Patient safety

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    I have been looking for information on scope of practice of LPNs concerning the removal of objects lodged in back of a patients throat. Situation: a patient choking on upper partial plate with metal prongs on both sides of the partial plate. I was unable to perform hymlick maneuver, so I grabbed my hemostats and reached back the patients throat and retrieved the denture plate. Another LPN was in the room holding the flashlight and the supervisor was in and out of the room making calls to 911 and the doctor. However the supervisor was present when I removed the denture plate. I have been questioned several times about the incident, the main questions were why did I retrieve it, where was the supervisor, and why did I not let the supervisor do it, where did you get the hemostats and were they sterile?, Why did I act so quick, was there another way to handle the situation, I have to check to see if you were working out of your scope of practice. I guess I am very disappointed that I did not get a thank you for saving the patients life. I am now looking for scope of practice regulation about choking patients, if I was working out of my scope of practice or would I be considered a good Samaritan? If I would have to do over, I would have done the same, I reacted quickly in that emergency situation and saved a life? Can anyone point me to the scope of practice act, or something to let me know if I was in the right or wrong?
  2. 12 Comments so far...

  3. 4
    Sorry, I don't have anything to add except some virtual support. But I'm a little confused about why they care if the hemostats were sterile. The mouth you stuck them in wasn't sterile! Do you have malpractice insurance? If so, you may want to call them. And good for you for saving a life and not just sitting back!
    GrnTea, aknottedyarn, KelRN215, and 1 other like this.
  4. 1
    Quote from Magjr
    I have been looking for information on scope of practice of LPNs concerning the removal of objects lodged in back of a patients throat. Situation: a patient choking on upper partial plate with metal prongs on both sides of the partial plate. I was unable to perform hymlick maneuver, so I grabbed my hemostats and reached back the patients throat and retrieved the denture plate. Another LPN was in the room holding the flashlight and the supervisor was in and out of the room making calls to 911 and the doctor. However the supervisor was present when I removed the denture plate. I have been questioned several times about the incident, the main questions were why did I retrieve it, where was the supervisor, and why did I not let the supervisor do it, where did you get the hemostats and were they sterile?, Why did I act so quick, was there another way to handle the situation, I have to check to see if you were working out of your scope of practice. I guess I am very disappointed that I did not get a thank you for saving the patients life. I am now looking for scope of practice regulation about choking patients, if I was working out of my scope of practice or would I be considered a good Samaritan? If I would have to do over, I would have done the same, I reacted quickly in that emergency situation and saved a life? Can anyone point me to the scope of practice act, or something to let me know if I was in the right or wrong?
    Have you checked your BON website to retrieve your nurse practice act and scope of practice? I know it's available that way in Indiana.

    I'm sorry this is happening. It sounds like you reacted quickly, calmly, and did the right thing for your patient. I hope things turn out ok.
    GrnTea likes this.
  5. 4
    No need for sterility. Lots of nurses carry hemostats - it's not like you were carrying a nuclear device in your pocket. And BLS teaches to sweep the mouth of a choking victim if the foreign body can be visualized -- no nursing license required. .

    Good grief -- there's a lot of hand-wringing seemingly being done by those who, um ... were not the ones who took action to rescue the patient.

    Good job!

    p.s. ... Seriously, here's what I would do: Is the family of the patient aware of what happened? Do you see them when they visit their family member? I would toss, "I'm so glad I was able to get his/her partial out when he/she was choking on it!" into the conversation. If, in their gratitude the family passes their thanks on to the facility's management ... this silly "investigation" will cease immediately.
    GrnTea, wooh, aknottedyarn, and 1 other like this.
  6. 5
    You acted quickly because 911 had already been called.
    You followed BLS recommendations regarding foreign bodies that you can see.
    You used hemostats rather than a gloved finger because you did not want to have a choking, hypoxic resident to clamp his/her teeth onto your finger, creating a situation with two "victims."
    GrnTea, wooh, brownbook, and 2 others like this.
  7. 1
    No good deed goes unpunished, huh? Of course if you hadn't done it, and waited for an RN or EMS to do the exact same thing, you'd be investigated for negligence. "Why did you act so quick?" Really? They asked you this? Good lord.

    This is probably CYA BS in case of a lawsuit. They're checking to see if they can throw you under the bus and put all the responsibility on you if something happens.

    As a nurse, I don't expect (or get, most of the time) thanks for doing my job. But I also don't expect a freaking inquisition when I did the right thing. Jeez. I'm sorry you're dealing with this. I second the notion of contacting your insurance carrier.
    wooh likes this.
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    I don't see how this would be out of your scope. Most likely (as usual) your facility is just trying to scare you/ cover themselves. Call your malpractice carrier, but I doubt this will lead anywhere. Awesome job saving the patient!
    GrnTea and wooh like this.
  9. 1
    items do not have to be sterile to be in the mouth. And please, if I am choking, use whatever you have!
    silverbat likes this.
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    Sounds like Monday morning quarterbacking to me.
  11. 0
    Basic BLS teaches to sweep mouth for objects one can see. The supervisor was present. 911 was called. I too would call your malpractice insurance. If you read your BON scope, it often is vauge and facility based. If your supervisor did not say "wait a minute, step back, I will do this" then I would think that the supervisor had no issue with your intervention.

    The only thing I can see as an "issue" is if you are in assisted living that specifically has a policy that states you can not start lifesaving measures, but have to call 911 and wait for EMS. And as difficult as it is to believe, there are some assisted living facilities that DO in fact have this policy in place.


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