lol mine is also a cat! Its of my 14 year old Kaya when she was 4 or 5 months old.

HELL NO! I use betterdiscord!

KCl labeled as asa? As a critical cardiac care nurse, I am duly horrified.

Trust me, so are we. Typically, the reason for the mislabel is due to the machine that is used for pre-packing from stock bottles. For the most case, standard meds are given their own containers for the machine, but when there was a KCL shortage going around something happened where a standard container was used for a non-standard medication and they didn’t make sure the old container was cleared before adding the new medication.

That being said the pyxis pharmacist checking, should have looked at EVERY pre-packed med (100 per batch typically) and see that they all looked correct (eg: no doubles, empties), and would’ve seen the size mismatch between the 2 meds lol. We have some great techs though and one of them caught it as they were doing their pyxis load.

Love my crit care nurses though! We have 5 ICUs (+ ER/Trauma) and most all those nurses typically have their stuff together, which makes my job much easier, when I gotta call with questions! So, thank you for being on the ball!

75-80% of the time. All the staff I work with will take initiative at some point, but some do it more/better than others. I have a certain level of trust with some co-workers that I do not with others.

As an example, We have 15ish pharmacists on staff (non-admin) and 25-30 techs… There are probably 5 or 6 pharmacists and 1/3 of the techs, that when I come in (rotating schedule btw) and I see “those people” are working I know I need to buckle down and really scrutinize what is going on.

Now, like I said in the first post, everyone makes mistakes. Including myself. But I think there is a difference between the mistakes and how they are handled.

There is this mentality of “I didn’t do it, So it isn’t my problem”. When really we should be looking at it as an “institution problem”, or its everyone’s problem! For example, the other day a doc called about starting a bicarb drip on a Hyperglycemia patient. We have a policy on hand to do 150 bicarb in 1L Sterile water. However, this one pharmacist doesn’t like using sterile water (because of HYPOtonic concerns), so instead talks the doc into doing a 150 bicarb in 1/2NS (well this makes it a HYPERtonic soln now and the patient only has a peripheral port AND their sodium is already 141)… OK well when it got to the IV pharmacist, they shouldve said WOAH what it going on here! Instead they let it through because another pharmacist did the order and it isn’t theyre problem if something goes awry. I would have called out there and said WTH are we doing? this isn’t policy! and got it changed.

In the grand scheme, the ordering pharmacist did talk to the phsycian and got the okay, but in the real world physicians are not as infallible as they are portrayed, and our pharmacist gave an inappropriate option for treatment, which the physician trusted was an okay treatment plan. Was the patient injured by a single infusion? no. However, it was a continuous infusion and when I saw the nurse was asking for a refill to start the 2nd dose, I said WTF is going on here and started digging.

Let me say though that this is a national problem, not just my hospital. Also, the things that usually go through when they shouldn’t is stupid things that never effect the patient. When it comes to dangerous medications, we have different procedures for checking of orders, or it goes through a specialist pharmacist first (eg: chemo pharmacist, pediatric pharmacist, critical care, infectious disease, etc you get the point). It is more of an annoyance on my part because I usually take the time to fix a problem when I see it, and other will let stuff slide because theyre not the ones who’ll get the variance, and it won’t hurt the patient anyways.

Just for posterity sakes, if you are curious, what is a “mistake that doesn’t effect the patient”?

Example: We have a NICU and those little babies will be put on continuous infusions sometimes like dopamine to improve their cardiac functioning. So, all our NICU orders are standardized to the weight of the baby to determine the size of the order. So let’s say that the order calls for 0.06ml/hr. That is 1.44ml/24 hr period. So, we would most likely send a 3ml syringe (to allow for titration). Well when the order is sent electronically to the pharmacy it always come stock as 1ml, and we have to change it to the appropriate size. If it isn’t then the nurse will be calling for refills more often than needed based on titration (1ml = 16.6 hour infusion). This is a mistake that is counted towards us.

Is it teachable? sure, pharmacy school rammed it down our throats. However, being short staffed makes people cut corners, and that become the learned state in those situations.

Ya know a lot of ppl think pharmacists are just about putting pills in a bottle… but in all honesty in the role that I work clinically in a trauma center, I would say what sets a good pharmacist from a mediocre one is being able to catch everyone’s mistakes.

Your fellow pharmacists, techs in the pharmacy make mistakes (150 bicarb in 1/2NS?? lol) (incorrect pre packing procedures and getting kcl w an asa label)

Your docs make mistakes (2000mg q12 vanc on an esrd pt with a bmi of 45 + Zosyn 4.5 q6)

Your nurses make mistakes (y-site compatibility, missing doses, losing meds, etc)

The issue is noticing the problem and taking initiative to fix it. Unfortunately, either by ignorance, not correctly verifying, or just plain laziness can lead to sub optimal care for our patients.

