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Incident report for infiltrated vein?

Hey guys, I'm a new grad and have been off orientation for almost two months and work the night shift (7-7) on a surgical unit. Everything has been going just fine, except the other night when I came into work my preceptor (who I had handed a patient off to the previous night) told me to make sure I pay attention to my patient's IV's because apparently his vein/arm was blown up because of an infiltrated vein. I apologized and told her I was surprised it had happened because the gentleman hadn't complained about the issue. Also, he had been sleeping all night and I didn't think to check his IV again right before patient handoff. She said no big deal, smiled, and shrugged off the issue as if i needn't worry about it.

Today my nurse manager pulled me into her office and showed me that she had written up an incident report on the issue. She told me not to worry about it, that it wouldn't get sent to HR, it would just go in my file, and that basically it was just to protect us in case of a lawsuit. She told me to always make sure I do my morning rounds (which I do) and make sure I watch things like this closer, because patient lawsuits are on the rise. She said not to worry about it and that i'm one of her best nurses, but I was not happy that my former preceptor (whom I thought we were good friends) felt the need to go to the manager and have her look at the man's arm. I feel that it made me look incompetent at my job, which I make patient safety my #1 priority. This is why I'm so bothered by this situation. I never would have gone to the manager had I found her leave a patient with an infiltrated IV. I debated texting her why she felt the need to talk to the manager, but for now I'm leaving it alone.

Also, are incident reports a big deal, as in effecting a future employment opportunity or going on my personal record? I'm trying to use this situation as a learning opportunity to make me a better nurse, but it's really discouraging that I have an incident report this soon in my career. Please offer any insights.

wound warrier

Specializes in med/surg, wound/ostomy.

Hind sight is 20/20 and just learn from the mistake. I do not think that it would affect future jobs. Feel it would only be a detriment to your present job if you continuously made mistakes and your file was thick with them.

Little Panda RN, ASN, RN

Specializes in Assisted Living Nurse Manager.

hey guys, i'm a new grad and have been off orientation for almost two months and work the night shift (7-7) on a surgical unit. everything has been going just fine, except the other night when i came into work my preceptor (who i had handed a patient off to the previous night) told me to make sure i pay attention to my patient's iv's because apparently his vein/arm was blown up because of an infiltrated vein. i apologized and told her i was surprised it had happened because the gentleman hadn't complained about the issue. also, he had been sleeping all night and i didn't think to check his iv again right before patient handoff. she said no big deal, smiled, and shrugged off the issue as if i needn't worry about it.

your paragraph here has me a little confused. i am not understanding what you are trying to say. did you know this patient had an infiltrated iv and you forgot to check on it through the night or did the iv infiltrate and you did not notice it during your shift?

I had no idea the patient had an infiltrated vein. When I had last checked the IV, it was fine, and like I said the patient never complained about any issue with his IV. If I'd known it was bad, I would have taken care of the issue long before the vein blew up.

Little Panda RN, ASN, RN

Specializes in Assisted Living Nurse Manager.

I had no idea the patient had an infiltrated vein. When I had last checked the IV, it was fine, and like I said the patient never complained about any issue with his IV. If I'd known it was bad, I would have taken care of the issue long before the vein blew up.

Then I would just take this as a learning expierence and move on. Not much you can do about it after the fact. In my humble opinion, I would not text her and ask her why she didnt come to you first. It could be considered harassment if you do.

She should have told you she was writing the incident up period. They say that occurance reports are used as a way to tract quality and for learning. At our facility they say they are not part of the pt record and are used for internal use only.

I have only been a nurse for 2 years. Unfortunalty some of the best lessons learned are learned when we make an error or forget to ck something. That being said maybe the day nurse didn't ck the iv until 1030 or even 0900. Did you ever think that maybe the iv infiltrated on her shift? I don't like to play the blame game and believe pt saftey is our number one priority. Hopefully she warm packed his arm and no harm was done.

