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The Evolution of Pill Crushing

We have to crush pills sometimes.  Either the patient (through aversion or physical limitation from stroke) can’t swallow whole pills so we crush them and put them in applesauce, or the patient gets their pills through a tube, so we crush them and dissolve them in water.

When I started nursing, we had a mortar & pestle.  (Yes, it’s an affiliate link.  They all are.)

mortar__pestle_large2

Anyway, this is what we used to crush pills.  (Pro tip:  the mortar is the bowl, the pestle is the bat-shaped object)  I always found it very satisfying to fill the mortar with pills and grind them up with the pestle. Of course, we had to then clean both very well afterwards to avoid cross contamination of pills, but overall it was a good system and worked well.  It felt good to crush up the pills and also offered a gratifying CRUNCH sound. Bonus:  Whenever the mortar would inexplicably get separated from the pestle, you could still crush pills!  You’d just take the pill (still in its package), put it on the counter and bang the hell out of it.  A professionally and socially acceptable way to vent your frustrations :)

Cost?  About $10.

Then came along the plastic pill crusher:

pillcrusherThis is a very simple contraption.  You put the pills in, then you affix the top and turn … it’s like a giant screw.  Every once in awhile I’d get the pills in there just right, and would be rewarded with a very lovely CRACK.  Unfortunately, it wasn’t extremely efficient – I’d usually have to unscrew it, jiggle the pills and redo it a few times in order to get them ground up enough to dissolve in water.  Cost?  About $5.

For whatever reason, TPTB decided to do away with the mortar and pestle and pill crusher.  Our then-manager decided to get us something called the Silent Knight.  Maybe the cross contamination became an issue, I don’t know.  But with this device, you would put the pills in a plastic pouch and crush them.  You’d then dump the crushed-up pills out of the pouch into a med cup, mix with water, and viola!  The only clean-up involved was throwing the pouch away.

SilentKnight

This device was pretty handy, I guess.  No pleasing cracks or crunches, unfortunately, either tactile or aural.  Cost: about $90, and from what I’ve seen, pouches are about 5 cents apiece!!  Doesn’t seem like much, but it adds up, and keep in mind that the pouches end up being one more thing taking up space in the trash.  Boooo!

Recently, a new contraption showed up in our med rooms – the First Crush.

FirstCrushwithCups

Now we’ve gone completely automatic!  You put the pills into one cup, put the second cup on top (so that they nest, not form a dome) and put it in the machine.  Then you choose the desired level of crushedness (“standard” or “extra grind”) and press a button.  It then whirs into action!  Whereas the Silent Knight is, well, silent, this machine isn’t very quiet at all – you get all kinds of cracks and crunches and machine-like sounds.

It’s very efficient, but also a bit wasteful as well.  You can add water to the bottom cup containing the pill powder and use that instead of the medicine cup, but you just throw away the top cup, which is wasteful.  The bottoms of the cups are “wavy” and the pill powder often gets stuck in the waves and it takes awhile to stir it all up.  The cups cost about 5 cents apiece, and you need to use 2!  If it were just one, it would be okay since you would have had to use a med cup anyway.  Cost: About $200-300 plus the cost of cups.

So we’ve gone from the mortar and pestle, which is cheap, immensely satisfying to use and creates no extra waste, to this electric machine that’s a whole lot bigger, a whole lot more expensive, and creates a whole lot more waste.

WTF?  If they’d kept the mortar and pestle in the med room, I’d just continue to use it, but they got rid of it!

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Interview – Nurse Journalist

For this interview, I sent Jamie Davis some questions.  Jamie is the force behind the website The Nursing Show. Jamie’s primary background is in emergency care both as a nurse and a paramedic.  He currently works as a nurse journalist hosting multiple online radio and TV programs on the ProMed Network.

Before he started working in the health care field, he pursued and achieved a media and journalism degree.  He worked in both studio and field production for TV, independent feature films, and on training and industrial videos.  He eventually transitioned from that to a career as Mr. Mom before becoming involved in local volunteer emergency medical services.  He continued to pursue training for a career as a nurse along the way.

When podcasting became a viable programming option in 2005, he discovered that there weren’t that many regularly produced health care programs for nurses, paramedics, or other health care professionals. He began the first of my many shows (the MedicCast) in late 2005 and the Nursing Show was started in 2007.

He has since started the ProMed Network as a location to bring together the best independent health care programming for and by health care professionals in all fields.  With over 40 shows on the network from a variety of disciplines, it is now one of the premier locations on the web for high quality online radio and TV style programming in the health care arena.

