Nurse Charged With Injecting 10 Patients With Bleach, Killing 5 - page 3

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  1. Visit  Lacie} profile page
    6
    I also work in chronic dialysis and initially trained with a Davita clinic. Within one week of completing the classes they provide I was charge and the only RN in the building. We also use Cobe's and I cant tell you how many times I have busted the pcts for not checking for bleach residual. I can see how this would happen. We also use syringes to bleach the who daily and after any pt with Hep C status. It is assembly line nursing with a converyor belt mentality from the corporate level. I cant tell you how many times it was just myself and one pct to cover 8-9 pts and yes it was in compliance by state #'s but not safe based on pt acuity levels. Pt's are coming to dialysis much sicker and much more demanding then ever. Many are nursing home patients, amputees, stretcher bond requiring more than just being put on or off the machine. Chronic Dialysis does not consider anything else but 1 body to 4 pts. At least in my state. I'm not with Davita but I still get it from corporate to cut my staff and cut supply use. If pts want more than 1 dressing change per week on thier cath then they have to bring the dressings!!! I'll save my judgement of this woman when all the info is in. By the way, some of the best RN's I have worked with were in or had been in IPN programs. Dont judge them until you have had to jump through the hoops these people do to keep thier license or continue to practice in nursing. Just because she was either a former user or undgoing treatment what ever doesnt make her a murderer. Negligence yes, as well as the company for thier negligent part in short staffing, budget cutting, and mismanagement.
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  3. Visit  rkitty198} profile page
    0
    Sadly, in any Nursing job,

    All Nurses are overworked, stressed and understaffed-

    I just cannot concieve that one person can kill five people because of not following policies and procedures and being overworked and stressed.
    Not saying she did it intentionally, but it seems sort of fishy to me.
  4. Visit  rabbitgirrl} profile page
    1
    Quote from rkitty198
    Sadly, in any Nursing job,

    All Nurses are overworked, stressed and understaffed-

    I just cannot concieve that one person can kill five people because of not following policies and procedures and being overworked and stressed.
    Not saying she did it intentionally, but it seems sort of fishy to me.


    I can't see it either: I think it kind of makes an argument for the scapegoating theory.

    I can totally see the scenario where these nurses were so rushed as to be unsafe, and when something happened, instead of the company and the system being held accountable, all the blame was heaped on one unfortunate nurse. Then the company still looks good and no one has to question the quotas or production demands.

    thank you delana, for the real-deal rundown. I feel for you guys.
    DeLana_RN likes this.
  5. Visit  nightshiftnut} profile page
    0
    This makes me
  6. Visit  stustressed} profile page
    2
    This is horrible any way you look at it..for the patients families, the nurses family ,etc. Im getting ready to graduate and more and more I am seeing nurses who are lazy, and put patients their patients at risk. It's a shame that someone doesn't take their license seriously.
    Vito Andolini and feliz3 like this.
  7. Visit  rdnkmom01} profile page
    1
    I cannot understand what can be going through someone's mind to knowingly hurt someone or kill them when they have supposedly gone into a field of helping and healing. I have no sympathy for someone like this. It makes me do even more to prove that nurses are caring individuals and only want to do what they can to help others. This story just makes me sick to my stomach.
    feliz3 likes this.
  8. Visit  rdnkmom01} profile page
    0
    Quote from DeLana_RN
    Originally Posted by Natkat

    I have seen dialysis nurses and techs draw bleach into syringes, and I have done it myself. Let me explain.

    I worked from 1999-2005 in an outpatient dialysis clinic for a company that was later bought by DaVita. We used COBE dialysis machines, which are cleaned internally with bleach (and once a week or month, respectively, also disinfected with other chemicals) at the end of the day, i.e., after the last patient is off the machine. The daily bleach cycle ended with a rinse cycle, which was to remove the bleach. However, because this rinsing could get interrupted (e.g., power problems), it was imperative that the machines' drain fluid be checked for residuals before they were turned off for the day. In addition, workers had to check the drain fluid again for chemical residuals (bleach or others, depending on which was last used) first thing in the morning. For this, we had special test strips for each chemical. These procedures were spelled out in great detail in the company P&P and drilled into all workers who worked with the machines (RNs, LPNs, PCTs, reuse techs) during their training period.

    The machines also had a special drain, called the "WHO", that was used when a patient's treatment was started (the dialysis lines and dialyzer were primed with saline, which had to be removed at the beginning of dialysis to avoid adding additional fluid to the patient's circulation. The worker had to be vigilant during this procedure ("dumping the prime") to prevent some of the patient's blood entering the WHO. However, occasionally this did happen and even a few blood cells in the WHO (the line was pink) required the that the WHO be disinfected with a syringe of bleach before the next patient was put on this machine. Therefore, you would draw up a syringe, 10cc usually, from a bleach bottle (there are many in a dialysis unit, bleach has many uses) and inject it into the WHO. Done correctely, there was absolutely no danger that any of this bleach could get to a patient (it was possible to do this procedure withthe current patient on the machine, since the WHO was just a drain, but I normally put a note on the WHO reminding me to do so after the pt was off. However, this wasn't mandatory.)

