saline flush ..Joint Commission

APRN., DNP, RN, APRN, NP · Jun 20, 2011

I worked at a facility in California about five years ago that got spanked by the Joint's for nurses leaving flushes at the patient's bedside on a Med/Surg unit.

Nurseclark · Jun 20, 2011

I work in a nursing home in rural Ohio and thankfully this hasnt been an issue yet.

punkydoodlesRN, BSN, RN · Jun 20, 2011

We keep them on a counter in the patient's room. Most are in the med room and we restock the rooms from there. My unit doesn't do bar-code scanning, but they've done some trials of it and those units have had to scan the saline flushes as a med. Dreading. It.
We have a list of drugs we're allowed to keep in the rooms: saline flushes, artificial tears, cough drops, nose sprays, advair inhalers, nitroglycerin, etc.

We have physicians that write for meds at bedside and we still have to keep them locked up. So stupid that our pt can't have throat spray in her room.

RockinChick66 · Jun 20, 2011

We keep ours in the med room in a large drawer. I grab a bunch of flushes and keep them in the bottom drawer of my COW and restock as needed.

Esme12, ASN, BSN, RN · Jun 20, 2011

The JC regulations are different for LTC and Acute Care. It also depends on whether your facility wants to put up with the regulations and policies required to ensure the saftey of patients. The major exception to bottled saline is all of the critical med errors that have occured in nurses giving HEPARIN!!!! instead of saline.......

http://www.jointcommissionconnect.org/NR/rdonlyres/98EEE33E-17F7-4EA3-83FA-3EDFC2611F4D/0/BP_MM_03_01.pdf

http://www.bd.com/sustainability/2010/product/patient_safety.aspx

http://www.webmm.ahrq.gov/case.aspx?caseID=201

nursej22, MSN, RN · Jun 20, 2011

Can't keep them in the pt's room anymore (because it's a med), plus we've been told we can't keep them in our pocket longer than 15 minutes :rolleyes:

Yet we have bottles of hand sanitizer outside and inside of every door.

We a small locked cabinet in each pt room, but the only things we are to keep in them are inhalers, eye drops and topicals. Not insulin, not NTG, not saline flushes. :banghead:

And yes we supposed to bar code scan each flush: 1)scan flush,2) indicate do we need to scan more than one, 3)key in the amount we are flushing, 4)scan pt, 5) press save. Oops, forgot the 2 patient identifiers. :eek:

And this is all in the name of patient safety.

And regarding heparin, 2 nurses to check IV gtts and boluses, but not flushes for central lines. Uh, guys, that's stuff that has caused so much trouble by giving the wrong concentration.

Bortaz, MSN, RN · Jun 20, 2011

We were forced to lock a mini-fridge that contained:

1. Glycerin Suppositories.

2. Surfactant.

The key was put inside the Pyxis.

The narcs are left by pharm techs lying all over the place (bedside cabinet, non-refrigerated med drawer, etc), but you're darned sure not going to be wanton with those suppositories.

360jRN · Jun 20, 2011

One facility we used for a clinical site during school didnt have the prefilled syringes on the med surg floor. They had a bag of saline hanging in the medroom that you had to draw up your flushes with.

Tait, MSN, RN · Jun 20, 2011

The JC regulations are different for LTC and Acute Care. It also depends on whether your facility wants to put up with the regulations and policies required to ensure the saftey of patients. The major exception to bottled saline is all of the critical med errors that have occured in nurses giving HEPARIN!!!! instead of saline.......
http://www.jointcommissionconnect.org/NR/rdonlyres/98EEE33E-17F7-4EA3-83FA-3EDFC2611F4D/0/BP_MM_03_01.pdf
http://www.bd.com/sustainability/2010/product/patient_safety.aspx
http://www.webmm.ahrq.gov/case.aspx?caseID=201

Interesting. According to the JC piece saline flushes are devices, not medications now. I have my nurse educator looking at this. We have been having a heck of time keeping the flushes constrained to the med room and not all over the COW's and patient rooms. Perhaps our policy is more about controlling a device that causes a lot of fiscal loss ($500,000 a year as reported by pharmacy last year, which is why we have to scan them now).

MunoRN, RN · Jun 20, 2011

The JC rule is "The hospital prevents unauthorized individuals from obtaining medications in accordance with its policy and law and regulation." The FDA defines a medication as a substance used to treat or diagnose a disease or condition. Since NS flushes are used for the maintenance of a medical device, they don't consider it a medication. The thing is, some state health departments do consider NS flushes a medication. In my state, the health department changed it's classification of NS flushes to a medication a few years ago since it theoretically could be used to treat a disease (I'm not sure who would choose to fluid resuscitate someone using 3ml flushes, but anyway). Which meant we all of a sudden had to start storing them securely. We then had a incident with a code and trouble finding flushes and risk management had us go back to keeping them in the rooms. We've had both JC and the health department come through since we went back to keeping them in patient rooms and we haven't been shut down yet.

locolorenzo22, BSN, RN · Jun 20, 2011

we had them in locked computer drawers in pt rooms, but they made us take them out. Think something about how every drawer had the same combo did us in. I'll NEVER let them take them from my pocket though...imagine, do they think I'm going to randomly go inject patients with saline? Give them so many flushes that they're sodium content will go up 5-10 points?

wooh, BSN, RN · Jun 21, 2011

Perhaps our policy is more about controlling a device that causes a lot of fiscal loss ($500,000 a year as reported by pharmacy last year, which is why we have to scan them now).

You nailed it. Patient safety takes a backseat to money. And nurse convenience will just get thrown in the trunk.