Needle Stick injury

enuf_already · Mar 1, 2015

I think you've handled it very well, by the way. Warning the employee, re-signing the policy, & educating staff were needed steps. I just think, even though you have limited information, it would still be wise to at least offer testing for HBV, HCV, & HIV to the employee. Refusing to offer testing to an employee reporting a sharps injury, no matter how delayed, would make the employer look pretty bad, if you ask me. I would also consider evaluating the safety of the medical device used and ensuring the employee is using it properly.

The big question then is what would you do with positive results? If the nurse would turn out to be HIV+ do you go back, like another poster said, and try to test all patients within that week that the nurse reports she was exposed? Do you pay for treatment?

The problem I see here is that if I had concerns about a needle stick in the beginning, I'd at least remember the date it happened and the time. Waiting 3 months puts the burden of proof that it even happened on her. Do we know for sure the nurse had a sharps injury?

This would be like someone saying they hurt their back 3 months ago on a patient but don't know the date or patient, didn't fill out a report, but now want a complete workup. If treatment is needed, the employee will expect the employer to pay.

From a legal standpoint I have no idea what the correct answer would be but I think this shows why employers have policies and procedures and why sometimes they need to be even more specific. (Do on the job injury reporting procedure policies at most of your workplaces have a specific time frame to report and mention what will/won't be done if you are out of that time frame?) I personably think that expecting an employer to cover something that allegedly happened 3 months prior with no report is asking too much. Of course this is my opinion only.

canigraduate · Mar 1, 2015

Your employee is coming across as very underhanded and sketchy.

I would go to your "powers that be" with the situation and advise them to engage counsel and then go from there with whatever counsel recommends.

If your employee is being truthful, then they screwed themselves by not following the correct procedures.

Esme12, ASN, BSN, RN · Mar 1, 2015

Thank you for replying! :)
This employee states she is not symptomatic but feels that testing is now necessary & is insisting on it. This person can't provide me with the exact date of the injury either (just the month & approx. week it may have happened). Employee also states they questioned pt (@ time of stick) & pt states clean hx. Unfortunately I don't have a RM department (small surgery center) I can turn to.

You need to check with legal or HR. What exactly does the policy state? Time limits vary state to state check with your state or workers comp carrier.

In most instances if the employee fails to file an incident report prior to leaving the facility THAT DAY the facility is under no obligation to test nor treat this employee. You can offer testing but advise the employee that they will be responsible for the cost as it is no longer considered a "work" injury as he/she failed to follow policy and procedure. If they continue to insist you need to get upper "someone" involved as the employee should be advised that they need to legal assistance to prove it is work related.

The employee cannot return after 3 months, not know the patient (even though they said they asked the patient) and expect to be covered by workman's comp. There is no proof that he/she was even stuck by a needle 3 months ago. She can't remember the day date nor the patient but she definitely remembers having a conversation with this patient about his HIV status? I smell a rat.

You must have some legal department for the facility....speak to the medical director.

Sweetxangel16 · Mar 1, 2015

Thank you, I'm giving it my best! I did change the device to a safer one as soon as employee told me what had happened (said employee did not like this change). This employee just asked me Friday at the end of shift. I told them that we'd talk more next shift, since she's on vacation for a week. I would never refuse to offer testing after a stick (regardless of time) but I wanted to see what other advice I could get on this situation. It doesn't make sense to offer it if there was a possibility it could've happened elsewhere or yrs before. How would one prove it happened at that needle stick & not a previous time of another stick that was not reported. I don't know how long or how many needle sticks could've happened since she's been there.

I appreciate our discussion! I like talking through problems & get insight from others. II've decided to go to the head of our medical board to see what our next steps should be.

trinitymaster · Mar 1, 2015

Here is my opinion:

Do not offer to provide testing unless you get it cleared through legal and risk management. The delay is too long. The patient needed to be tested (so long as consent was obtained) and treatment started immediately. The employee also would have been tested to confirm a negative HIV/HEPB. There are possible reasons why it was not reported on time:

1. It did not happen.

2. The employee was under the influence of drugs or alcohol at the time.

3. The employee was scared.

Either way, you do not want to be liable. Check your state's laws and your facility's policies. Generally an incident has to be reported within 48 hours of its occurrence.

My gut feeling is that the employee believes that they are HIV possible and wants to try to hold the facility responsible.

mariebailey, MSN, RN · Mar 2, 2015

Your employee is coming across as very underhanded and sketchy.

Underhanded and sketchy? Maybe, but I doubt it. Dumb and lacking conscientiousness is more likely. It's weird to me how many people on this thread are assuming that because she made a mistake (delaying telling her employer), that she's obviously infected with HIV and wants workman's comp for it. Nurses get thrown under the bus all the time by their employer; we should not advocate for this to continue. I listened to an NPR show discussing how often nurses injured their backs on the job and how many employers refused to pay and even fired the nurse. Employers should support their staff, as fallible as they may be.

canigraduate · Mar 2, 2015

Underhanded and sketchy? Maybe, but I doubt it. Dumb and lacking conscientiousness is more likely. It's weird to me how many people on this thread are assuming that because she made a mistake (delaying telling her employer), that she's obviously infected with HIV and wants workman's comp for it. Nurses get thrown under the bus all the time by their employer; we should not advocate for this to continue. I listened to an NPR show discussing how often nurses injured their backs on the job and how many employers refused to pay and even fired the nurse. Employers should support their staff, as fallible as they may be.

Fair enough. I have been around a sketchy demographic lately and it may be coloring my perceptions.

Dumb is far more prevalent.

edmia, BSN, RN · Mar 2, 2015

I'm sorry but a nurse with 20+ years experience who doesn't know what to do with a needle stick? Yeah. Not buying it.

Sent from my iPhone -- blame all errors on spellcheck