal therapies. You are scattered all over the communities in which you practice, whereas the doctors are all in the 'better' areas/towns which are away from the majority of folks they treat. You will be the first line of intervention/treatment for health in your community. Time to prepare for that. A good way to help your family through the tough times as you could charge modestly for your ministrations, provide care and really provide the community an alternative to misery and perhaps avoidable deaths.

Maternity nurses all of the above as well as midwifery. Don't wait on this one. You will be the only one there for many birthing mothers and their babies.

-- .. (-@dot.dash), June 04, 1999

Answers

So for all those GI y2k nurses out there, what legally will you practice out there, medicine?

-- Barb (awaltrip@telepath.com), June 04, 1999.

Hhhmmm, legally? The chain-of-command hierarchy is rigid and enforced.

We've been telling this Forum for months: don't go into a Hospital anywhere near Rollover! We've posted lengthy threads as to why, what is at risk, the JIT supply of care necessities, etc.

We knew about Y2K in September of last year when we resigned our positions at a large prestigious Hospital. We did not stockpile supplies. Why? Because that would have been stealing. Yes, the waste is incredible, and yes, we easily could have (we were in charge of the ordering). And yes, it was a choice of various evils.

However, after much thought and prayer, we decided instead to try to raise awareness and go thru "proper" activist channels to get the Hospitals and health care industry, locally, to stockpile. Results = nada. Our decision even in view of what we have now seen would be the same.

There are going to be cause-and-effect consequences to the current system of management. The Cassandras once again have sounded the valid alarm to deaf ears. It is tragic but still does not justify [our personally] breaking laws in anticipation of disasters. Our whole life is aimed toward liberation, and nothing on this earth is going to jeopardize that.

Guess it comes down to a longer view of consequences, and being willing to accept death and a sure permanent entry and stay in a much better place, with God, than incurring questionable karma.

However, those who have chosen to stockpile supplies in order to help their neighborhoods, we applaud your efforts. This is a sticky dilemma and we don't have definite answers. There is strong argument for all positions on this.

It would be interesting to hear another nurses' opinions on these issues. Most in the health care teams we've observed are clueless and dismissive of Y2K, so it hasn't exactly come up.

xxxxxxxxxxx xxxxxxxxxxx xxx

-- Ashton & Leska in Cascadia (allaha@earthlink.net), June 04, 1999.


Well, I told myself to spend less time posting, but I guess I can ignore myself this time....

I'm an RN and EMT, living in the country. Right now, before any visible signs of y2k problems in my area, neighbors and friends already come to me for "first aid". They cannot afford emergency room care and have no "regular" doctor -- and most of what I see is minor "clean and bandage" stuff. I have on hand a supply of 4x4s, tape, ointments and various vet supplies, all of which I've purchased with my own money. I do not charge for helping people -- and, I believe that I may be legally covered under "good samaritan" laws. Remember, this is NOW. I'm sure most nurses, especially rural ones, are in the same boat.

If y2k is even a "bump", I fully expect to do a good deal more "first aid" gratis. Of all kinds.

I am profoundly concerned about the vast number of individuals who are routine users of psychoactive medications -- Prozac, Zoloft, even such "benign" meds as Xanax, Buspar, and Valium. These seem to be as plentiful as candy in the general population. People who cannot acquire these meds -- supply chain slowups, delivery problems, y2k shortages -- could face very serious withdrawal consequences...hallucinations, suicidal or violent behavior, seizures, etc. There is nothing in my bag 'o tricks to handle this kind of extremity.

Anita Evangelista

-- Anita Evangelista (ale@townsqr.com), June 04, 1999.


No kidding with those! Dealing with hospice patients coming off Haldol, Lorazepam, Paxil, etc. is not pretty, easy or fun! There's a period of raving confusion, suspicion, and really loopy behavior. But then, they're MUCH better, unless the Attivan switched their body clocks and they've got a permanent case of Sundowners. The worst!

