Combative Pt. Spat in my Face, Eyes, Mouth-Dealing with Policy/Procedure now :(

[Gr8Dane]

So at work Saturday, I was called by another floor to come assist w/ a combative patient. They were preparing to place 4 pt leather restraints (Just to give you an idea how combative this pt. was being) on this pt.

I arrive to the floor just as the leather restraints were being broughtup from the ER where they are kept. There were 10 of us all together to restrain him. 6 of us held him down while the others began to apply the restraints.

I was holding the pt's thighs/knees down, and the pt. began to go in a spitting motion, we threw his gown over his head to protect us.

The leather restraints do not hold the pt down like a Posey vest does, they only go on the arms, and legs. The Pt. lifted his body up, the gown fell off his face, and he coughed up junk from his lungs and spat it all over my face, I felt it go into my eye, on my lips, and when I got home it was all over my back (really sick!!)

So heres where the real fun began. We finished up restraining him, another nurse ran with me into the med room and flushed my eyes out w/ saline using a syringe. I then went to the nursing supervisor, explained what happend. I get sent to the ER to do an occurence report.

I expect to get right in, get baseline bloodwork drawn, get some paperwork then sent back to work. Not hardly! They make me sign in like everyone else who goes to the ER. Then I wait 30minutes to get seen in Triage, where they ask me questions, what happend, take my vitals. They then tell me they will get me seen in our "ER" fastrack as soon as possible.

4 hours later they call me back, 30minutes later they draw my blood, go over some paperwork incorrectly (They didnt fillout anything they were supposed to) then send me back to the nightshift nursing supervisor who was now on duty. This supervisor was very mad that the previous one allowed the ER to keep my waiting 4 hours before seeing me after a bodily fluid exposure, and even madder to see the ER didnt fill out the workmans comp/bodily fluid protocol paperwork correctly. She said the previous supervisor really dropped the ball and should had done more.

I called the Employee health nurse today. He tells me he cant tell me any test results from me or the patient, and that he would call me back in a day or two to tell me when I have to go to a Walk-In clinic our hospital owns to get the bloodwork results. I tell him I was disqusted by having to wait 4 hours in the ER just to have bloodwork drawn. His responce was the ER was probally to busy.

THen he tells me I will have to go to a Walk in clinical that is handling the bloodwork in a few days to get the results, and that I will have to be "patient" as the wait will prob be 2 hours or so.

Does anyone else get treated like this by their employer? Am I in the wrong to think like this? Does professional courtesy not exsist? I basically feel like I am being held hostage legally as I have to follow policy/procedure for this situation.

I truely hope the patient comes back negative for hepatitis C/B, thats all I am really worried about. Just ranting off here

[NewYorkGirl]

Oh honey I totally feel for you. That sucks! I had a similar horrible experience just two days ago, on Saturday.

I'm graduating with my BSN in May and I want (wanted?) to be a psych nurse, so I was working as a mental health worker at an inpatient psychiatric hospital. An aggressive patient spat in my face, then kicked me in the belly so hard he knocked the wind out of me. I was crying so much that they sent me home (after filling out the incident report) b/c I just couldn't pull it together...

Today (Monday) I come into work where they basically fired me... although it was more like I was told to resign - probably b/c if they fired me after I got injured it wouldn't look good on them...

So now I'm out of a job and I'm seriously wondering if I want to be a psych nurse after all... I'm just really not okay with getting attacked at work!!!!!!!

[Gr8Dane]

Well in Psych I couldnt imagine the abuse. I dont mind being punched, hit, etc. The bodily fluids do bother me a bit. I generally take more precautions but at this time there was no time to put a face shield on. Part of the job I suppose.

[Dolce, RN]

I had a needlestick injury a couple months ago and was immediately taken to ER to have blood drawn--no waiting around. I found out the HIV/Hep C results the same day. I'm sorry you had such a horrible experience.

Hoping and praying for the best.

[classicdame, MSN, EdD]

Another possibility - have you considered suing the patient? Just because they are crazy does not mean they are not liable.

[leslie :-D]

this is such b.s.

of course you should have been seen stat.

you were subject to the venom of a crazy person, on their premises.

i also think that psyche nurses need to change their uniforms, preferably to protective headgear, goggles, masks.

obviously, no one else is going to protect you.

sheesh.

the freakin' nerve.

leslie

[RNcDreams]

You should have been made a higher priority!

Once I got trach secretions from a MRSA + patient coughed into my eyeball.... and my eyeball is just fine.

I think we're all carriers, anyway.

Sounds like you flushed your eyes quickly.... I'd say find a way to contact the NM of the ED.... There should be some kind of guidelines for the triage nurse.

It makes no sense to hold you hostage in the ED waiting room, as time ticks away... everyone benefits if you are seen, evaluated, drawn, and D/C'd quickly, so that if you are willing, you can get back to work and life can move on.... but not over 4+ hours.

(I had a needlestick recently and got triaged, seen, and D/C'd in 20 mins)

[psalm51]

i would press legal charges. i know our hospital frowns on that - but tough! unless the patient has assets worth going after, a law suit could be a waste of time (??)

[Blee O'Myacin, BSN, RN]

i would press legal charges. i know our hospital frowns on that - but tough! unless the patient has assets worth going after, a law suit could be a waste of time (??)

I would also file a grievance against the amount of time you had to wait to be screened. We *never* make an employee with an exposure issue wait - even if means that they sometimes have to sit in a chair in fast track, but still they are in and out - given their followup info and to the point where we will find them clean scrubs to wear either back to work or home.

Your ED needs some inservicing about how to handle employee incidents.

Blee

[EmmaG, RN]

Wow. I've never heard of a facility that didn't treat an employee exposure stat. And asked to resign after being assaulted?

Both of you should contact an attorney specializing in WC/employment law.

Good Lord.

[traumaRUs, MSN, APRN]

Depending on the state you are in, it can be a felony to assault a health care worker. I had a similar scenario - spit on in the face by a drunk/high pt. I pressed charges and off to court we go. At the trial - the attorney asked me what happened and I pointed out the guy who did it. The guy starts crying and stands up saying he didn't remember anything because he was too drunk. Oh well...off to jail he went for 120 days. Gave him plenty of time to remember! And...he has a felony on his record too.

As to the procedure for bodily fluid exposure: HIV prophylaxis must be started asap if it is a high risk exposure. Please check your policy and procedures manual as I'm sure you have the availability of rapid HIV testing. Also, hepatitis panels can be run stat too.

Good luck.

BTW...this is the law in IL!

[EmmaG, RN]

Also consider the window for starting post-exposure prophylaxis... I think the CDC recommends within 2-3 days, but at my old hospital, they wanted employees to begin treatment within 6 hours after an exposure.