Can someone reassure me?

[clarabelle81]

Hey

just wondering can someone reassure me.yesterday at work i was giving a patient his anti clotting (tinzaparin) injection. he asked to self administer it as he normally does it himself at home.so i handed him the container and he took it out and inserted the needle into his upper arm. then he said i think its empty-so he removed it and yes it was empty. now initially i thought maybe its faulty batch and said to the patient that it must be faulty. when i left the room i mentioned it to my colleague and she said she'd never heard of it before. i then went to the box i took it from and found another the same (empty) but i cant say that both werent already used and someone put it back in box the drug press by accident thinking they werent opened. i thought i'd taken them from a brand new box though but couldntn be 100%. i feel so bad. i should have look at the entire container but i just checked the dosage/expiry and handed it over. i then reported it to the manager and the patient had bloods taken. we also filled in an incident report. i just feel i was too slow in identifying that it may have already been used- i genuonly thought it was a dud. anyway he was tested for hep c, hep b and hiv and i rang my facility earlier and they said the bloods came back clear. he's from a medical background himself. I totally accept that this was 100% my fault and whilst i know the bloods came back clear-it still happened and i am so anxious. also i thought the HIV testing took longer.

thanks

[Idaho Murse]

I have to ask what kind of facility you work at where used needles/medical containers are just laying around?

Please dont take this the wrong way. I am just baffled how this could have happened in the first place.

[clarabelle81]

its an acute medical unit. i was giving two patients their anti-clotting and had 2 in the tray. went to this man first so i know i didnt use it before or anything. the actual syringe goes back into the container and thats what we normally do and then dispose of it in the larger sharps bin. but sometimes people have a few to administer and will dispose all at once and unless they put them back into the drug trolley. i'm just dreading the consequences of this even though my main priority was the patient.feel sick and cant sleep.

[gentlegiver, ASN, LPN, RN]

Sounds to me like you did what you were supposed to do. You listened to the patient, investigated his "complaint", found a problem, reported the problem to your supervisor, filled out the correct documentation. Is the injector made so you can see if it's full? Does it have a safety mechanism to prevent re-use?

As for being slow by not catching it before you gave it to the patient? I don't really think so, most Nurses dispose of empty injectors so why would you be looking for one in a med drawer? However, this does create a learning opportunity, at least now you will be looking closer at injectors, as will your co-worker and those of us who read your post. Kudo's for not ignoring the patient and following thu!

[clarabelle81]

thanks gentlegiver

yes the syringes are visibly full and i just didnt see that it was empty. i am kicking myself that i didnt go to administer myself and not have let the patient self administer. i just keep going over it in my head. obviously my main concern was the safety of the patient and he's now fine but now i'm focusing on myself and the consequences of my licence. i'm dreading going back to work for my next shift. now our unit has been very understaffed of late and maybe somebody put them back in accidentally but thats no excuse.my colleagues said that they have had experiences of finding these containers used but you just dont expect to find them already used.i've never had an incident like this before and dreading that i will be pulled up in front of management and suspended.

[himilayaneyes]

It sounds like there's a flaw in the system at your facility. The needles are just lying around in a box. There's not a pyxis or some sort of machine to get it out of...plus, most places have sharp containers in the rooms so that sharps can be disposed of right away. What type of facility do you work at? As far as following up with the patient after your discovery, you did the right thing.

[gentlegiver, ASN, LPN, RN]

I can't see a suspension from this, possibly a verbal warning to pay closer attention, you may have to have someone check you out on med pass. But I don't believe your licence or job could be in danger. If it is then how do they keep staff? No-ones perfect, we all make mistakes, and this one was caught by you, you self reported, it's not like you were trying to cover it up.

[Chin up]

I thought used needles were to directly go into a sharpes container, or similar. I think the facilities policy is illegal and if not, unsafe. Do you have infection control policies in place? I can't believe in 2011, used needles are lying around. I could not work there. Peace!

[Chin up]

Another thing...does this mean you are also recapping?

[Horseshoe, BSN, RN]

hey

just wondering can someone reassure me.yesterday at work i was giving a patient his anti clotting (tinzaparin) injection. he asked to self administer it as he normally does it himself at home.so i handed him the container and he took it out and inserted the needle into his upper arm. then he said i think its empty-so he removed it and yes it was empty. now initially i thought maybe its faulty batch and said to the patient that it must be faulty. when i left the room i mentioned it to my colleague and she said she'd never heard of it before. i then went to the box i took it from and found another the same (empty) but i cant say that both werent already used and someone put it back in box the drug press by accident thinking they werent opened. i thought i'd taken them from a brand new box though but couldntn be 100%. i feel so bad. i should have look at the entire container but i just checked the dosage/expiry and handed it over. i then reported it to the manager and the patient had bloods taken. we also filled in an incident report. i just feel i was too slow in identifying that it may have already been used- i genuonly thought it was a dud. anyway he was tested for hep c, hep b and hiv and i rang my facility earlier and they said the bloods came back clear. he's from a medical background himself. i totally accept that this was 100% my fault and whilst i know the bloods came back clear-it still happened and i am so anxious. also i thought the hiv testing took longer.

thanks

i don't want to be negative, but you are right, there is no way that they can determine he is in the clear for hiv only the next day.

here is a link to the cdc site which discusses the timing of testing and follow up testing after hiv exposure:

http://www.cdc.gov/hiv/topics/testing/resources/qa/index.htm

he's probably going to be just fine, but the definitive proof is still pending.

[gentlegiver, ASN, LPN, RN]

With out knowing this companies policies, I believe the test they did was to assure the patients baseline. I had a needle stick from a pt with HIV, I was sent to the health office, they did a base line and said I was clean but, I would have to come back in 6 months for a re-test and then every 6 months for a few years to ensure I had not contracted anything. So if the test showed no anti-bodies then the test would be considered clean. That does not necessarily mean something can't pop up in later years.

[mmm cdiff]

It sounds more like your facility is at fault. Needles need to be disposed of as soon as they're used.