Exeter Hospital employee led to an outbreak of hepatitis C

[Esme12]

Frightening........

EXETER, N.H. (WHDH) -- The New Hampshire attorney general's office is investigating the hepatitis C outbreak at Exeter Hospital's cardiac catheterization lab, and eight of the 20 infected patients are suing.

Hundreds of patients who visited Exeter Hospital's cardiac catheterization lab between October 2010 and May 2012 are being told they'll have to be tested for hepatitis C -- a virus that can lead to chronic health issues.

The article goes on to say.....

Nineteen patients and one staff member have confirmed cases, according to public health officials who say the patients were likely infected when someone used their needle to inject medication before injecting them.

Read more: http://www1.whdh.com/news/articles/local/north/12007739600924/drug-diversion-suspected-in-nh-hepatitis-c-cases/#ixzz1xsMpzncV

[Rose_Queen, BSN, MSN, RN]

For how long have stores had surveillance cameras all over the place to pick up shoplifting? Aren't there enough mysteries in the hospital that maybe it's about time to put cameras up all over the place? I can hear the moans of "NO Big Brother!, but think about it.....if there was surveillance cameras in med rooms, pt rooms, nursing stations, wouldn't it be easier to track down the behavior that starts a good deal of the outbreaks and situations of abuse? Are these outbreaks less serious than shoplifting?

But people walking around in department stores aren't wearing gowns, having invasive procedures like foley insertions performed, and the big one, aren't protected by HIPAA. There is no expectation in a public place like the local mall; there is an expectation of privacy in the hospital that is legally provided for.

[PrimaFacie]

But people walking around in department stores aren't wearing gowns, having invasive procedures like foley insertions performed, and the big one, aren't protected by HIPAA. There is no expectation in a public place like the local mall; there is an expectation of privacy in the hospital that is legally provided for.

Well of course that is very true, but the films could be protected as well, and only reviewed when there is need for an investigation. I'm sure it wouldn't be a simple thing to implement, or legislate, but it could be a valuable tool, no?

[minnymi]

But people walking around in department stores aren't wearing gowns, having invasive procedures like foley insertions performed, and the big one, aren't protected by HIPAA. There is no expectation in a public place like the local mall; there is an expectation of privacy in the hospital that is legally provided for.

if someone is willing to have their privacy invaded by an airline to take a leisure trip to jamaica....i'm pretty sure they'd be willing to be 'under surveillance' to protect themselves from instances like this.

[Esme12, ASN, BSN, RN]

IF, and that's a big IF, this has been caused by a staff member and diversion. The actual cause of the outbreak has yet to be determined this could also be the case of using a multidose vial that got contaminated and then cross contamination occurs. The CDC, board of Health, The JC, and the attorney General are all over this event. This I assure you.

The subject of cameras have been talked about for years and it has been decided that with rare exceptions for self harm, cameras violate the Right for Privacy and Unlawful Surveillance, Search and Seizure. These Rights are protected by the Constitution of The United States, and patients Do Not Want them.

Hospitals have decided that the liability and risk that accompanies this on a large scale isn't worth the extra security threat may provide. EICU's...ICU with surveillance to another protected room where patients are watched are rare and get limited use due to the liability issues and patients don't want to be video taped at their most vulnerable time.

To say "the films could be protected as well, and only reviewed when there is need for an investigation." Is Pipe dream. Heck ....."we" (as the collective whole) can't keep people from being irresponsible and negligent to keep them from posting confidential stuff on Facebook! Taking pictures/videos of patient withtheir personal phones or creeping through electronic records. Protecting all that 24/7 footage? Jeeze....impossible on a large scale.

The extra expense involved is probative when there are cheaper, easier solutions. Like single dose vials. The abusers/addicts will ALWAYS find a way. Cameras for security are all over hospitals in ares of "High Security Risk" such as Emergency department/Hospital doors and hallways of OB/Nursery units. PLaced in public accessways.

