A Few Simple Rules For Electrical Safety
Codes and electrical mishaps aren't really funny -- but if you can't laugh you'll never make it through three decades of nursing. And besides, once you've been struck by lightening, maybe electrical mishaps ARE somewhat humorous.
I learned some of these rules the hard way, and others I learned through the misfortunes of others.
When defibrillating a prisoner in custody, remember to remove his wrist AND ankle shackles before using the electricity. This is especially important if the prisoner is shackled to a metal bed frame. And if the respiratory therapist is leaning against the bed frame to bag the patient. If you find that you have forgotten to remove the shackles before defibrillating, please do not shout "Oh My God, those shackles have to come off right NOW!" causing the prison guard to rush forward with his (metal) key to try to remove the shackles RIGHT NOW. Fried respiratory therapist is one thing; fried prison guard is quite another. Now you have successfully resuscitated a prisoner in custody, only the guard is in the ER being treated for injuries sustained when you accidentally defibrillated HIM. (Although I'm not in anyway implying that fried respiratory therapist is a good thing or even an OK thing!)
Do not ever allow the intern to hold the paddles, but especially do not allow the intern to hold the paddles in July while they're still all gung ho and ready to save the world. Certainly do not allow them to hold the paddles before they've had their ACLS course and learned to shout "Clear" and actually LOOK to make sure everyone IS clear before shocking. The older nurse that gets shocked may go into a potentially lethal arrhythmia and suddenly you have two codes on your hands instead of one. Do not allow the intern to run the code for (or accompany to the ER) the nurse he just shocked. Some nurses just don't take that sort of thing very well.
Understand that certain types of codes are more likely to get out of hand than other types, but electrical safety must be maintained regardless. If the patient is the husband of the cardiologist's office receptionist, especially if young, the code is likely to go on for a very long time, and it's possible that various liquid substances will leak onto the floor. Blood from the central line they just placed but forgot to hook up to anything, IV fluid from the IV that was supposed to be hooked up to the central line they just placed but somehow got overlooked, and the epinephrine drip attached to that other central line that just got inadvertently pulled out can all pool under the bed. If it's an older hospital building, it's possible that there could also be a mouse under the bed. A mouse trapped in a puddle of fluid under the bed in a really long code may end up being electrocuted. Really. It's a solution to the rodent problem, but not a good solution.
If the patient is wet, attempt to wipe them off somewhat before attempting to defibrillate. It is also best NOT to defibrillate the patient who is lying in a puddle of water. (Patient coded in the bathtub, but that's another story.) If you DO decide for whatever stupid reason to defibrillate a wet patient lying in a puddle of bath water, do not for any reason be kneeling in the bath water when you do so. Do not let any essential personnel be kneeling in the bath water either. If someone HAD to be kneeling in the bath water, it's probably just as well it was the intern -- the youngest and healthiest person in the group and therefore the most likely to recover from the experience without any lingering effects. (Also probably the least essential person there, but that is also another story.) And after you do stupidly defibrillate a wet patient lying in a puddle of bathwater and accidentally shock the intern in the process, do not under any circumstances be heard to utter "WOW! That was really cool" about the electricity that arced over the patient in a visible, multicolored bolt.
When rushing the patient off to the OR or Cath Lab or wherever in the bed, it's best to unplug the bed before the rushing off commences. If you've forgotten the proper order in which to do things and are left with an electrical cord trailing the bed down the hall and a plug still stuck in the electric socket, please remember not to grab the plug with your bare hand and attempt to remove it from the socket. The engineering people have tools and protocols for that sort of thing. You've probably just violated every rule of electrical safety in the hospital manual.
When raising a bed to the highest position, make sure to pay attention to where the attached IV pole is in relation to the overhead fluorescent lights. If, by chance you forget this and the IV pole goes through the ceiling panel and takes out the overhead lights, causing a spectacular light show, extrememely loud noise and shower of glass to occur, please do not under any circumstances be heard to utter "Wow! That was really cool." Especially if there is a patient IN the bed, and especially if management (or your nursing instructor) is anywhere in the vicinity.
Look at your patient before attempting to defibrillate even the most lethal of arrhythmias. If the monitor says V fib but the patient is conversing on his cell phone while scratching his armpits, the monitor might just be wrong. In fact, it's pretty likely that the monitor IS wrong. That nice, regular arterial line tracing may be another clue. If you DO manage to defibrillate (or allow the resident to defibrillate) artifact, please do not under any circumstances be overheard to mutter "no harm, no foul."