This may be dreadful. But we like the "First Aid" angle ;^)
How many nurses will be willing to be on the front lines in a chaotic situation? Time will tell.

xxxxxxxxx xxxxxxxxx xxxxxx

-- Ashton & Leska in Cascadia (allaha@earthlink.net), June 04, 1999.


* * * 19990604 Friday

Anita, RN/EMT:

Important skills you have. Use them wisely!

My wife's 76 year-old ( retired RN ) aunt in the Upper Penninsula of Michigan is a very lucky lady. She is never for want of almost anything; FREE or AT-COST. Her local folks take REAL GOOD CARE OF THAT LADY!

My only skill is/was as an Information Technologist for 33+ years

I'm hoping to not have that too widely known and keep a Kevlar Suit close at hand until the Y2K dust settles... *wink*

Good Luck, Anita!! YOU WILL BE VERY WELL TAKEN CARE OF!!!

Regards, Bob Mangus

* * *

-- Robert Mangus (rmangus@hotmail.com), June 04, 1999.



Anita, maybe some Valerian root, St.John's Wort and a can of mace ?

-- Barb (awaltrip@telepath.com), June 04, 1999.

Last fall I started working at a hospital where I had worked 4 years ago. I talked incesssantly to my lab supervisor about y2k. Asked her what she knew, if administration was saying anything at the department head meetings. She was barely aware of it and said that no one from administration has said anything to her. I asked the administration and got the standard "we're working on it answer". I decided to take matters in my own hands and personally did an assessment of the lab equipment. Gave the results to my manager (2 noncompliant pieces of equipment). I asked her about supplies and reminded her that things like gloves are made in Malaysia. She was listening to me but getting nowhere with administration. 1 month ago the head of environmental resources asked me for my list. They had started combing the lab, when my boss said, we've already done that don't waste your time. I know our hospital is not going to beef up inventory. I know they just started dealing with this a month ago. Thankfully we have a 10,000 gallon fuel tank for the generator. (Nobody knew that, but the community task force found that out.) Heaven help anyone who gets sick. If things go bad, it could be disasterous. I am only a per diem employee and am planning on not being anywhere near the place come 1/1/00. I am raking in the money now while there is work to be had. Oh by the way, our hospital is currently at a deficit of over $200,000.

-- don't get sick (lab@labtech.needle), June 04, 1999.

Barb:

Valerian is good for calming individuals -- but it's potency is not adequate to deal with the kind of situation that can occur when someone is in withdrawal. Besides, you'd have to get the individual to drink the (very nasty smelling) tea....

St. John's Wort is useful only for depression -- not hallucinations, paranoia, etc.

Mace? Ownership is regulated. Maybe you mean "hot pepper spray"? Sounds a little unnecessarily cruel to me.

Anita Evangelista

-- Anita Evangelista (ale@townsqr.com), June 04, 1999.


Anita, thanks for the medical perspective regarding herbs and their indications/usage in the psychiatric treatment regimens. Don't know if mace is regulated, don't really care, have other options. I'm not really overjoyed at thinking about these things but I realize that LIFE can be cruel at times, sometimes unecessarily so. I think the need for thinking things through,perhaps a form of mental/emotional remediation and testing is part of the prep. So worst-case-scenario-bottom line thinking is what helps me to prepare.

-- Barb (awaltrip@telepath.com), June 04, 1999.

Uh, Valium and Xanax are not benign drugs. Very habit forming with potential consequences for rapid withdrawl. Prozac, Zoloft, Paxil, etc. can be abruptly stopped without withdrawl effects.

I am currently not aware of any limits on elective surgery starting 01/01/2000.

-- lparks (lparks@eurekanet.com), June 04, 1999.



Hmmmm....