What do you do all day?

I spend a lot of my day working on staying up to date on what is going on in nursing and health care worldwide. I record 5 weekly programs on nursing and EMS topics that include discussions and news overviews and I have to be able to spot trends and hot stories each week.

I also spend a lot of time mentoring and educating others about online media, social media, and using them in relation to a business and health care practice.  In addition to this mentoring work, I am proud to be able to work with several corporate partners to help them create their own high quality medical content. These include Physio-Control, Inc. and Johnson & Johnson’s Campaign for Nursing’s Future (DiscoverNursing.com).

I record shows two days a week for editing and release on their respective release days later.  I currently work almost entirely from a home based studio I built myself slowly over the last 6 years. I also am able to employ my children in the “family business” and it gives them a steady job with more flexible hours than most teens can find. I’m looking forward to the fact that because my business is online, my son will be able to continue to work with me while away at college next year.

I continue to be active in my community, volunteering as both an active paramedic and an nurse in various capacities.

Jamie has been involved in nursing for 6 years and was an EMT and paramedic for 10 years before that.

He loves being able to care for patients in some very special ways. While he enjoys the face to face patient contact he gets in his clinical activities, he is most excited about the opportunities he’s had to influence and instruct so many in the nursing and health career fields via his programs. He says he is passionate about providing high quality patient care and improving outcomes and believe it is important to spread news and information via online programming targeted at health care professionals like nurses.

What frustrates you about your job?

I wish I had more time in the day. As an entrepreneur who has built a business with very little starting capital and expanded slowly, I have to be careful about how I spend my time. While I’m working on several exciting partnerships and enjoying a lot of success, there is so much I’d like to do.

As advertisers in the nursing and health care marketplace begin to move in to supporting and advertising on our programs, I hope that the podcasters and hosts on the ProMed Network (myself included) can expand the scope of their content and continue to create a 24/7 resource for high quality, trusted programs in their fields.

What about your job makes you proud to be a nurse?

It makes me most proud when I get an email from a listener or viewer who tells me about some way I influenced them to improve their patient care or their studies (in the case of students). When I cover a news item, I try to convey my commentary about why it’s important to the individual professional and how they might apply that knowledge in patient care and education.  When I hear that this goal carries through and actually works for someone, I’m ecstatic!

Do you feel you receive adequate support for your responsibilities?

Being the boss, I’ve got no one to blame but myself.  I will say that this is going to be one of the biggest issues for nurses moving forward. As we continue to have to work harder and harder to care for a larger patient load, workplace support is going to be vital for the nurse involved in direct patient care.

What is something a nurse who does not work in your particular field might find surprising about your job?

I think that those nurses whom I have helped to become involved in blogging, social media, or podcasting (creating online shows like mine) are most surprised at how easy it is to get started. When I tell someone that they can create their own webshow and talk to nurses worldwide for about $100 using their home computer, they are amazed. When I take the time to show them how easy it is to set up and do, it empowers them to begin sharing their nursing experiences with a broader audience and help more patients by default.

Are you salaried or paid by the hour? What are your hours?

As an entrepreneur, I’m salaried but it will vary from month to month.  Most weeks, I work about 40 – 50 hours. I’m paid through advertising and consulting revenue primarily.

While I started working on my programs alone, they have all become a team effort. I value the input from my listeners and viewers for their insights in to what is going on in their areas.  I also work closely with the team of programmers and hosts at the ProMed Network to continue to build the audience for everyone.

Was there any extra training besides on-the-job learning that you were required to complete for this job?

My B.A. in communications and training in the media field was instrumental in helping me work in the field I am today.  I think that one of the biggest strengths in nursing is the capability to carry your career in so many directions based on your passions and experiences. I don’t know of any others that provide that kind of range.  I truly apply my entire scope of learning and experience in my nursing career.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

I have no one to blame but the boss when I work through meals (which I do too often).  In the hospital arena, and in my experience, this is largely based on an antiquated expectation and tradition that has no place in the current workplace. It is not healthy or productive to care for patients this way. Unfortunately, nurses are great at caring for others’ needs but not so great at caring for our own.  This needs to change and it is up to the nursing supervisory staff to change this paradigm and become advocates for their nurses.

Thanks to Jamie for giving us a glimpse into the world of nursing journalism!  If you are a nurse who works in a non-traditional setting and would like to be interviewed, send me an email at codeblogrn at gmail dot com. My post about this project and a list of interviews done so far is linked here.

