ICU ERRORS

[RN45RN45]

I have been an ICU/CCU RN now for 20 years. I have worked in a 48 bed ICU/CCU at a University(trauma 1) and was the Team Leader for several years there and ICU/CCU, 30 bed ICU(trauma 2) and was a coordinator/charge RN. 2 1/2 years ago I moved to a smaller city and took a job in the ICU/CCU. The manager stated when I was hired that I would be started on the heart program the first week. When I moved down and started she kept saying soon. I started in Jan 2011 and finally took a heart in Sept 2011. It is a 14 bed ICU/CCU. Once I started taking the hearts I noticed that the RN's that I was following were making many errors. They were marking that all swan ganz were at 60cm, when checked they would be at 50,54, 62, etc.... rarely at 60cm. No one was checking the placement. It was pointed out to me that that is where they all should be by the charge RN. I know that this is not true that it is based on the height of the patient and proper placement into the pulmonary artery. Over these past few years many patients are placed on Amiodarone, or Cardizem, for Afib, SVT etc... The manager had been made aware of this and she stated that 55cm is the standard and it should be based off this!!!!INCORRECT!!!! These same nurses where charting that NG/OG placement was verified, yet no piston syringe. 12 hours would go by with no NG output. Ng's found in mouth, lung etc. Manager aware and states that they could tell from chest xray or from wall suction. Told by charge RN to pull artline at beginning of shift due to dampened artline. when pressure bag checked, no fluid. Told that that does not affect monitor, but it did when bag was placed. There are RN's taking IABP's that do NOT know what it does. They leave the patients unattended, obviously they have never had a patient get up and tear renal artery or aorta. I've never had happen but it happened at one of the hospitals I worked at. These same RN's are the charge nurses and coordinators here. There are many other errors with medications. The manager keeps covering up for these RN's as they are her friends. I no longer take hearts at this facility, I transferred to another hospital. My friend still works in this ICU and I have to float here. He is a recent heart RN but he is now seeing the errors. He also has pointed these out to manager and is now being restricted on taking the hearts and harder patients. I am afraid for patient safety, but do not know where to turn as the manager and her manager are aware of these issues. Should I call JAYCO?

[calivianya, BSN, RN]

You should absolutely report the hospital. That is really scary, it nearly gave me anxiety just thinking about places like that existing... I can't imagine working in one.

[Hoozdo, ADN]

Just imagine finding yourself as a patient or having a loved one in this hospital! Oh, the horror.

RN45, is there a compliance hotline you can call where you can report anonymously? Since you said you still have to float here, I wouldn't want to leave my name. I would feel compelled to report this since it so obviously flaunts patient safety. I can't even imagine an animal being treated with such incompetent care, let alone a human!

[Esme12, ASN, BSN, RN]

Wow....frightening. I'm surprised the surgeons tolerate this! You could try corporate compliance. You can also complain to JACHO,

The Joint Commission (TJC), formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and previous to that the Joint Commission on Accreditation of Hospitals (JCAH)

TJC......The Joint Commission

[h=1]Report a Complaint[/h]

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The Joint Commission uses information from a variety of sources to improve the quality and safety of the more than 20,000 health care organizations it accredits and certifies. One of these sources is complaints from patients, their families, government agencies, and the public, as well as from an organization’s own staff and the media.

If you have a complaint about a health care organization that we accredit or certify, The Joint Commission’s Office of Quality Monitoring is interested in the details of your complaint. Although we cannot serve as complaint mediators, we can use the information you provide to identify possible noncompliance with our accreditation or certification standards.

[xoemmylouox, ASN, RN]

Scary stuff.. I think you need to report this ASAP. Try to do it anonymously.

[Calabria, BSN, RN]

I'd report them to the Department of Health.

And anybody who listens, really.

[BSNbeauty, BSN, RN]

This is frightening !!!! Wow. I would document all of my findings and move up the chain of command. Especially non-trained nurses taking care of IABP patients. Rule number one, you never leave that patients side and they are supposed to be a 1:1. I've caught some mistakes during my CVICU days but none of them were that bad! I would even contact the BON!

[HouTx, BSN, MSN, EdD]

TJC (Joint Commission) is a voluntary accreditation agency.... not a legal entity. Systemic Quality/safety issues should be reported to the state organization that licenses hospitals. They have the authority to SHUT IT DOWN if patient safety is jeopardized.

But the OP's post appears to also reflect NPA violations that should be reported to that state BON. In most nurse practice acts, making inappropriate assignments (e.g., IABP to nurses who are not competent) would be at least considered unprofessional practice and therefore subject to disciplinary measures by the BON... Nurses who accept assignments for which they are not competent are in violation of their NPA.

Nurses are mandatory reporters... we are professionally and legally required to take appropriate actions to protect the public when we become aware of them.

[nor902]

Wow ! You need to report this ASAP. Think of how you would feel if something serious happened to one of those patients and you did not take measures to report it and hopefully avoid a tragdey.

[MunoRN, RN]

.... Over these past few years many patients are placed on Amiodarone, or Cardizem, for Afib, SVT etc...

I had trouble following how that fit into the rest.

[Biffbradford]

Tell the surgeons directly or via their NPs. THAT will agitate the bees nest!

Ultimately they are the ones who need to know that their patients are being taken care of correctly.

[ANnot4me]

I have been a nurse for many years now and if I knew then what I know now, I would never have chosen nursing. In the end, I have discovered that unit politics, in many cases, determines a nurse's success. I have spent far too much time at the beginning of my shift cleaning up after a "wonderful nurse" only to be criticised at the end of my shift for not having dotted every "i" or crossed every "t".