The thought just struck me that perhaps a different kind of "herb" could help mellow out those suffering withdrawals.... Can't handle the stuff myself - learned long ago that it makes me zone out completely but personally don't see it as nearly as harmful as some of the psyche drugs commonly used. Also valerian is available in capsules - still smell like a linebacker's old socks but quick to swallow - if caps are not available you could make small pills of it mixed with a binder. Also generic Benadryl (diphenhydramine) is cheap and effective for sedation. Stocking up a bit of it - has a decent shelf life and multiple uses.

We can actually cover a lot of problems with anti-inflammatories, pepto/maalox/lomotil, critter antibiotics/epinephrine as long as we triage. I can also easily envision radio contact (oversight) with ER doctors much like paramedics used to have to do. Some of the ER docs I have worked around walk on water as far as I am concerned and wouldn't be afraid to hang their butts out a bit if they knew you from before the hard times. I think I will try to spend more time in the ER, come to think of it - lots to learn and good contacts if things get tough.

Thanks for sharing all the good thoughts and energy.

Kristi

-- Kristi (securx@succeed.net), June 05, 1999.


Please be very careful about using pot on someone coming off of antidepressants. Began using Paxil two years ago after a sudden onset of debilitating panic attacks (after four deaths in my family in a period of eleven months.) I now recognize the symptoms are the same thing that used to happen to me when I'd smoke pot as a teenager. While my friends became easygoing and mellow, I'd freak out. If someone tried to force pot on me in the middle of a paranoid panic attack, I'm afraid I'd lose it forever. Maybe it's just me, but maybe not. Sorry to veer OT slightly, but couldn't let that suggestion go without offering this observation. No disrespect intended to the suggestor, as I am referring to the population in general but am reminded of the quote, "A little knowledge is a dangerous thing." Regardless of how well- intentioned, sometimes help could be harmful.

-- anonymous (good@heart.still), June 05, 1999.

Anita-

As both a Paxil (20 mg./day) and Xanax (.5 mg/day) user, I have now had the hell scared out of me by reading your post.

What is the solution to all this while there is still time? Start weaning off drugs now? And then what? Become a depressed, unable to go out of the house person?

I have made great strides in the last 3 years using these drugs. Do I give that up? OTOH, my family and I will/would have enough to deal with, without having me go bonkers.

Some good sound advice needed and welcomed. This is a very serious, scary thing to contemplate. Jokes about mace are not appreciated, as I am a very real person with a very real problem, not some kind of animal. I could be your sibling, best friend or neighbor. People need to think a little more before they post "cruel" (thanks, Anita) "solutions" such as these.

BTW, Anita, obviously the last part was not directed towards you.

-- (scared@now.com), June 05, 1999.


Prozac and other antidepressant drugs should NEVER be abruptly discontinued, unless the patient is having a severe adverse reaction. Abrupt withdrawl in a patient who has been responding to this drug therapy can cause quite a number of bad things to happen, including violent behavior.

-- Wilferd (WilferdW@aol.com), June 05, 1999.

Wilferd,

What information are you basing your statement that antidepressants like Prozac, Zoloft, etc. can not be abruptly stopped. Though you are correct that some individuals who are on this medicine for certain conditions may have an exacerbation of their symptoms; as a general statement, most of these newer antidepressants do not need to be tapered off.

-- lparks (lparks@eurekanet.com), June 05, 1999.



Anita,

I am with you in rural America. If I had a penny for everytime I looked at a rash etc out here I would be rich!:> Some of the people have jokingly called me "frontier doc"....:> I am very careful what I do, ( I tell them to contact a Dr alot if it continues)...But I am storing lots of ASA, pepto, advil, vit's, basically all overcounter drugs/oitments firstaid type stuff.....

-- Deborah (RN@thistime.com), June 05, 1999.


I still have yet to understand what unnecessarily cruel means? What then is necessary cruelty?

I have a sense of humor. Some people don't. Hey, that's LIFE! Have a good one!

-- Barb (awaltrip@teleapath.com), June 05, 1999.


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