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Food allergies are a big deal!

I wrote an article for Kevin, MD and he was gracious enough to post it.  Thanks Kevin!

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Re-post – 8 Month Old Does CPR; Saves Gloworm

My 4 year old and I were rooting around in the baby toys today to pick something out for the baby to play with and he came across his old Gloworm, “Glowie.”  (I know, very unique and creative)

He was pretty delighted to see it, but not because he remembered it.  He just though it was a neat toy.  It made me think of the comic that I made of him saving her after he carelessly crushed her head under his foot.

Unfortunately, in moving the blog to wordpress, apparently the comic was lost in the shuffle.  The post is there but the comic is not.  So I found it again and decided to repost because it’s just so darn cute.  The big shame is that the original pictures are all gone, lost in the Great Hard Drive Crash of 2007.  I wasn’t even thinking about making such a comic at the time; I was just snapping pictures of him with his toy.  Later when looking at them I realized they resembled the graphics that I have seen oh-so-many times in CPR recert class.  Enjoy!

GabeDoesCPR

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Interview – Correctional Nursing

Before we get to the interview, I have to say I’ve been fairly overwhelmed with responses to my request for nurses to interview.  I didn’t exactly mean for this to morph into an interview site, but I have had no interesting experiences of my own at work lately, and I have plenty of people to interview, so this is definitely going to become a regular feature.  I hope you like it.  I am having a blast learning all about the different types of non-bedside nursing.

For this interview, Lorry Schoenly at correctionalnurse.net very kindly answered my questions.

Lorry defines “correctional nursing” as nurses who take care of inmate-patients in jails and prisons.  She got the position by responding to an ad on monster.com when she was exploring new employment options.  She says that before reading the advertisement she didn’t even realize there were nurses in jails and prisons!  She has worked in corrections for 6 years.

So what’s it like to be a correctional nurse?  Lorry says she has many things to do – some days she may give medications in “pill line” (This is prison lingo for medication administration. The nurse is usually at a window or a special location in the pod or barracks. The inmates are lined up and report to the window to receive their dose of medications they have been prescribed) and other days she may be involved in sick calls.  This is where the nurse visits inmates who have simple illnesses such as a sore throat or a rash.

What frustrates you about your job?

It can be frustrating to not have all the equipment and resources that are available in the hospital. For example, there are no oxygen valves in the walls. We have to roll out a big oxygen tank if an inmate is in need. Equipment needs to be located from outside sources when needed. If we need an IV pump, it may take some time to get it delivered.

What about your job makes you proud to be a nurse?

I am proud that nurses are willing to provide care to the unloved and underserved. Inmates are often from the most disadvantaged of backgrounds. Jails and prisons are not always pleasant work environments. It makes me proud to see how dedicated some correctional nurses are to their patient population.

Do you feel you receive adequate support for your responsibilities?

Generally the support is there. It can make a big difference to have a good relationship with the custody officers and administration. Healthcare is not the primary mission of a jail or prison – safety and security is the main goal.

What is something a nurse who does not work in your particular field might find surprising about your job?

It is surprising how many dental issues nurses get into in corrections. Folks coming into a jail often have bad teeth and mouth infections. This isn’t really something you get exposed to very much in nursing school. You need to be able to differentiate a dental emergency from just bad looking teeth.

Lorry, as management, is salaried, but says that most correctional nurses are paid hourly and work 8 or 12 hour shifts.  As with all jobs, she has to set priorities in order to get everything done; the big things are completed but there are always things left on the to-do list for the next day.

Everyone has to work together to get the job done. Working as a team with the custody staff is important because they make sure the right inmates come to the medical unit for various appointments. Custody also makes sure you are secure when dealing directly with the inmates.

Her position required no extra formal training but the orientation did include security training, personal safety techniques and an understanding on inmate behavior.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom. Do you find that to be the case with your job as well?

One of the advantages of correctional nursing is that the pace is a little more manageable. Sure, there are days when it is difficult to get a break, but mostly things are organized enough to get to the bathroom and to actually get out of the medical unit to go to a meal.

Have you ever been scared of an inmate or attacked?

I have never been attacked by an inmate nor have I heard of a nurse attack in the system I worked in. I have been nervous on occasion. Some inmates just look menacing. I am especially careful to be in eye-view of a custody officer in those situations.

 

(My post about this project and a list of interviews done so far is linked here.)

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Author

  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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