This just burns my butt!!!

[BBFRN, BSN, PhD]

http://www.wave3.com/Global/story.asp?S=1540132&nav=0RZEJKfx

By Eric Flack

(LOUISVILLE, November 26th, 2003) -- For more than 160 years, University Hospital has been a cornerstone of the Louisville healthcare community. But all that could have come to a screeching halt this year when state investigators uncovered problem after problem. Those inspection records have been uncovered by WAVE 3 Investigator Eric Flack.

University Hospital could have been forced to shut down because of what investigators found there over the past couple months. The report we uncovered showed repeated instances where patients were given inadequate care or mistreated. One patient even died. And in each case, nurses didn't follow orders.

Thousands of patients come through its doors every year. But the state says at University Hospital, instead of bedside manner, some patients got bedside misery. "We found that University of Louisville Hospital had some serious issues with restraint and seclusion," said Pamela J. Murphy with the Cabinet for Health Services.

This past summer state inspectors started looking into allegations that nurses at the hospital were misusing and overusing security restraints. Hospital officials refused to let us take pictures of their restraints, but we checked the records for ourselves.

According to state inspection records, in more than 60 percent of cases reviewed, nurses put patients in restraints without orders from doctors, failed to regularly checking on them while they were strapped down, and in some cases, restrained patients would go for hours without being offered food, water or a chance to go to the bathroom.

And there's more. A 29-year-old man found himself in 5 South -- the emergency psychiatric unit. The problems started at 2:48 in the morning.

By 3 a.m., after the patient had walked into a wall hard enough to dent it, nurses had the patient in restraints. What the state says they didn't have was the doctor's permission.

"They did not have a physician's order to put the patient in restraints," Murphy said.

In fact, it wasn't until the patient started to have trouble breathing that the doctor was finally called at 3:28. Meanwhile, the nurse worked to open the patient's airway.

According to Murphy, "shortly after she turned his head to the side with both hands he simply stopped breathing."

CPR didn't work, and at 3:55, the patient was pronounced dead.

Then there was the fingerbiter incident. Trent Taylor faces assault charges for biting off the tip of a nurse's finger in 2002, and footage from a security camera shows what happened. After Taylor became combative and spit at nurses, a nurse can be seen trying to tape Taylor's mouth shut through a mask known as a spit sock.

Even though the hospital says Taylor was drunk and abusive, guess who the state blames for what happened? The nurse.

"The better judgment would have been to apply the new spit sock and not have her hand anywhere near the man's mouth," Murphy said.

And, once again, the state found doctor's orders had been ignored. This time Taylor was put in too many restraints.

Two months ago the hospital learned that if it didn't fix the problems fast its Medicare and Medicaid funding -- tens of million of dollars -- would be taken away, effectively putting University Hospital out of business.

The hospital responded immediately, re-training nurses on how and when to use restraints, and revising its policies and procedures. The hospital denies there was any patient abuse.

The state discovered some other problems too, including incomplete intake exams, treatment plans that weren't thorough, and an overall lack of oversight. Hospital officials say those concerns have also been addressed.

"I think quality is a continual function, so we will constantly be re-evaluating," said Dr. Mark Pfeifer.

The state says University Hospital is now back in good standing.

We believe we provide the best care in the city," Pfeifer said. "We feel very comfortable in saying that."

Administrators at University Hospitals weren't happy with WAVE 3's decision to cover this story. They told us they were being singled out, and that other hospitals have faced the same threat. But they wouldn't name any.

The state told WAVE 3 News that, once a month, somewhere in the state, hospitals face the threat of losing funding, but they can't remember a time in the last couple years when funding has actually been pulled. That's because getting the problems corrected is a lot better than dealing with a hospital shutdown.

