I had to write my first incident report today, and I'm just not sure if I handled the whole situation properly.
Background: Patient is a 9 month old infant who has been with us since day one (never home). He's quite fragile ... look at him the wrong way and, if he has an IV, it blows. He had a rough night yesterday, febrile, GI issues, and was made NPO with IV fluids for a few hours to give his gut a rest. When I came in in the morning, the report I got was, "His hand looks a little red. You'll probably be able to see it better during the day. It the IV has great blood return, so it's fine." I walked into the baby's room, touched his hand, and he screamed. I stopped his fluids, turned on the light, and saw that the IV was totally infiltrated, phlebitic to the point of his skin starting to peel! Took it out, (after which he was afebrile the rest of the day), gave him some TLC, and told the charge nurse. (Round our parts, it's a big deal when this kiddo loses an IV ... everyone gets told so we can gird our loins to find the next one.) She told me right away to write up an incident report. So I did.
NOW, here's the thing ... when the nurse came in again after my shift, I told her his IV had infiltrated and told her what had happened. She immediately said, "No, it looked fine. He had fluids running for hours, and nothing was wrong with it. His temp was because of his GI issues." So I shut up at that point and didn't mention the incident report. I just didn't want to get into it with her at the end of a long day.
Was this the way to handle it? Something tells me it wasn't. Should I have told her that I wrote up the report? Was there a better way to have approached the situation to get across my feelings of frustration with the way she handled him overnight? Another nurse told me I was overreacting because I'm "too attached" to the baby. Given the fact that he's set to go home on Tuesday for the first time EVER, I think an infiltrate like that was a big deal, because this boy doesn't need any more setbacks.
I'm still new at this nursing thing (15 months into my oh-so-long career), so any input is appreciated.
(PS, I can't spell ... could a mod please correct my subject line?)
Indeed, the filling out of the thing wasn't so bad. I'm just left wondering if I should have said something to the nurse involved. We don't use names on the reports or anything (other than our own when we sign them), but the HN's go back and find out who the nurse was at the time of the incident and follow up with her/him. Should I have talked to her about it so it wouldn't b a surprise? Is there a nice way to do that? (Interpersonal conflict = not my favourite thing.)
PIV restarted in left foot with 24 gauge angiocath."
Which would have been nice, and also would have made me the world's best nurse, if I had been able to just restart an IV on that kid lickety-split like that ... I would have been everyone's hero. =) When his IV's come out, we just switch him to PO or IM (ouch!) abx and pray he doesn't spike.
Indeed, the filling out of the thing wasn't so bad. I'm just left wondering if I should have said something to the nurse involved. We don't use names on the reports or anything (other than our own when we sign them), but the HN's go back and find out who the nurse was at the time of the incident and follow up with her/him. Should I have talked to her about it so it wouldn't b a surprise? Is there a nice way to do that? (Interpersonal conflict = not my favourite thing.)
I found out, through experience, that people don't like it when you write an incident report and don't tell them about it.
No conflict necessary, just tell the person in a polite, friendly manner that such and such happened and that you had to write an incident report about it, and that you just wanted to let them know.
There are a multiple of factors at play in this situation.
Should you tell the coworker you filed an incident report? Yes, as a courtesy heads-up.
Should it be a surprise? Probably not if you're following your facility's policy on when to file one, but we know that's often not followed regarding infiltrated IVs.
Might your coworker be angry that you filed one? Yes, especially if she suspects you did it to make her look bad. However, if your NM instructed you to file it, you can redirect her to the NM.
Did you do the right thing in filing the incident report? Absolutely! It's always possible that the infiltration could result in some damage. And it gives your NM an opportunity to review the situation with the other nurse, if there are any concerns about care.
HollyVK (with peds and risk mgmt experience)
Indeed, the filling out of the thing wasn't so bad. I'm just left wondering if I should have said something to the nurse involved. We don't use names on the reports or anything (other than our own when we sign them), but the HN's go back and find out who the nurse was at the time of the incident and follow up with her/him. Should I have talked to her about it so it wouldn't b a surprise? Is there a nice way to do that? (Interpersonal conflict = not my favourite thing.)
I found out, through experience, that people don't like it when you write an incident report and don't tell them about it.
No conflict necessary, just tell the person in a polite, friendly manner that such and such happened and that you had to write an incident report about it, and that you just wanted to let them know.
AliRae
421 Posts
Indeed, the filling out of the thing wasn't so bad. I'm just left wondering if I should have said something to the nurse involved. We don't use names on the reports or anything (other than our own when we sign them), but the HN's go back and find out who the nurse was at the time of the incident and follow up with her/him. Should I have talked to her about it so it wouldn't b a surprise? Is there a nice way to do that? (Interpersonal conflict = not my favourite thing.)
Which would have been nice, and also would have made me the world's best nurse, if I had been able to just restart an IV on that kid lickety-split like that ... I would have been everyone's hero. =) When his IV's come out, we just switch him to PO or IM (ouch!) abx and pray he doesn't spike.