Things I noticed as a patient...

  1. I just got home from an overnight stay at a prominent facility in my area. I had a cardiac ablation procedure, and because they didn't have a Tele bed available, I got to spend 24 hrs in the CCU.

    Overall, my experience was a good one, but I kept noticing things that I probably wouldn't have noticed before I became a nursing student. And I have to wonder why some of them are allowed since they're obviously against the hospital's policies, and if some of them are as big a deal as they seemed to be to me.

    1. At least 3 different people who stuck me for bloodwork did the following actions in this order: Put the tourniquet on, felt for a vein, swabbed the area with alcohol, put on their gloves, RE-FELT THE AREA OF THE VEIN WITH THE GLOVED FINGER, and then stuck the needle in. Part of me thinks this isn't as bad as it seems to be, and part of me is squicked by it.

    2. Four of the six nurses and two of the techs I encountered from pre-op through CCU (though not anyone in the cath lab) had on multiple rings with gemstone settings.

    3. Two of the six nurses and three of the techs I encountered (again not in the cath lab) had LONG fake nails on, and one of them had badly chipped fake nails.

    4. I developed phlebitis from the IV, not too horribly, but I had a marked reddened, hot, and hard area extending about 2 inches up from the catheter site and out about 1/4 inch on either side. When I showed it to my nurse she didn't even palpate it, and said my skin was just so fair that everything shows up on it, and not to worry. I didn't make a fuss since I was at that time waiting for my doc to come and release me, but I would have thought she'd have at least examined it and personally I think it should have been d/c'd immediately.

    I know that things aren't always "best practice" like they teach us in school, but aren't some of these pretty blatant violations of infection control procedures?

    And given some of these issues, should I contact the hospital administration with any of my observations? I don't want to score them badly on the surveys because I know hospitals are going to be living and dying on those scores.
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    About theantichick, BSN, RN

    Joined: Dec '08; Posts: 328; Likes: 295


  3. by   Zookeeper3
    Oh honey,

    1. yes a re-swab is needed for the gloved finger, provided the nurse didn't swab the gloved finger with alcohol. I swab my gloved "find it finger" and patients generally don't see it.

    2. Unless we are scrubbing to assist the MD in the procedure, we can wear rings, only the NICU, and scrub areas have these restrictions. If I am circulating, I am not sterile, I provide sterile equip. to the doc... can wear rings. I worked EP lab.

    3. Nails, two choices: you either ask your nurse to wash their hands in front of you, or immediately state you are concerned of infection from fake nails.... after the fact.... hmmmn, you're loosing me here with your concerns as you are a very astute student. Not all facilities have a no- extention policy

    4. A presumed phelbitis, a real concern. If you were waiting for d/c and I know at this point nothing is infusing or being administered into that IV, the only option is that the nurse re-stuck you for an IV for the time you waited to be discharged. Until there are actual d/c orders written, all patients post procedure need an IV... so that was your option... another stick for 30 minutes to an hour, or just pull it after?

    I know my post sounds nasty, and yes I have been in your shoes as a student getting health care, so I really can recall my own misgivings.

    Be well aware, you will be held to the same standards you are expecting others to uphold, and contacting administration to these concerns to a hospital you may very well wish to work at in the future... welll.....

    I'm sorry, but in my humble opinion and many experienced nurses may disagree... you are trying to use the bit of knowledge you have to find fault, when there are so many other things that went right that you couldn't see through. When we are in school we are critical and astute to find errors, and that is great. You will look back at this post in 5 years and laugh. That I promise you.