It’s not easy though. I easily go through 500-1000+ orders a day, while calling doc/nurses, double checking techs and other pharmacists work. It can be stressful, and it’s easy to put blinders on and just keep hitting approve, but the pharmacists who look at that 4th 40meq kcl bag of the day for 1 patient without a lab drawn in 18 hours and calls the provider to see if maybe they want to draw a lab before the next admin. Those are the pharmacists doing a good job. This can go for the retail folks too who have to put up with way more shit than I.

Not worried in the least, house is < 10 yo and don’t plan on moving anytime soon. I also think my houses “value” is over inflated anyways.

Now if I bought in the last 3 years? Yea I might be sweating a little bit about being under water, depending on price and location.

Nice! I had it on my list, but hadn’t seen salo yet, thanks for the reminder!

A Serbian film… That ending I just cant… It is the only movie I actively tell people to avoid. My wife and I like to watch the most mind-fuck movies imaginable, but that one took it a step too far. We literally just stared at the screen for like 5 min after it was over.

So unless you live in an area with fiber, asymmetrical speeds are pretty typical… I’m not sure if it is because it’s all coax so there are infrastructure limitations? But it’s actually gotten faster because 6 months ago my upload was only 30 mbit/s.

Once fiber is in my area I’ll switch to that, but symmetrical will add more cost…but of course it will lol

Since the day before the Reddit strike… so mid June?

pay $180/month for 1gbit down/100mbit up and it is unlimited… It would be $130 for 1.75TB, but I wanted unlimited and that is an extra $50/month

How do you tell you parents goodbye when the next massacre hits though?

Christian brings up some great points worthy of consideration; however, if your going to use traditional routing through their network (A/cname) your still doing the same thing. CF will still see your traffic.

The second thing I should say is, I only use zero trust for websites I share with family. So, I have a Searxng and wef/voyager dockers running through zero trust.

For admin, homeassistant/iot/ip cams, I use an always on IPSec vpn on my iPhone, iPad, and steam deck (take it to work and plug into 3rd monitor) … this is cool because I get 24/7 ad blocking no matter where I am because it routes all my traffic through my pihole at home. This is a great solution for a single person, but I do not want to manage vpn access for multiple ppl. So, I agree with christian in NOT putting admin stuff/sensitive info behind CF at all (zero trust OR tradition web routing) unless you fully trust them. Otherwise do a 24/7 vpn like I do.

I do this for some dockers in my unraid, except I use the zero trust tunnels. MUCH easier, can use SSL, and can set up a login page for users. Also, you don’t have to open any ports on your router!

Im not sure about synology, but I would assume you can find a “cloudflared” docker in the app store.

check out this youtube video for a good explanation: https://www.youtube.com/watch?v=ZvIdFs3M5ic

That’s not necessarily true, my hospital uses google services (gmail, chat, etc) and it is hippa compliant. If I need to send an email with PII I need to append the subject line with “-phi-“. Now whether you trust google encryption is another thing, but HIPPA says nothing about only using fax

Currently my UPS is reporting 207 watts, that’s with a unraid server (3600 + 32GB ram + 2060 super for plex, and 6 drives), a mini pc for pf sense, a rpi 4 running pihole and vpn server, a single poe ap, a modem, and security cameras… it can spike to 250w with multiple encodes going on from family … but overall not bad… I did have a dedicated 20A switch installed for just my network closet as well

Thankfully with the knowledge from my server, the switch will be more kind than if I’d never touched Linux before.

For real man, close to a decade ago I started off with a raspberry pi b+ and literally copying and pasting every code I found, and today I feel I can do almost anything I want in Linux. Moving from tinkering with Xbmc and retropies, to setting up openhan and pi-holes, then moving on to dockers, home assistant, and web-servers to building out a server/networking closet and running cat6 through the house lol

I love that the steam deck has a desktop mode as well. If steamos was out for desktop AND it supported nvidia (which it currently doesn’t), then that would be my new OS and I’d drop windows today.

I like android and have a couple android devices (mostly retro handhelds and CCTV, and have spun up a few VMs), I also have many devices with linux (unraid, pihole, vpn servers, web servers) and run a pfsense firewall (FreeBSD), AND my gaming PC is windows…

I say all that because when it comes to mobile devices, however, I am all in pretty much on apple. Phone, watch, Pro 2s, and Ipad mini go with me pretty much every where. Why? not really the app eco-system (because I do so much self-hosting and use a lot of PWAs, and I dont play games on my phone), its the inter-operability between all the devices, its the find my device, Its the earpods going from my ipad to my iphone in an instant, Its the battery life, its (for the most part) security of the devices.

The blue/green bubble thing is weird and I don’t understand why people get so upset over it. I use everything, and to be honest the only thing at this point in my life I would like to get rid of is windows, but I can’t yet because of gaming.

This is exactly what I do as well, especially with Cinnamon Toast Crunch milk