Previous Stories:

Man Charged With Biting Off Nurse's Fingertip Was Fully Restrained

Online Reporter: Eric Flack

Online Producer: Michael Dever

I am so ticked off about this, I am speechless (well, almost

). Hello! We are a Level 1 Trauma hospital, and half our patients are drunk, or have some type of psych issues when they come to us. If the resident won't come up to the floor within an hour after we page him repeatedly to come up and sign the restraint sheet, what the heck are we supposed to do??? Also, a couple of weeks ago, we had a patient on our floor with a GSW after he tried to stab a police officer. The guy was going so crazy, he scared his roomate's family to death. Was there an officer in the room with him (he WAS placed under arrest), and was he handcuffed while in our care??? Of course not- we were left to deal with him, and he was extremely threatening toward the nursing staff. He pulled out every line he had several times, and kept coming out of his room. Finally the resident came up to sign the restraint sheet for the guy. His nurse was up in arms as to what to do with him until then. This story insinuates that it's all on the nurses. It's our fault, and has nothing to do with other extenuating circumstances. It also lays the blame on the ER nurse who got her finger bitten off last year. I really want to go on the news to defend us U of L nurses, but I am unsure as to how to go about doing this without having to face repercussions from the hospital. Any advice? This story is pretty biased, BTW.

[BBFRN, BSN, PhD]

[email protected]

Here's the reporter's email addy if any of you feel inclined to email this jerk.

[Katnip, RN]

Put the man in scrubs and invite HIM to handle these combative patients with no restraints and no backup.

[BBFRN, BSN, PhD]

Thanks for your reply Cybercat, and I agree.

I would also like to say that I don't understand myself why the Dr. wasn't called after the Psych patient walked into the wall- if even for an incident report. But, it was on the emergency psych floor so I don't have any idea what else they could have been dealing with.

As far as the ER nurse who got her finger bitten off, everything has been so hush-hush about it that I just learned through this article that she was held to blame by the state for the incident. That upsets me as well. Nobody backs up the nurses, including the state that licenses them. Now I understand why so many nurses feel the need for unions- we are at risk every time we go to work and we have no support or voice.

http://www.osha.gov/SLTC/etools/hospital/hazards/workplaceviolence/viol.html

I was reading the OSHA statistics for nurses who have sustained violence related injuries in the workplace. It was an alarming average of 21,900 American nurses a year that this happens to. I found this to be particularly interesting:

Taken from: Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers. OSHA Publication 3148 (revised 2003).

Identify potential reasons why hospitals may be hazardous, such as:

The availability of drugs or money in the pharmacy area, making them likely robbery targets.

Hospital/healthcare personnel must work evenings and night shifts at facilities hat may be located in high-crime areas.

Overall prevalence of firearms.

Low staffing levels, high turnover rates, and stress.

Hazard of exposure to violent, confused or mentally unstable patients.

Dealing with combative, disoriented, uncooperative patients.

Mentally unstable patients, that are possibly dangerous.

Exposure to workplace violence in rooms not prepared for violent patients:

Moveable furniture that could be used as weapons, or to entrap employees.

Possible items on countertops that could be thrown at workers.

So, what are we supposed to do about this? If we can't place certain patients in restraints BEFORE they inflict violence on us, what are our options???

[SharonH, RN]

The last time they did their story on the fingerbiting incident, a lot of us wrote and gave them a hard time for it. I got a reply from the editor which I think was similar to most people's. This sounds like payback. These people have a real bias against nurses. I don't like the tone of the story: nurses don't follow orders. It insinuates that we are mindless drones who act only according to doctor's orders and when we don't it leads to poor patient outcomes. I guess it's time to write more letters.

[BBFRN, BSN, PhD]

Thanks, Sharon. I remember your help with the emailing campaign to the editor when the finger-biting story came out. I emailed the reporter this time as well- a lengthy letter too, I might add. I don't expect a reply until after the holidays, though. Right now, I'm trying to pull together my resources to do something. I have emailed OSHA with some questions, too. Mainly, how are we supposed to immediately protect ourselves when the situation turns violent. Any suggestions out there? I'm also compiling a list of questions for my administrator. I really want to know what we can do, because we are facing more violent patients with less options as to what to do to protect ourselves.