Bottom line to me is the day nurse should have been more upfront with you concerning her future actions. Keep up the good work. One thing I am finding is that some nurses no matter how good they are will do anything to cover there own butt. Sorry if this sounds harsh. I know that the pt is number one and with this in mind you must also protect your own license. I try to be a total team player. if something has gone wrong or been forgotten I will go to the nurse responsible and tell her or him. if it is glaring and has caused harm I will write it up sure, if not I leave it up to them if they want to write it up or not. Maybe that is incorrect though and I should just do it.

You sound like a good nurse hang in there we will learn to play the game and also give the best care possible.

Things must be different where I work, because at my facility, the INCIDENT is written up, not the person. I've reported a handful of incidents, and I've always named myself as a witness (there is no where on the report that casts blame) but to my knowledge, nothing has been placed in my file. Also, when I've come in and found an IV infiltrated, I don't name the nurse before me as a witness. I describe what I KNOW, that I came in to the room, checked the site, found that it was infiltrated during the infusion of Vanco or whatever. I've also had IVs infiltrate when it's been my "fault." I still create an incident report, basically to acknowledge that something unsafe occurred.

And, I also want to add that I had nearly the same thing happen to me when I was a new grad fresh off of orientation (also 7p-7a, also on a surgical floor). I came back in at 7 and the day shift nurse told me the IV infiltrated. I didn't ask if he filed a report, and I still don't know if he did or not. All I know is that it was more than three years ago, and nothing's ever been mentioned about it to me.

Stuff happens. And it sounds like you're doing well!

Edited by Penelope_Pitstop
life is like a box of chocolates

I agree with the above post 100%. I will write an incident report up if I have done something in error if I am aware I did it. I guess the only thing different is at our facility we have this new computer based incident report where if you don't name witness or someone involeved it will not let you file the report. When we did the old way on paper it was that way. No names. Anyway this whole thing is oviously still a learning process for me as well!!

llg, PhD, RN

Specializes in Nursing Professional Development.

Oops. What I was going to say here was not correct.

Incident reports I written up things such as IV infiltrations because they could lead to other complications and this way you have a written record of the event. At my facility I wrote one up yesterday about a patient who for a procedure with an infiltrated IV. The IV was restarted in the procedure room and the only reason I knew it happened was because the patient looked at his hand and said why is it swollen.

Incident reports are also written when a patient goes AMA, or will not allow you to follow hospital policy such as taking a photo of a patient wound that he comes in with.

Believe me this you will author some incident reports at some time too. Like someone else said it is writing up the incident not necessarily the person.

In this instance you might want to write you only note for safe keeping regarding the other person not noting it until 10am.

LA_StudentNurse

Specializes in Med Surg, ICU, home&pub health, pvt duty.

Before I decided to change professions, I was a malpractice paralegal. I am surprised to hear that the incident report was put in your employment file. Normally, risk management receives incident reports, and they 'disappear' into their black hole. That is, no one knows whether they exist or not, other than the risk management team. Rationale: A malpractice attorney would love to subpoena the report, which contains specifics about the incident in the nurse's own words. Should a suit be filed, and the nurse's memory has faded, the attorney would compare the nurses written explanation with her oral/video deposition or trial testimony. Now, how an employer tracks such incidents and addresses the problem with the employee and/or the employee's file is beyond my experience and education. :twocents:

BrnEyedGirl, BSN, MSN, RN, APRN

Specializes in Cardiac, ER.

I agree with some of the previous posters,.where I work the incident report is for in house tracking only and does not include names. In theory, these reports track possible problems with policy, training, equipment malfunction etc. If a certain issue seems to happening with frequency on a certain unit or with a specific piece of equipment the issue is investigated to find the problem. We found a malfunction with a certain IV pump once this way. Without the incident reports we would have had no idea that this problem was occurring frequently throughout the whole hospital! I wouldn't worry about it. As someone else said unless you start accumulating these it isn't a big deal. I wouldn't ask the other nurse about it. From her point of view she was just doing her job. I bet you will be more aware of IV's from now on,..so count it as a learning experience and move on.

