Disillusioned educator

KatieMI, BSN, MSN, RN · Jan 7, 2016

I am really sorry for your experience but I'm just itching to ask a few more questions, if you do not mind:

1) what was the nurse/patient ratio in the unit?

2) what was allowed drug interwal?

You see, if you have one hour, or 60 min sharp to do all morning pass for all your patients, it makes a difference if you have 3 or 8. It may not be physically possible to do everything by the book if you have only one hour and 8 patients plus usual morning rush. You will have to cut some corners.

3) what was the unit acuity? If I have one of my ICU level patients going south, I sometimes have to miss my hourly rounds on the rest... yes, I park my station strategically and CNAs know what to report, but I still need to spend 70% of my time with that sick cookie. Add charting to that.

4) did the unit had small colorful plugs to put onto IV lines'ports? In this case, scrubbing is not necessary (whatever policy says; read the manufacturer's notes). Phlebitis is not 100% resulting from "dirty line", most commonly it happens because of overdated IV and irritants in solution.

You need to speak with the unit supervisor and up to the chain, including CNO and CEO, and if staffing was regularly above recommended norms, bring this to their attention.

Sorry again for your experience, hope you mom is getting better

zzisaac · Jan 7, 2016

KatieMI - thanks for responding. Yes, there are many variables to consider for sure.

To try and answer your questions #1 - I don't know the nurse/patient ratio - I didn't ask and wasn't in a position to know. When I discussed it with the nurse after she did say she is on a time crunch (1 hour) to pass the 9am meds, which I do understand, but she could have went and passed for someone else and come back. It is never appropriate, nor hygienic to pass meds while someone is on the commode.

#3 - I do not know the unit acuity - it was a small hospital with quite a few chronic type patients. It isn't something I could ask about as they are not at liberty to talk about the other patients. I do understand about acuity - even when I was a floor nurse and only had 4 patients, one of them could certainly take up the majority of my time.

#4 - the IV tubing was the 'old fashioned' kind that did not have the self-cleaning ports or hubs or caps, etc. Clearly the kind that needed scrubbed.

I plan to visit with the unit director for one of the hospital units we were at, and if my mom gets a survey to fill out I will be glad to help her.

I try so hard not to be critical or picky when I am in the hospital or a family member is, as I know there are so many other variables that are always involved, but the concerns for the past 3 weeks have compounded and I know they are a result of a larger system of problems.

Thanks again for your response!

IVRUS, BSN, RN · Jan 8, 2016

"did the unit had small colorful plugs to put onto IV lines'ports? In this case, scrubbing is not necessary (whatever policy says; read the manufacturer's notes). Phlebitis is not 100% resulting from "dirty line", most commonly it happens because of overdated IV and irritants in solution."

What is an "overdated" IV? Are you referring to an IV med or solution which was hung, but has already expired? If so, this is definitely a rare occurrence. Yes, chemical phlebitis can occur with an IV med that has an extreme pH or high osmolarity and yes, that happens when the nurse is attempting to infuse the medication into a small hand vein per se'. But mechanical or bacterial phlebitis can occur when bacteria enter into the bloodstream from a needleless connector which wasn't cleansed thoroughly, or you may see it from the friction of the catheter in the vein because of a ill fitted IV dressing allowing to much movement or too much manipulation of the line.

To the OP, I would not have let that nurse near my Mother's IV catheter if she wasn't caring for it appropriately.