Things I noticed as a patient...

Zookeeper3 · May 23, 2012

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

jadelpn, LPN, EMT-B · May 23, 2012

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!!

sauconyrunner · May 23, 2012

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!!!

Aliakey · May 23, 2012

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! :barf01:

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.

classicdame, MSN, EdD · May 23, 2012

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.

dudette10, MSN, RN · May 23, 2012

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.

Double-Helix, BSN, RN · May 23, 2012

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.

Double-Helix, BSN, RN · May 23, 2012

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.

Jackfackmasta, ASN, RN · May 23, 2012

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.

GitanoRN, BSN, MSN, RN · May 23, 2012

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~

BelgianRN · May 23, 2012

OP,

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.