    Personally, I would not contact anyone, aside from thanking them for the good care you received. Cookies are a nice touch too
  4. by   jadelpn
    Chalk it up to "things I will not do as a nurse". If I am unclear on where a vein is, I will use my gloved finger that has been alcoholed up to feel for it. Remember in your own practice to do so. Rings and fake nails.....nasty, but hopefully gloved covered if touching you in a way that would expose you to an infection risk. What is the only thing I would have made sure someone other than the nurse caring for you know about was the phelbitis. The IV should have been pulled and a hot pack applied, with direction that it needed to continue at home, and observed by you. Sometimes, phelbitis needs antibiotic treatment. I would have pointed it out to the MD when I saw him upon my discharge. I also would make use of the infection control nurse. Bring to her attention the phelbitis--and also that you were concerned about risk of infection due to fake nails, rings, etc. Infection control is usually interested in this information to review and revamp infection control policies, and you could send an email to her just regarding your concerns. Hope you are recovering well, and best of luck!!
  5. by   sauconyrunner
    As a New Infection Prevention person in the hospital. YUCK.

    Fake nails and chipped fake nails are something to be concerned about. I've worked at oh 15 facilities (Traveler in the past) Not one allowed any sort of nail extenders.

    Gemstone rings should not be worn, although this is a policy that is very very rarely enforced. I've had some luck showing some people how gross their setting gets with the "glo-germ" and a few have stopped wearing them, but its a hard policy to enforce.

    If an IV site is red and bothering a patent, it should be pulled, and documented, because it could get worse later. we would want to know when it started and what was done.

    I personally would want to hear of this at my hospital. A nice letter to the quality office which includes risk management and infection prevention would help. You may also want to say WHY you didn't say anything to the Nurses at the time...Many patients are afraid of retaliation and only will say something after DC. It would have been a nice touch if you had photos of the IV site. I work on having a good relationship with our nurses, and if this had happened at my hospital, I would want to be able to educate, not discipline the persons involved...including possibly the MD... I have a few MD's who sort of hide from me now, but oh well...
    Hope your ablation went well!!!
  6. by   Aliakey
    Maybe I'm in the minority, but I would've been eeeked out too, lol! I'm a neat-freak.

    Slightly off-topic, but I learned: Do the vein palpation and such to find a suitable victim and scrub properly with alcohol preps. If the vein is not obvious, I then take the last prep and place it above the selected vein with a corner of the prep aiming down at it, like an arrowhead. Buys you that extra couple of seconds to let the alcohol dry and spin your catheter before venipuncture. Stick about a 1/4" below the prep, and remove it once your catheter has been established and before securing.

    I don't touch the site again before sticking... if I do, scrub again. Maybe its just knowing the environment we just retrieved my patient out of eeeked me out enough... love those cockroach welcoming parties when the front door opens, lol!

    Fingernails... our policy here is no longer than 1/8" of white and no fake nails at all.

    OP, considering that hospital-acquired infections are a big problem, I'm personally glad you noticed this stuff.
  7. by   classicdame
    Glad too that you noticed. I recommend you send a note to the CNO. If you noticed, then surveyors will too!!

    Also glad your visit was a short one.
  8. by   dudette10
    I know that things aren't always "best practice" like they teach us in school, but aren't some of these pretty blatant violations of infection control procedures?
    Regardless of how many posts you will receive that minimize effects of the practices you describe, yes, they are violations of infection control. Many healthcare workers don't follow all infection control procedures, but that doesn't change the fact that they are violations.

    On a personal note as a recent outpatient, I was more squicked out for the MRI tech than for myself.

    He put in my IV for the contrast without wearing gloves, and a little blood came out of the hub before he attached the J-loop.

    I might look like the 21st century version of June Cleaver, but little does he know that I spent a lot of time exploring my *ahem* sexuality in college in my late teens/early 20s. No, I don't have hep C or HIV or STDs, but, good Lord, do NOT go on looks alone, dude. You never know what's in someone's past.
  9. by   Double-Helix
    1. Yes, this was a violation of proper technique. But when you learn how to do venipunctures, you'll learn that it's sometimes necessary to feel for the vein immediately before sticking. Many patient's have veins that move and roll, and if you just stick for the spot you felt the vein a few seconds ago, you might end up having to do multiple venipuntures. Ask your patients what they prefer: 1. several needle sticks, or 2. for a clean, gloved hand to touch their skin before they are stuck. Also realize that the chance of infection from a clean, gloved hand touching your skin and then a venipuncture being performed is extremely, extremely small.

