scared...

Chad_KY_SRNA · May 28, 2005

Eek! Good luck, sounds like trouble to me. The computer charting caused this problem. As far as advice tell the truth, maybe this is a problem that could be addressed with the computer charting.

alintanurse · May 28, 2005

I just heard from my coworkers that a patient that we once had discharge had surgery because his old iv site became infected. I remember him clearly because he told me that he sued someone before was able to get money. Now he had a meeting with the hospital administrators and I'm scared because I discharged him. I remember specifically that the night shift nurse endorsed to me that he didn't have an IV access because he said he was going home in the morning. When I came on the shift and assessed him, he didn't have an iv access and I asked him if i could put one in. He said no because the doctor stated that he was going home today and he didn't want to get poked again. We have computer documentation and it automatically documents that the patient has an iv site and it autimatically documents what the previous nurses have put unless you discontinue or "click off" the assessments that did not apply. So because I was in a hurry I wasn't able to discontinue the part there that says that the patient says he has an iv and that it is red. I did not discontinue the iv because there was no iv to discontinue. however there is no documentation that the iv was discontinued except for when I had him. The previous nurse had left the iv part blank, so no assessment was done on the iv site (i'm assuming because he had no iv site). I'm scared. How can I defend myself if my documentation is going to bring me down? Any advice please... Thanks...

See if you can speak with the hospital's attorney, he should be able to advise you. Unfortunately, this is a hard lesson to learn regarding the importance of documentation. I had a legal situation to deal with several years ago and it dragged out for 2 years, very nervewracking!!!! :uhoh3:

Salty1 · May 28, 2005

I just heard from my coworkers that a patient that we once had discharge had surgery because his old iv site became infected. I remember him clearly because he told me that he sued someone before was able to get money. Now he had a meeting with the hospital administrators and I'm scared because I discharged him. I remember specifically that the night shift nurse endorsed to me that he didn't have an IV access because he said he was going home in the morning. When I came on the shift and assessed him, he didn't have an iv access and I asked him if i could put one in. He said no because the doctor stated that he was going home today and he didn't want to get poked again. We have computer documentation and it automatically documents that the patient has an iv site and it autimatically documents what the previous nurses have put unless you discontinue or "click off" the assessments that did not apply. So because I was in a hurry I wasn't able to discontinue the part there that says that the patient says he has an iv and that it is red. I did not discontinue the iv because there was no iv to discontinue. however there is no documentation that the iv was discontinued except for when I had him. The previous nurse had left the iv part blank, so no assessment was done on the iv site (i'm assuming because he had no iv site). I'm scared. How can I defend myself if my documentation is going to bring me down? Any advice please... Thanks...

Your post is somewhat confusing to me. The question is : At the time of discharge, did the patient have an IV access or not? If not, did he have one previously and did you inspect the site? Not what may have been or may not have been entered in the computer documentation. That is a separate issue.

As I understand it, the patient said he did not have an IV as he was going home and you asked if you could insert one. Why, if he was going home, i.e., being discharged, would you want to insert an IV?

If you have Nurses Liability (malpractice) you might be well advised to notify your insurance carrier of the possibility of a claim.

Salty

Onlyhuman · May 28, 2005

Your post is somewhat confusing to me. The question is : At the time of discharge, did the patient have an IV access or not? If not, did he have one previously and did you inspect the site? Not what may have been or may not have been entered in the computer documentation. That is a separate issue.
As I understand it, the patient said he did not have an IV as he was going home and you asked if you could insert one. Why, if he was going home, i.e., being discharged, would you want to insert an IV?
If you have Nurses Liability (malpractice) you might be well advised to notify your insurance carrier of the possibility of a claim.
Salty

Sorry for the confusion... The patient did not have an iv access when I had him and he did not have an iv access the shift before me... The reason why I asked if I could start another iv is because there were no orders yet to send him home... I'm a new nurse and everyone tells me to make sure that all pt's have an iv access in case they code even if they look perfectly healthy. Also I did assess him and I did not notice any swelling on his arm or any other signs and symptoms of iv infiltration... Thanks again...

alintanurse · May 28, 2005

If you are involved in a pending lawsuit believe me they will find you. Be aware that the plaintiff's attorney may seek you out where you work. If you are approached---don't answer any questions-just direct him/her to administration. I recommend that you speak with your hospital's attorney if possible--to give you some peace of mind.

Daytonite, BSN, RN · May 28, 2005

(1) I was taught in several nursing and the law seminars that I've taken over the years NOT to notify my malpractice insurance company unless I was personally served with a lawsuit. We were told that it sends up all kinds of red flags against you even if nothing ever comes of the incident.

(2) The first thing I would do is sit down and write a very clear narrative account of what you can remember about this patient and the shift that you had him. Make it as specific as you can. If it takes 10 pages, OK. Date it and sign it. Put it away in a safe place with your other very important papers. This is your own personal insurance policy and you don't show it to anyone. You don't tell anyone it exists, especially any of the lawyers. :stone

(3) Now, you do nothing :stone until someone contacts you. Most likely, the hospital will want an accounting from you of what you remember about this patient and his IV. I'm betting that the incident report forms are flying off the shelf at this point! Do you remember how to make a correction or an addendum to your charting? You always have the option to correct your charting, but remember that you must record the date you are making the corrections. You're not going to find that chart in medical records anyway. It's probably in administration and it's being checked for fingerprints (sorry, that was my lame attempt at being funny). :chuckle Do not knowingly let anyone alter anything you've charted. Do not let anyone force you into making a change in this record that is false.

(4) If you are called by the hospital's lawyer you cooperate with them. As an employee of the hospital you are obligated to do that, but you do not have to participate in anything that would end up being false or illegal. There is no need to call your malpractice insurance into the matter unless you are personally sued. You pretty much let the hospital lawyer(s) handle this and do what is asked of you.

