Incident report for infiltrated vein?

[09NewGrad]

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.

[Virgo_RN, BSN, RN]

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, NP]

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]

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.

[09NewGrad]

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]

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]

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]

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.

[sasha1224]

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.

[tokmom, BSN, RN]

I can't say enough about documenting throughout your shift, like the previous poster mentioned about the TPN. We have new grads that write in the notes on pm shift, "hourly rounds done." I tell them all the time, that, that one simple comment is going to come and bite them in the butt one day. That is ripe for a potential lawsuit. They think I'm old fashioned and write too much. I have BTDT with a pt that sued and the only thing that covered my hiney was my 'over charting'.

As for the write up. They suck. Some nurses are totally write up happy. I work with a new grad that lives to fill out incident reports. She finally made a goof last night. I didn't write her up. The pt wasn't harmed and it was no big deal. Had there been pt harm, that would have been another story.

[that_judi_girl]

Don't take it personally that an incident report was done. Incidents are documented for various reasons including corrective action on an individual or if there is a patern of one kind of incident, additional staff training or policy change.

[RedhairedNurse, BSN, RN]

I can't say enough about documenting throughout your shift, like the previous poster mentioned about the TPN. We have new grads that write in the notes on pm shift, "hourly rounds done." I tell them all the time, that, that one simple comment is going to come and bite them in the butt one day. That is ripe for a potential lawsuit. They think I'm old fashioned and write too much. I have BTDT with a pt that sued and the only thing that covered my hiney was my 'over charting'.

As for the write up. They suck. Some nurses are totally write up happy. I work with a new grad that lives to fill out incident reports. She finally made a goof last night. I didn't write her up. The pt wasn't harmed and it was no big deal. Had there been pt harm, that would have been another story.

This is a great thread that's been started.....I'm learning a lot here.

tokmom........can you give other examples of what type of over charting you do and perhaps elaborate on how your covered yourself with the charting in the lawsuit. I feel weak in this particular area, maybe not so weak, but I work at night and it's always so hard to think of something to write other than, 'resting with eyes closed, resp even and unlabored and in no distress.' I will however, always start documenting on my IVs at end of shift thanks to you all and the OP. : )

[Bklyn_RN]

Redhaired

Charting is a double edged sword. It can cover you and it can also expose you. My rule of thumb is that I chart as though I know my notes are going to be read in court. Litigation is an industry, pts lawyers are very clever. Law firms actually hire nurses to decipher legal strategies (and read charts) to procecute other nurses and medical facilities. Across the street from my hospital, near the main entrance no less, is a billboard with this, "HAVE YOU BEEN INJURED BY THE NEGLIGENCE OF A DOCTOR, NURSE OR HOSPITAL?"

It then goes on to mention about monetary compensation and provided an 800 number.

Needless to say, this billboard has made me a more careful nurse. It serves as a daily reminder of the legal climate we are providing care in.