    Of course, the correct technique is to put on the tourniquet, find the vein, put on gloves, secure the vein with the non-dominent hand, swab the area with alcohol with the dominant hand, and then pick up the needle to perform the venipuncture with the dominant hand. This requires a little more preparation, as you have to have the alcohol pad opened and the butterfly set up before you start.

    2. Most units don't have a policy against wearing rings and there is no evidence that they spread infection in non-sterile environments.

    3. There was probably a policy about no fake nails/no chipped nails in patient care areas. Yeah, long fake nails kind of gross me out too. But consider that, as long as the nurse is washing their hands appropriately or wearing gloves during patient contact, you're probably protected. Still, if you find it warranted, you could send a letter to the department head and explain about this violation of policy.

    4. If there was anything infusing into the IV, then yes, the infusion should have been stopped immediately and the IV shouldn't be used. But if it was a saline lock with no infusions and I knew the patient was going to be discharged and I'd have to take out the IV anyway, I would be okay with leaving the IV in for a short period of time until I got the DC order. Like a PP said, some floors have a really strict IV policy- where a patient must have an IV while they are admitted. So removing that IV might have meant the nurse needed to put another one in. Which if you were going home anyway, would have been a waste or time, supplies, and one of your veins.

    You'll soon realize that the way you are taught in school is not at all like the real world. I wouldn't make a habit of pointing out these discrepancies to the nurses you meet during your clinical experience. Just notice them and ask yourself if there is really a potential for harm here. If there is, then report it to your instructor. But if it won't cause harm and is just a difference in practice, make the decision to perform the task "by the book" when you're in practice. But be prepared for a little bit of a rude awakening once you actually enter practice.
  10. by   Double-Helix
    I'll also add that even if you follow infection control practices to a "T", you can't always prevent contamination. Just yesterday I was helping a resident perform an arterial stick on one of my pediatric patients. We were both gloved, the area was swabbed with beta dine, and all supplies were sterile. After the stick, the resident was applying pressure with gauze. But she released the pressure too early- which resulted in me getting a rather large streak of blood across my gloved hand and bear arm.

    Since we just had another infant patient diagnosed with HIV recently, I was a little nervous and scrubbed my arm right away. I didn't have any open areas on my skin. Just an example of how you can do everything right (well, the resident probably will hold arteries for the full five minutes next time) and still break infection control.
  11. by   Jackfackmasta
    I used to be like you when I was a nursing student and started as an ED tech. I would see nurses not scrub the hubs all the time and sometimes meds were pushed in faster than what I remembered them to be. I soon learned that in a code situation a nurse is not going to sit there and scrub the port for 15 seconds or if its an emergency. I also know that if there is a 6'4 guy high off a 4 day meth binge with 7 nurses on top of him just waiting to rip us apart, the nurse is not going to push Ativan slowly over the prescribed time. Its going in NOW.

    Be careful about pointing things out because a lot of times there is a certain reason behind it and until you are a nurse you won't understand that. On the other hand I have seen lazy nurses do things with no excuse and I choose not to incorporate that into MY practice when I become a nurse unless it is something that is a threat to patient safety.

    I have to tell you school and working on the floor are not text book perfect. I work in an ED as a tech and will be starting a level one STICU job in June as a new graduate.
  12. by   GitanoRN
    once again, this is a perfect example of what is learned in nursing school is not always applied in the real world. in my humble opinion you didn't received a bad service at this given hospital, there may have been a couple of questionably techniques but all in all you survived and you're on your way to a full recovery. having said that, this is another lesson for you to learn from and applied to your own practice once you have your own patients...wishing you the best always & a speedy recovery....aloha~
  13. by   BelgianRN

    I seriously wonder where your priorities lie and why you didn't voice your concerns during your stay. What good can come from you contacting administration that couldn't come from you speaking up to the nurse or tech performing care. You were obviously well aware of what happened at the time since you memorized the number of nurses and techs that made errors.

