> -----Original Message-----
> From: Accident and Emergency Academic List
> [mailto:[log in to unmask]]On Behalf Of Adam Fendius
> Sent: 19 May 2004 16:14
> To: Martyn Hodson
> Subject: Re: Acute Medicine
>
>
> Pop quiz:
>
> Who is called when a nurse with appropriate training in IV
> cannulation, with the relevant certificate and permission
> from their trust to perform cannulation, fails to cannulate?
>
> Answer: (Eventually) a member of the team of doctors
> responsible for the patient's care, no?
as a last resort, depends on the environment - if we are talking wrad
environments during the day there often isn't the support in place for it to
beanyone else
>
> Now I have noticed amongst members of the junior doctor grade
> more junior than myself, a number of people who end up
> calling more senior staff because they have been unable to
> cannulate, e.g. Anaesthetic SHO, which currently includes
> me. And this observation is not mine alone. We come along,
> and find several potential locations to cannulate, and
> granted we spend some considerable amount of time putting in
> cannulas, but I feel that I might have been able to cannulate
> these patients when I was a House Officer.
this is not necessarily something related to the grade or expeirence of the
doctor, it is quite common for Other Nurses with experience e.g. ED or
Anaesthesia Nurses / ODPS / ED CSWs to fins sites for access where others
have failed
> Why?Because I did a significant number of cannulations as a
> house officer.
but were you taught how to effectively cannulate - often now we find that
the problems are becasue the HOs still aren't being properly taught and
assessed and this tips over to the more junior SHOs , and occasionally with
other staff groups becasue they don't take advantage of all the sties they
are prermitted / encourged to use
there is also the principle of leave at least one site untouched
> Now, this task is being taken away and carried out by other
> HCPs of professionals allied to healthcare to such a degree
> that some juniors don't get a chance to 'practice' on people
> whom it is relatively simple to cannulate, so when it comes
> to the 'difficult' cannulation, they don't know where to
> begin.
> A skill is being lost, which I would think that a doctor
> should be able to carry out. Especially in an emergency in a
> shut down patient. This psychomotor skill is an important
> one.
>
> The point I'm trying to make is that by farming out all these
> types of tasks to other people, we are losing the skills, yet
> we are the people who are called when the task becomes more
> complicated than e.g. the ENP/HCA level 2 feels is more
> complicated/difficult to handle.
your argument relies solely on the assumptions that junior docotors will
remain the second line of provision of takss now develoed doesn't it ?
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