Cameras maybe in department stores and the Airport but they are not in the bathrooms or changing areas......where there is the expectation of privacy is maintained. Besides many people don't like the scanners nor the TSA and at the hospital there is no danger to National security to warrent their use.

Cameras in patient care areas on a large scale...not likely IF ever.

[PrimaFacie]

Cameras in patient care areas on a large scale...not likely IF ever.

Remember in 20 years that you said this. :rotfl:

You may be young, but I am old, and I remember black and white TV.

Video conferencing was thought to be a space aged idea and none of us ever thought we would see it in our lifetime. Now there are sophisticated EMRs, remote surgery, unmanned drones, swiping your phone to pay at Starbucks....etc....

There will be cameras everywhere eventually.....this is just a matter of putting them to use now, to do better evidence based investigations.

I found a few articles online where hospitals are using TV surveillance in ICUs.

If you Google search cameras + hospitals you actually get quite a bit of hospitals implementing them....and they are allowed by HIPAA.

"Using monitoring devices is acceptable if it is done for legitimate reasons related to patient care and if patients or their legal representatives give permission for the monitoring."

(I think) Soon, the permission won't be necessary.

[PrimaFacie]

I just want to add, what is the difference of protecting all that EMR data from protecting video data?

None.

[PrimaFacie]

Had another thought that related to this......What about those nanny surveliance systems?

Everyday, another babysitter is caught abusing a child, and it's all caught on the nanny-cam.

Concrete evidence, she shook that baby.

Fired

Arrested

inprisoned (hopefully)

------------------------------------------------------------------------------------------------------------------------------

There is SO MUCH substance abuse by nurses, there has to be a better soloution than a electronic sign out machine.

Maybe hospitals need pain management teams who administer all narcs.

-Remove the narcs from the floor nurses reach.

-Pain management team does regular drug testing as part of the equirements to stay on the team.

-Some will argue that this is a demotion of responsibilities to non addict nurses, but its really just the same as having an IV team.

Is that a viable soloution?

[GitanoRN, BSN, MSN, RN]

there is so much substance abuse by nurses, there has to be a better soloution than a electronic sign out machine.

maybe hospitals need pain management teams who administer all narcs.

-remove the narcs from the floor nurses reach.

-pain management team does regular drug testing as part of the equirements to stay on the team.

-some will argue that this is a demotion of responsibilities to non addict nurses, but its really just the same as having an iv team.

is that a viable soloution?

unquestionably, you have a point a mere one but a point nonetheless, which brings me to a remind everyone that is not only the nurses with the substance abuse, we can't eliminate the other medical personnel involved in this issue. let's say for the sake of argument, we bring in the pain mngt. team to deliver all narcotics what guarantees us then that within this team there isn't some medical staff suffering from substance abuse? the drug testing offers a more reliable solution with the blessings of hippa, however, i have always said that where there's a will there's a way. in addition, then we're confronted with the violation rights of certain individuals regarding to the camera surveillance. therefore, it would take a good amount of research and legal review in order to establish a concrete solution to this difficult dilemma that we're confronted in every facility and it has become a taboo subject which can't be solve with a band-aid... just saying

[Esme12, ASN, BSN, RN]

Had another thought that related to this......What about those nanny surveillance systems?

Everyday, another babysitter is caught abusing a child, and it's all caught on the nanny-cam.

Concrete evidence, she shook that baby.

Fired

Arrested

imprisoned (hopefully)

------------------------------------------------------------------------------------------------------------------------------

There is SO MUCH substance abuse by nurses, there has to be a better solution than a electronic sign out machine.

Maybe hospitals need pain management teams who administer all narcs.

-Remove the narcs from the floor nurses reach.

-Pain management team does regular drug testing as part of the requirements to stay on the team.

-Some will argue that this is a demotion of responsibilities to non addict nurses, but its really just the same as having an IV team.

Is that a viable solution?