And remember to have a sense of humor. No, codes and electrical mishaps aren't really funny -- but if you can't laugh you'll never make it through three decades of nursing. And besides, once you've been struck by lightening, maybe electrical mishaps ARE somewhat humorous.Last edit by Joe V on Jan 13, '15
Apr 1, '10I am laughing so hard, Ruby. You are very good!!!! This was excellent. Keep them coming. LOL!!Apr 2, '10Quote from ruby veei laughed so hard, i'm in tears! thanks for the benefit of your wisdom, mizz ruby!if it's an older hospital building, it's possible that there could also be a mouse under the bed. a mouse trapped in a puddle of fluid under the bed in a really long code may end up being electrocuted. really. it's a solution to the rodent problem, but not a good solution.
if someone had to be kneeling in the bath water, it's probably just as well it was the intern -- the youngest and healthiest person in the group and therefore the most likely to recover from the experience without any lingering effects. (also probably the least essential person there, but that is also another story.)
Apr 3, '10This has me, my MD father, my paramedic co-workers, my massage therapist boyfriend, my friend the medical student and my other friend the pre-med student/EMT all cracking up. Thank you so much; it's wonderful.
(And sad how many of these things have happened to me ...)Apr 6, '10My two decades of nursing have clearly been entirely too uneventful - I think I've missed out bad!Apr 10, '10I guess it's not directly an electrical issue, but more of a joules-to-jewels transfer. You need to be not touching the pt, and also not have the pt's arm flopped off the gerny and between the legs of the unfortunate man who made sure he wasn't touching anything prior to the pt being shocked.
I snickered through your entire 'inservice'Apr 11, '10Quote from simbokaouch! that would be as bad as peeing on an electric fence, only you didn't decide to do something stupid, it just happened!i guess it's not directly an electrical issue, but more of a joules-to-jewels transfer. you need to be not touching the pt, and also not have the pt's arm flopped off the gerny and between the legs of the unfortunate man who made sure he wasn't touching anything prior to the pt being shocked.
i snickered through your entire 'inservice'Jun 5, '11dang.
i came here to look for a training aid on electrical safety for nursing, then i saw the posts above. wow. unbelievable - no.
i have over 40 years experience as a biomedical/clinical engineer (as, bs, ms in electronics and biomedical engineering). i have always believed the healthcare community has far too little emphasized the technology side of patient care. you study infection control but not technology, you learn proper syringe techniques but not ecg monitoring electrode placement, on and on, and, on and on.
in the er you have a patient monitor designed for the patient care environment and next to it a computer designed for an office environment. a medical device ul and iec approved with a hospital grade plug connected to a power strip bought at the local office supply store with no approval. what’s the expression about the weakest part of a chain?
it is a matter of knowing - it is a matter of caring – it’s a matter of doing. extension cords permitted? maybe- maybe not (i say no - never - except a real emergency - like one time mid open heart - power went out in that room - extension cords one room to another - permitted - but monitored until end of procedure).
cords on the floor? no. ever see frayed cords, ever spill conductive fluids on the floor in or - ok then why no cords on the floors. same reason for extension cords. you violate the cords insulations integrity and fluids may enter the connections. also extension cords increase the likelihood of miss wired connectors. powl.
be careful quoting others. i hear it said so often “joint commission requires it”. oh really, where, cite me a reference, page, section, paragraph, let me read it.
even many of my colleagues disagree. the point is, a an emphasis on a safety in the past lead to a safe today and now a lax of techniques, which will lead to an unsafe tomorrow. the pendulum theory.
every nurse, every employee providing patient care should be required to undergo an initial and annual training - sort of like bcls - acls, fire training. some places do it - most not.
every day - without exception - i see things that literally blow me away. frayed power cords in or ("oh that’s not good?" - or “we can't take it out of use now - we need to use it", "we have done it that way for years, why do we have to change now?"). all too often md’s use their position to override someone else who knows better. we need to truly all be members of a team, all play by the say rules, and use the same game plans.
one example, defibrillating a patient with metal shackles? oh yes and also you say "stand clear" when you discharge. i guess we need to watch reruns of er more.
equipment is generally designed to be safer now than ever. but we have increased the exposure far greater, so are not safer today than years past. the or has more technology than radio shack. oh yes, the entire hospital.
Jun 6, '11Perhaps you should visit allBIOMED.com to complain about how horrible all of us nurses are, and allow us nurses to enjoy a little humor on allNURSES.com.
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