    Eventually, a new procedure was mandated for starting a dialysis treatment (forbidding "dumping the prime"*) which would make it unlikely that the WHO would have to be bleached during the workday.

    That said, there are also some facts about outpatient dialysis clinics that need to be considered.

    In my experience, dialysis does attract some troubled nurses (e.g., hx of substance abuse). In general, it's difficult to attract nurses to outpatient dialysis. The work is hard, exhausting, sometimes demeaning (the lines between nurses and UAPs are very blurred in dialysis; many techs have bad attitudes and are difficult to deal with. Due to staff shortages, this insubordination is usually tolerated by management.) The patient load is heavy (assembly line nursing comes to mind, especially during 'turnover' when one group of pts is taken off while the next group has to be put on the machines) and the hours are bad. If you like to do things right, avoiding "shortcuts" and following the law (e.g., that UAPs cannot give meds), it is very difficult. Plus, RNs have a lot of responsibility as there is rarely a physician on the premises, and often only a single RN.

    So why do I think dialysis is attractive to nurses who have problems? Well, I have seen it in several of my coworkers (one RN was in an intervention program for diverting drugs in her previous job - there are no narcs in a dialysis clinic; another was an alcoholic). Most nurses allowed their assigned UAPs to illegally give heparin boluses and other meds (so they wouldn't have to leave their own assigned pts to do so for the UAP) and many took short-cuts violating P&P and, sadly, patient safety. It is a high-stress, very fast-paced environment. Checks and double-checks are in place, but what good do they do if they're not followed? (e.g., to avoid putting a pt on another pt's dialyzer, two staff members had to verify the pt's name on the dialyzer. I know of several times when a pt was put, or almost put, on the wrong dialyzer (and those are only the ones that were caught). In each case, the LPN in question was "written up". Several times for the same no-no offense (remember, staff shortage). Common short-cuts also included not checking the machines for chemical residuals (essentially trusting that the rinse cycle had worked, or that "someone else probably did it").

    And my point? Well, I find it very hard to believe that a nurse, even a trouble one with a hx of drug divertion, would deliberately inject syringes of bleach into a pt's blood lines. I don't see that such a deed would not be immediately caught (for instance, there has to be an RN on the premises, she could never have been the only nurse there). Injecting even a trace amount of bleach directly into the bloodstream would cause intense burning and pain immediately, not something that would manifest later.

    More likely, P&P was not being followed here. This relatively new nurse may have felt the pressure of having to keep up with the frantic pace ("team mates" are very unforgiving when you're "slow") and took irresponsible short-cuts, including not checking bleach residuals (bleach in the machine would affect the pt's blood indirectly, via the dialysate, and cause hemolysis. The bloodline could show traces of bleach). She may have dumped the prime, contaminated the WHO, and drawn up bleach to inject into the drain (dumping the prime is no longer allowed, but I know this doesn't always mean much in a clinic; I had nurses try to encourage me to use forbidden procedures - e.g., squeezing the bag; dialysis nurses know what I mean).


    * * *

    I guess I find it hard to believe someone with no previous hx of pt harm (I assume) would use bleach to try to kill pts... why not simply use air? This could easily happen and be more easily covered up. My guess would be extreme negligence and carelessness - and who's to say that this one nurse wasn't made the scapegoat for others who were equally careless (e.g., not checking residuals). The very limited facts given in the media make it difficult to say (I assume the nurse did not confess).

    Just my .

    DeLana



    *Rumor had it that this was because a careless worker had walked away from a patient while dumping the prime and much of the patient's blood drained out of his body, leading to his death. This was never officially confirmed, however.




    Please note that I have focused on the "bad" in dialysis here. I have to add that there are also some excellent nurses and techs who work in this field and would never take short-cuts or do other unethical things that could put pts at risk.
    Thanks for the post DeLana. It is very eye opening. As I said in my previous post, i can't begin to fathom what would be going through someones mind to do this.
  9. Visit  DeLana_RN} profile page
    5
    Quote from Lacie
    I also work in chronic dialysis and initially trained with a Davita clinic. Within one week of completing the classes they provide I was charge and the only RN in the building. We also use Cobe's and I cant tell you how many times I have busted the pcts for not checking for bleach residual. I can see how this would happen. We also use syringes to bleach the who daily and after any pt with Hep C status. It is assembly line nursing with a converyor belt mentality from the corporate level. I cant tell you how many times it was just myself and one pct to cover 8-9 pts and yes it was in compliance by state #'s but not safe based on pt acuity levels. Pt's are coming to dialysis much sicker and much more demanding then ever. Many are nursing home patients, amputees, stretcher bond requiring more than just being put on or off the machine. Chronic Dialysis does not consider anything else but 1 body to 4 pts. At least in my state. I'm not with Davita but I still get it from corporate to cut my staff and cut supply use. If pts want more than 1 dressing change per week on thier cath then they have to bring the dressings!!! I'll save my judgement of this woman when all the info is in. By the way, some of the best RN's I have worked with were in or had been in IPN programs. Dont judge them until you have had to jump through the hoops these people do to keep thier license or continue to practice in nursing. Just because she was either a former user or undgoing treatment what ever doesnt make her a murderer. Negligence yes, as well as the company for thier negligent part in short staffing, budget cutting, and mismanagement.
    It may appear that some current or former (as in my case) dialysis nurses are trying to "defend" the accused ex-dialysis nurse. However, there are some factors to be considered that may not be obvious to those unfamiliar with the specialty.