Again...this has not been proved to be from diversion. Nanny cam's are in the PRIVACY of one's home. If you click on the stars on my profile you will see that I have been a nurse 34 years this month. I have practiced through amazing advances in medicine and I agree who knows what the future holds.

The monitoring you mentioned "TV surveillance in ICU" is the EICU/Telemedicine concept and they are not widely used and may have a use in the future.... Let me google that for you I am unclear as to how that would stop this situation that "we" are talking about.

I hope that we as patients/humans/citizens of the US ever lose the right to privacy or lose the right to grant permission.

With the amount of medications given everyday the actual incidence of abuse is rather small. I would believe that routine random drug screening would become more popular before A "Narcotic Administration Team" will be necessary. Imagine the wait if you are in pain for the TEAM to respond. Imagine the wait for such nonsense in a critical care area, surgery, or Cath Lab is not an attainable goal.

I don't think we need to lower the standards and decrease the responsibility of nurses as we demand higher education of bedside nurses. I think the development of improved needless administration. Single dose administration will in the long run be the effective standard of practice.

This may be a case of cross contamination of a multi-dose vial. This may not have been a nurse at all. This may be an incidence of a huge systems error that need to be rectified.

So I do not agree that the removal of nurses responsibilites is the corrective action to take.

[Esme12, ASN, BSN, RN]

I just want to add, what is the difference of protecting all that EMR data from protecting video data?

None.

EMR data is breached ALL the time. Intentionally and unintentionally........having naked restless, intubated, coding and dying patients don't need to be on camera to be later viewed on YouTube.

[PrimaFacie]

Gitano, You are very smart and perceptive, and I'm glad you weighed in on this discussion.

I hear what you are saying....so let's say this fictional (for now) Pain management team takes over all the narc administration in a hospital. As part of the requirement to be a member of this PM Team, they have to have weekly drug testing. This may sound excessive, but remember the idea is to eliminate any misuse and to be beyond reproach. The positions would be RN with special pain management training. Each floor would have their own PM nurse and those nurses would only do pain management and nothing else. Units and ED would share one.

Pain management for patients would probably improve.

Narcotic abuse would go to 0.

The spread of disease potentially caused by abuse of multi dose vials would be eliminated.

The only negative would be budgetary, paying another FTE for each area but that would have to be studied as far as it lightening the work load of the other nurses and time/monies spent on abuse, etc...

I really cant see a negative here with this soloution....maybe someone else can?

[PrimaFacie]

I am unclear as to how that would stop this situation that "we" are talking about.

With the amount of medications given everyday the actual incidence of abuse is rather small. I would believe that routine random drug screening would become more popular before A "Narcotic Administration Team" will be necessary. Imagine the wait if you are in pain for the TEAM to respond. Imagine the wait for such nonsense in a critical care area, surgery, or Cath Lab is not an attainable goal.

I don't think we need to lower the standards and decrease the responsibility of nurses as we demand higher education of bedside nurses.

So I do not agree that the removal of nurses responsibilites is the corrective action to take.

1. wow, congrats on 34 years!

2. I am just trying to think of a solution - Some people (not you, but just saying) will complain, but me, my mind jumps to how do we provide a fix? This fix not only eliminates the potential of the contamination but addresses the huge problem of substance abuse by nurses in the system.

3. Nurses are always worried about their responsibilities being decreased, and at the same time, they are often complaining that we are so busy and overwhelmed. It does not remove the professionalism of nursing or lower the standards, to create specialties within our profession. ie: Diabetes educators, wound care specialists, etc.

4. If the pain management team is staffed appropriately, the wait for a narcotic shouldn't be any longer than the current system.

5. I disagree with your statement of: "....the actual incidence of abuse is rather small." I recently reviewed the public records of disciplinary actions on nurses in a few states where I am licensed, and they are mostly for substance abuse.....and there are gazillions of them.

6. It is ok to not agree, but I hope you are open minded should the situation ever present its-self as a reality.