Malpractice attorneys have nurses and doctors working for them as consultants who will scrutinize this chart before any decision is made about a lawsuit. They are going to be looking for and most interested in when and who inserted this IV and any comments made about it. If they subpoena the chart they will also ask for information about how the computer charting software works. With computerized charting an exception has to be charted. If nothing is charting one must assume that there was no problem. Since you noted nothing, then it is assumed there was no IV problem. Get it?

If the patient's lawyers think there has been a big mistake made that can be translated into some money for them and their client there will be a lawsuit. However, when you say you heard the patient had a meeting with the hospital administrators it makes me think that he already saw his lawyers otherwise they would have been the ones sitting in the administrators office. I'd be willing to bet that his lawyers told him that he doesn't have much of a case. The patient is probably trying to get the hospital to dismiss the charges for the surgery.

I've seen several patients over the years who had surgery due to infection and subsequent rupture and hemorrhage following an IV and/or arterial line. It happens and it's not necessarily due to anything the nursing staff did. Some people have bacteria hanging out in their bodies just waiting for a site of opportunity. A bag of IV fluid or the IV needle could have been contaminated, who knows? A lot of different factors could have contributed to what happened to this patient.

Just sit tight and wait. Bet you'll never forget to chart on a patient's IV site again, will you?

Onlyhuman · May 29, 2005

Also another clarification... the computer charting record states that the patient did have an iv and it was red (because the other nurses before me had charted that so it automatically transfers to my chart unless I specifically "unclick" it. Which is what I forgot to do.) So even though the patient didn't have an iv access with me, my charting states that he did and that it was red... Does this mean I have no way to defend myself? Thanks again everyone... Oh, and the hospital offered to pay for his bills and he said no because medicaid covered the expenses... Thanks again...

Daytonite, BSN, RN · May 29, 2005

Also another clarification... the computer charting record states that the patient did have an iv and it was red (because the other nurses before me had charted that so it automatically transfers to my chart unless I specifically "unclick" it. Which is what I forgot to do.) So even though the patient didn't have an iv access with me, my charting states that he did and that it was red... Does this mean I have no way to defend myself? Thanks again everyone... Oh, and the hospital offered to pay for his bills and he said no because medicaid covered the expenses... Thanks again...

I was thinking about this throughout the day yesterday. What interests me the most about it is the electronic charting. But, to get to your question. . .the IV site was already noted as being reddened. It establishes that phlebitis was already there. Once phlebitis is there, it's there.

Based on what you've written. . .I don't see that you did anything wrong as far as nursing care goes. You checked to see if he had an IV and he said nothing to you about his old site bothering him. You defend yourself by telling the truth. . .I forgot to unclick the IV when I charted. Don't make any more out of this. You are not responsible for this guy getting phlebitis.

However, in the future, I would make it a point to ask the patient to point out to you where the IV was just to take a quick look at the old site. I used to run my thumb or the flat of one of my fingers across the sites very lightly to see what kind of response I got from the patient. Sometimes, redness clears as soon as a cannual is removed, but the phlebitis is still present in the deeper tissue. Make it a point to chart on IV sites, wounds, drainage tubes, and any other devices coming out of a patient that aren't natural. And, FYI, IV sites really should be changed after 24 hours (Infusion Nurses Society standard). Once they get to 48 and, got forbid, 72 hours there is usually a phlebitis going on even if you can't see it. It's hard to convince patients that you would like to change the IV site because it is usually such a trauma that it got put in in the first place. But, it's for their own good if you can convince them. I was an IV therapist for 6 years and certified with INS so I know a little about this. You cover your butt by charting that the IV site is XX hours or days old, appears a little red, and is tender to light pressure, patient was advised that IV should be discontinued and restarted in another site because of the danger of developing an inflammation in the vein, but REFUSED. But you have to do it with a lot of concern in your voice, not in a commanding way. What I found was that the patients stewed on this for awhile and finally broke down and called for the IV to be changed. Psychology, you gotta love it. :wink2:

Also, read up on the inflammation response. Anytime a tube or catheter is placed in the body, our system recognizes that something is there that shouldn't be and goes into action, the inflammation response. In veins, it becomes phlebitis, but you've seen urticaria on the skin, I'm sure. An -itis can occur at the site of any tube coming out of someone's body, so just be aware of it and look for it, note it, and report it. Your IV patient had the misfortune to also develop an infection with the phlebitis somewhere along the way so he got a double whammy.

I have a lot of criticisms about the kind of electronic charting your hospital is using. It's too easy for something to slip by as you now know. However, armed with that knowledge, I would take my charting very seriously and read each line item very carefully being satisfied with what I was putting my electronic signature to.

I bet this is going to work out OK. :crying2: Nursing, gotta love it!

And, kiddo, I've had my moments too. I had a patient put her side rail down, fall and break not one, but both hips. I thought my career was over. Nothing ever came of it.

Onlyhuman · May 29, 2005

Thanks so much for the responses... I'm really thankful... Please pray for me... I'm still trying to find my way in nursing...

Binkey, BSN · Aug 1, 2005

As an FYI...

INS standards don't say that IV sites should be changed q 24 hours.

INS standards say that you should change your sites q 48 hours unless you can prove that your phlebitis rates are less than 5%, than you can change them q 72 hours ( Of course all of this is in the absence of any complications)

:uhoh3:

**canoehead, BSN, RN** · Aug 1, 2005

As a previous poster said, you should document everything you remember about this situation and save the papers. I suggest you mail the documentation to yourself, and get the envelop registered so you can prove you wrote it on a certain date- before you were approached with legal issues- and then don't open the envelope- let a lawyer do it and have them document what was in it.