    As a nursing student and as a nurse to come you are to be an advocate for your patient and you are a professional responsible for your behaviour. What will you do later on as a nurse when you see your resident accidentally contaminate himself while he is inserting a central line, I hope you will have the guts to speak up and force the matter and not tell administration afterwards what happened as your patient is lieing there septic from a CABSI. That's not in the best interest of anyone.

    What worries me more is that you seem more concerned about scoring a hospital bad on a survey as a whole but you seem unburdened about contacting hospital administration and potentially cause some caregivers a lot of grief.

    By all means I don't agree with the things that happened to you as being best practice, not in the least. But remember that this is no way to perform feedback. Because if this complaint makes it back to the caregivers that made these errors it is potentially in a very negative way or in some twisted version of the actual facts.
    Remember that these stories get passed from person to person and in the end nobody will remember the actual story, the actual patient but luck will have they'll remember the actual caregiver. And then a nurse out there has to defend herself why she didn't remove an IV from a gangrenous arm...

    By all means fill out the survey, contact administration. But do some soul searching within yourself and speak up next time... you owe it to the future patients and the caregivers.
  14. by   theantichick
    I'm sorry some of you seem to think I'm on some sort of witch hunt or have some nefarious purpose in posting this.

    I tend to be more than just a bit of a germaphobe. I realize that I'm more sensitive about some of this stuff than most people are, which is why I wanted to get some feedback from experienced nurses about the things I saw and whether it warrants any kind of feedback to the administration. Kind of get a reality check.

    I also recognize that I have a vibrant, robust immune system, and nothing that happened to me there is likely to cause me any problems to speak of. Which is why I didn't say anything at the time, and have not said anything to administration without getting that reality check. So as far as advocating for myself, I don't think I was at any risk to speak of.

    Frankly, it's more that I was just surprised by some of it, (the long, chipped fake nails, mainly) especially on *nurses*. All of the hospitals I've done clinicals at, I've never seen a nurse with extensions. Lots of techs with extensions, but no nurses. And I know for a fact that this hospital system has policies against fake nails. For this to be happening in *CCU* just surprised me more than anything. And they make such a big deal about phlebitis in school, I expected the nurse to at least assess it and she didn't even look at it. It didn't occur to me to point it out to the doc who discharged me.

    As far as contacting someone in administration, I mainly was asking because if I were the infection control nurse, I'd want this kind of information. But if I were an infection control nurse, I'd use this information as an indicator that this particular unit warranted some inspections and closer oversight, *not* to pull the chart and reprimand everyone who touched me. And I'm more than slightly concerned that the latter is exactly what would happen. These were all good, competent caregivers who gave me excellent care, and may just need some education and reinforcement about procedures and policies - I don't want them getting reprimanded for this. Also, I have concerns about contacting administration because this was so wide-spread throughout my stay that I can't believe the managers and infection control aren't aware of it. Which means that THEY have not gotten serious about enforcing the policies.

    I don't intend to ding them on the survey because I know that the surveys are going to be used against hospitals instead of informing them and providing an avenue for needed changes.

    Also as a side-note - I find it amazing (not that I don't believe the poster who said it, I just am amazed) that rings with gemstone settings aren't as much of a reservoir for germs as fake nails. We cultured gemstone rings in micro, and they grew all sorts of colorful stuff, much like the nailbeds.

    Oh, and as for the "re-feel" with the glove... I know that it's sometimes necessary to re-feel the stick site. I've seen this handled many different ways before such as swabbing down the gloved finger before "re-feeling", or by feeling above the actual point where the stick is happening. I just don't think it's good practice to be feeling all over the area you just cleaned and are about to stick with a non-sterile glove, and I saw it *a bunch* which makes me wonder if anyone watches the tech's techniques after they're trained.

    Thanks for all the constructive feedback.
    Last edit by theantichick on May 23, '12