Honestly...Did I over-react?

[oliveralways]

Here is the situation:

During my 7p-7a shift, confused pt becomes combative when myself and care partner are trying to help her to the BSC. I reached out to help her and she grabs both my arms and scratchs me (took off the skin, small bleeding). After the patient is safe per security, family, and doctor intervention, I become concerned about myself b/c then it dawns on me that this is a VRE and MRSA positive patient with a history of alcholol and drug abuse. I've only been at this hosptial for 2 months, so I start asking how do I fill out an incident report. Everyone gives me the blank stare. I eventually get an incident report. I call the charge nurses giving end of shift report, they tell me that they have to page the house supervisor and they'll be out in about 20 minutes, but to wash my arm. I believe that is too long, therefore I call the house manager and report it, then go to the charge tell them what has happen, give my 5 patients to the charge and go to the ED. I'm in ED for about 4 hours, return to the floor and take my patients back.

Was a scratch worth the report and ED visit? Also, during this event the charges never stop report to assist (the patient became very combative needing security, a call to family who rushed in and the md)

[DDRN4me]

I do think that an incident report was the correct action. Not sure that I would have gone to the ER for a scratch or two.... but again I was not in your position.

Regardless, your charge nurses should have assisted you in dealing with the patient.

[Tweety, BSN, RN]

It was not worth an ED visit in my opinion. Sounds like local treatment that you could have provided yourself was in order.

It was definitely worthy of an incident report that states what happens, who the witnesses were, etc. This way is MRSA or another infection settles in you're covered.

[traveljen]

Actually I might have gone to ER depending on your facility policy regarding things like this. Where i use to work we would have had to go to ER in case something did happen to prove that it wasn't there before we went to the ER on that day so work comp would cover.

[NurseCard, ADN]

If you contracted MRSA or VRE from this patient, I'm not sure that there was really anything that could have been done for you in the ER. But again, maybe it is your hospital's policy to be seen in the ER for ANY injury, like another poster said. You were absolutely correct to fill out the incident report. We don't know how badly scratched your arm is; never know when that actually could become badly infected, resulting in you having to seek further medical treatment.

[morte, LPN, LVN]

d/t to the bacteria cited and the fact of addiction, you dont know what else this person may be carrying, i think the ed was the way to go....had this been days, i think emplyee health would have been appropriate

[NewWayofLife]

I had a very similar incident with a patient... as I was restraining her, she dug her fingernails into me hard enough to create several crescent marked open areas on my fingers. I noticed the blood on my hand as I was leaving the room, but didn't realize it was mine until I was on my way home, LOL. Of course, she was MRSA+, but I didn't know that at the time, and hadn't been wearing gloves.

I did fill out an incident report, and spoke with Employee Health... who told me that all they recommended was a good washing, neosporin and a bandaid- so I did politely decline the offer to be seen.

Nothing came of it, but I'm glad I reported it (just in case). I kind of felt silly at the time, but they assured me I was doing the right thing. Fingernails ARE very dirty!

[DA314]

From a practical standpoint, the ER trip seems a little much.

From a legal standpoint (I handle worker's comp cases all day long!), going to the ER was very smart. There have been several nurses to call us, saying they contracted something from a needle stick or a bite from a patient, but they didn't go to the ER that day. With no proper medical documentation, you can't really prove where you got the disease/illness. Even with documentation, on an illness like MRSA,that you could pick up from the Arby's bathroom, it would be a stretch to prove. Having the medical documenation helps.

The saddest I saw was a person who got Hep. C from a needle stick. She didn't report it, so there was no proof. We couldn't help her. I think she gave the infection to her BF too. So sad.

[racing-mom4, BSN, RN]

Honestly if I was your co worker I would be a tad ticked off that you were in the ER for 4 hours, what exactly did the ER do for you??

I think filling out the paper work section was fine and then going to Er or corp health after you got off work, just out of curiosity, did you have to clock out while you were sitting in the ER?

[CoffeeRTC, BSN, RN]

Yeah...what did they do in the ER?

LTC pts often act out and might scratch you...MRSA, VRE and other infections are often common.

Yes, an incidient report is a must, but ER trip??

[GrumpyRN63, ADN, RN]

I think the incident report was enough, you could have followed up with employee health within the next day or two, I think the ED went overboard. I've had needle sticks and other esposures in my eyes/mouth- pretty nasty stuff, didn't go the ED, f/u w/occupational health

[FireStarterRN, BSN, RN]

Is it your facility policy to go to ER for any and all work related injuries? If not, then I think an ER visit was unnecessary.