For the record,....I don't think I would have made an incident report for one infiltrated IV,...unless maybe the pt or family was making a huge stink.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

At my facility, we are required to fill out IRs for IV infiltrations. IRs are for the purpose of process improvement. So, if enough information is collected about IV infiltrations at our facility through the IR system, then processes can be changed in order to decrease the incidence of IV infiltration.

Spacklehead, MSN, RN, NP

Specializes in Emergency, Cardiac, PAT/SPU, Urgent Care.

I agree with the other posters who stated it is odd that it will be going in your file. As LA student nurse stated, your manager gets them, reviews them, then fowards them to risk management. I have never heard of an incident report being placed in an employee's file.

belgarion

Specializes in Med Surg.

I was taught the reason we don't ever use the words "incident report filed" in our notes is to keep the IR from becoming a part of a legal record. It makes no sense to me that a copy should go into your file since if a lawsuit is filed the plaintiff's attorneys would most likely demand to see an employee's record so they could use any disciplinary actions, poor evaluations, or other negative info as ammo in the suit.

Thanks guys, I feel alot better after reading your posts. However, I still am upset about this situation as I'm not one of the night nurses who just sits on their butt and doesn't ever check on their patients. I'm constantly seeing how they're doing, monitoring pain control, and seeing if there's anything i can do to help. I know some nurses who go in the patients rooms as little as possible, and this has probably never happened to them. Oh well, I'll use this as another situation to make me better.

Bklyn_RN

Specializes in Medsurg, Homecare, Infusion, Psych/Detox.

Happened to me yesterday. Was making my morning rounds and found an infiltrated IV. Removed, notified MD and nursing supervisor, applied compress, instructed pt to keep hand elevated, entered note in chart. The nurse before me was the unit assistant head nurse. Highly competent and very pleasant. But certain procedures still have to be carried out. Nothing personal.

UM Review RN, ASN, RN

Specializes in Utilization Management.

Thanks guys, I feel alot better after reading your posts. However, I still am upset about this situation as I'm not one of the night nurses who just sits on their butt and doesn't ever check on their patients. I'm constantly seeing how they're doing, monitoring pain control, and seeing if there's anything i can do to help. I know some nurses who go in the patients rooms as little as possible, and this has probably never happened to them. Oh well, I'll use this as another situation to make me better.

It's happened to me a few times. When you find a patient with an infiltrate, take the proper corrective action for the patient, make your note, and write it up. Nothing to take personally; I've had IV's infiltrate in less than half an hour to alarming sizes, so I don't feel it's necessarily a relfection on the previous nurse.

RedhairedNurse, BSN, RN

Specializes in Med Surg, Ortho.

I've seen many infiltrated IVs, but never notified Dr. Are we suppose to notify a dr in this case?

It's hard to believe they wrote up an incident report for this. I work at a teaching hospital so

situations such as this are not a big deal. We treat, elevate, and chart it.

Another question...... they use an incident report for record? Well isn't that what charting is for....?.

To the OP:

I wouldn't worry about this. But you have learned that you can't trust any body, right? Always

CYA. I got a write up for an absence when I was still a new nurse and I felt just like you do now.

It's not a good feeling but it's all part of nursing. Believe me, an infiltrated IV is not going to

look bad on you to future employers at all, without a doubt. It happens all the time!

Your post as taught me a great deal and that is to always check my IVs again before shift end.

So see......you've helped some body through your situation. lol

Take care and please have a good weekend and don't feel bad about this.

To the OP: I have worked some places that do IRs for IV infiltrates but they were for tracking not disciplinary action. The key is to monitor the site and DOCUMENT. This saved a co-worker of mine. She had checked a peripheral site in the hand that had TPN/Lipids running before hand-off. The next nurse found the IV infiltrated 30 minutes later. Unfortunately, the infiltrate developed to the point that the patient needed a skin graft. And they sued. Because she had checked the site and documented about it, nothing came back on her.

Chalk it up to a learning experience, monitor and DOCUMENT.

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