    For profit dialysis companies such as DaVita (and they're not the only one) manage to make a handsome profit despite severe cuts by Medicare (their major third party payer). As Lacie pointed out, they do this at their pts' and staff's expense. Short staffing and the ever-present pressure to be faster and faster in this assembly line nursing environment may cause some people to take dangerous short-cuts (e.g., not checking bleach residuals in the machines) that could cause pt harm; this is of course negligent and in no way excusable. I'm just saying that it definitely happens, and may have in the case of this nurse. Negligence certainly, but not necessarily murder.

    Without knowing more facts in this case, it's of course difficult to judge. Some chemical (including bleach) residuals are actually permissible; test strips only indicate whether they are above the permissible ppm. Just how much trace bleach was found in the confiscated blood lines? In an environment where most companies (including DaVita) reuse dialyzers, which have to be disinfected with powerful chemicals such as Renalin between uses and which have to be rinsed out with saline before the next pt tx (but again, trace residuals are allowed), pts are exposed to trace amounts of chemicals on a daily basis. Those are just the facts of chronic dialysis.

    In addition, the comorbidity and mortality rate in this pt population is extremely high. Some 40% of ESRD pts are diabetics, many of whom were noncompliant - which led to ESRD (needless to say, many are no more complaint with the often complex ESRD dietary and fluid restrictions, which shortens their lifespan). Another 40% or so are on dialysis due to chronic HTN, which of couse will also cause cardiac problems and strokes. Not surprisingly, mean survival once dialysis has started is only 5 years, and the major cause of death is cardiac. My point: The mortality rate among this pt population is very high. One of our sister clinics once had 3 codes in a week... none of the pts made it. This didn't mean that the staff had anything to do with it, though. (In another case, however, another sister clinic had a code while most of the licensed staff were at lunch due to poor planning and the O2 tanks didn't work; pt died, manager fired, company sued. Rightfully. Negligent yes, criminal no.)

    Large for profit health care providers have deep pockets, of course, and are at risk of getting sued in case of questionable pt deaths. Of course they know this. Are they therefore capable of "throwing a nurse under the bus" to try to limit their own liability? I have no doubt.

    Of course, no one knows what the facts are in this case. Hopefully, the truth will come out. If this nurse is guilty, of course she should be punished. I'm just not convinced that she is or, if she had something to do with the deaths, that these are necessarily murder cases.

    DeLana
    Last edit by DeLana_RN on Apr 4, '09
  10. Visit  azhiker96} profile page
    2
    I appreciate the insightful posts from nurses who have or currently work in dialysis. In my limited contact I've always found them to be very friendly and helpful. (Occasionally I'll get a patient out of surgery where their IV fluids are running through the permacath. The first couple of times I called our dialysis unit to make sure I knew how to correctly disconnect and repack it. One time the nurse offered to come to my unit if I wanted, just to make sure it was done correctly.)
    DeLana_RN and rabbitgirrl like this.
  11. Visit  aklgap} profile page
    2
    This is a great thread on so many levels and it has enlightened me. I know in the different areas I have practice that patient safety is often compromised due to staffing or heavy patient loads. Anyone of us may find ourselves in a predicament where we may not have a defence of our negligence. Being busy and understaffed is no defence. I am not saying that every case of negligence (if that's what it is) is this serious. We just call it "cutting corners." I have even worked in facilities that encouraged practices that were dangerous.
    DeLana_RN and rabbitgirrl like this.
  12. Visit  feliz3} profile page
    0
    This is so sad!!! Whatever measure of justice is given to the responsible party, the families affected by this tragedy will never recover their loved one gone...I can imagine their anger and rightfully, so. feliz3
  13. Visit  ghillbert} profile page
    4
    Man, you guys are tough. What happened to innocent until proven guilty in a court of law?
  14. Visit  justwannabanurse} profile page
    0
    This story is horrible, all my life all I wanted to do was just care for people that's why I went to nursing school. Unfortunately I think alot of people do it for the money sometimes, and there heart is not in it. I cannot imagine wanting to harm one of my patients.


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