[smartynurse]

hi,
I have lost sleep last night worrying about something that happened at work. I am an agency nurse. A few weeks ago I cared for a patient who came up from the ED. The patient was being admitted because he had a cough for one month and the day of admission coughed up blood. I can't remember the patient's admitting dx, however, the patient was ordered for AFB cultures. I did the admission paperwork, and told the charge nurse about the possible tb, she actually got the proper masks for me and others to wear. I also requested that she get maintenance to turn on the negative pressure in the room. I educated the nursing assistant and family about wearing a mask. I wrote a note in the bedside chart about educating the family to wear masks. I gave report to the oncoming nurse that night about the patient, I am absolutely certain that I told him/her that the patient was being worked up for tb. The problem is that my boss told me that they (hospital infection control nurse) have called him because apparently no one knew that the patient might have tb and no one was wearing a mask for the next several days.The one thing I forgot to do was put the droplet isolation sign on the door. I remember this because it hit me later when I thought about it. Although I feel bad that I forgot the sign, the charge nurse was aware, and so was the oncoming nurse. Am I legally responsible for others not wearing a mask? Is this considered negligence, or a public safety issue? Please help, as I have lost sleep over this! I have recently started a new job working monday-friday and won't be going there again. I feel bad and am worried. Thanks for any response.

[Angie O'Plasty, RN]

If you alerted the charge nurse as well as the oncoming nurse, then I would have to say that you were not the person who dropped the ball on this one.

Even if you forgot, don't the oncoming nurses have a responsibility to read the chart?

[oMerMero]

The doctors should have caught this as well. They should have ordered the isolation and also noticed that people were not wearing masks in the room.

[oramar]

Sounds to me as if a lot of people forgot a lot of things. This is a system failure, SNAFU for sure. Sorry you are being tormented about this. I know how it is, so many things to remember, so much trouble if you forget even one of them.

[JessieRN]

Sounds like the ball dropped in mid air, and the agency nurse that no one really knows that well was the best scapegoat. If you charted about teaching, and made the charge nurse aware then it is not your problem. They should be able to pull up the patients lab and see that he was suspected of TB. The ER doc should have reported to the attending md as well.

[Emmanuel Goldstein]

I did the admission paperwork, and told the charge nurse about the possible tb, she actually got the proper masks for me and others to wear. I also requested that she get maintenance to turn on the negative pressure in the room. I educated the nursing assistant and family about wearing a mask. I wrote a note in the bedside chart about educating the family to wear masks. I gave report to the oncoming nurse that night about the patient, I am absolutely certain that I told him/her that the patient was being worked up for tb. The problem is that my boss told me that they (hospital infection control nurse) have called him because apparently no one knew that the patient might have tb and no one was wearing a mask for the next several days.The one thing I forgot to do was put the droplet isolation sign on the door.

Just so you know, TB = airborne precautions. But what you say here doesn't make any sense. It sounds like a hell of a lot of people knew of the possible diagnosis.

[smartynurse]

sorry, I knew that!!! and thanks everyone for your kind responses!

[Elvish]

Definitely sounds like only a very small part of this is yours to shoulder.
Not enough for you to beat yourself up for, that's for sure.

[theboysmom]

I haven't worked in a hospital in awhile but shouldn't the patient have come with an order for isolation that would have triggered the correct isolation materials as well as a sign? or did you have the sign and just didn't put it up?

[xviii-xxv]

well you have documented everything and youre not the only nurse in that area and you know you have endorsed the pt properly so, dont burden yourself too much. but you are still part of the team so, yeah you are still responsible..but anyways as health care professionals, they should strictly comply with the universal precautions.. goodluck to you.