On a need to know basis? How would you approach such situation?

[rksgray13]

So I was just thinking. I have seen this and witnessed a "mum" kind of speak. Personally, I acknowledge and education when faced with such incidents, be that as it may. When face with, for instance, any type of IV drg change that it LONG overdue, would you let your patient in on it? I have seen wound drgs, IV dsgs, and many other "boo boos" that have been more or less neglected from previous shift duties. I am quite emotional with my facial expressions and get pretty pi$$y with a potential for nosocomial issues. Nasty PICC lines drgs with dried blood and tape coming off. I tend to put an "attorney hat" on. Question after question to figure of the reason behind incidents and I will say to my patients, "this should not look this way or could you help make your caretakers aware when your drgs looks like... such and such?" And I chart everything pertinent. I'm not trying to blame or point fingers but these things are avoidable. I would want someone to call me out if it overlooked any part of assessment because any good attorney will if needed. The last thing I want is a patient with a nurse badmouthing their colleages or facility over this but rather that than a lawsuit for neglect or wrongful death from nosocomial infections or whatever. So are you "MUM" and just do the duty or do you speak up?

[rita359]

I'd be careful about whom I spoke up to. Dressings not changed on a routine basis should be reported to supervisor so offending person can be counselled. If it is an occasional thing then you have to figure out if the nurse had a code or 3 patients she admitted and just ran out of time as you can't be 2 or 3 places at one time. Sometime you have to figure that is why we have 24hr nursing. In a suit happy environment with some people needing little or no reason for suing but still doing so I would be selective in telling patients you judge they got sloppy care which is basically what you are proposing.

[rksgray13]

I agree. I have been "MUM" and chart. If its severe enough I report. I know we nurses aren't perfect but our patients think we are. :)

[classicdame, MSN, EdD]

does not correct the situation if you discuss with the patient. Do what is needed for the patient then report the incident. Involve Infection Control if necessary.

[BluegrassRN]

You are not solving the problem by complaining to or putting on pi$$y facial expressions or attitudes with patients (or frankly, with your fellow staff). You are simply eroding their confidence in *all* the staff, including yourself.

If you have a problem with someone's care, you need to discuss it with that person directly. When you complain to patients, you *are* placing blame and pointing fingers. Whether you are correct or not in your assessment of the situation, it isn't helping. Not only do you undermine your pt's confidence in your facility and all it's staff, you don't come off looking too good, either.

Situation: Dried blood under a PICC line dressing with tape coming off.

Let's think about how this appears to the patient.

Reaction #1: Ah. Your PICC line needs changing. We like to keep them clean and secure to prevent infection. I'll get those supplies and change it as soon as I've finished my assessment.

Reaction #2: Your PICC line dressing looks terrible. Who let it get like this? Your day shift nurse should have changed this. Hopefully it doesn't get infected.

Which one seems more appropriate? Which reaction would make you think that your nurse was a calm and professional nurse in a quality setting, and which one makes you think your nurse is a drama queen who works with idiots in a crappy environment?

If you see a pattern of issues with a nurse or with a procedure, you should address them directly and professionally. Be careful how you present yourself, though. From your description, you sound like you come across as a finger-pointing, blame-game playing nurse. I sincerely doubt that is the case; I'm sure you honestly just want everyone to do their job right and to provide and document great care. I typically will address an issue *privately* with another nurse. If the issue continues, or if it's something that I feel is not my place, I will take my concerns to my director and our CNS nurse. I'll write up an incident report, if it's a systemic issue, a big deal, or a chronic event.

Just make sure you don't ever do it in front of the patient, and that you are doing it in a constructive, professional manner.

[Altra, BSN, RN]

I am quite emotional with my facial expressions and get pretty pi$$y with a potential for nosocomial issues. Nasty PICC lines drgs with dried blood and tape coming off. I tend to put an "attorney hat" on. Question after question to figure of the reason behind incidents and I will say to my patients, "this should not look this way or could you help make your caretakers aware when your drgs looks like... such and such?"

I know we nurses aren't perfect but our patients think we are. :)

Respectfully - your patients don't.

Your patients have been put in the unfortunate position of not only having you call attention to what you feel are shortcomings in care, but also making them feel as if they play some role in that care.

I can only imagine the anxiety and possibly outright fear this induces in patients who are already compromised by their illness and in situations out of their control.

Please reconsider your approach.

[FlyingScot, RN]

But the patients DO play a role in their care. I think each situation and each patient is different. If I have an awake, alert patient who is cared for at home or in an ECF and they have a PICC line I educate the heck out out of them about proper PICC line care. They are the absolute first line of defense in preventing infection. This includes proper showering techniques, how to disinfect prior to flushing, what the dressing should look like and how and how often it should be changed. I have instructed them to protect it from staff who are not doing something correctly such as not masking or using sterile gloves to the point of putting their hand over the PICC and telling the person to "Stop, don't touch me. Please call your supervisor". Unfortunately there are enough un-educated or un-caring nurses out there who do not do things correctly and they put patients at risk. If it is an ECF patient I explain to them and their family what the expectation of the ECF staff is pertaining to line care. They pay a higher fee for a higher level of care and they should receive the proper care. If it is not done I alert the family to be vigilant in the future and I call the DON of the ECF. I also send the expired dressing with the date tape on it in a biohazard bag with the EMT's to give to the DON. I don't do this for dressings a few days expired. I'm talking about ones that are literally greater than 2 weeks old! I'm sorry if this seems over the top but my job is to protect the patients and leaving them in the dark about their care, or lack of as the case may be, does nothing to prevent it from happening again. How many times have we, as nurses, monitored the care our hospitalized family members get? Why do we feel we have to monitor it? Because we know if we don't something will get missed.

Now, when I did work in the hospital if I saw a shortcoming I would fix the problem without involving the patient and then have a chat with the person who committed the error and perhaps the unit educator. If it was repeated then it was time to go up the chain.

[RNperdiem, RN]

In an inpatient situation, the nurses are responsible for things like the PICC line, not the patient. This is a nursing concern to be dealt with among nurses. The patient does not need any extra burdens right now; they are welcome to speak up, but I do not hold them responsible for policing the nursing care.

Things the patient is responsible for would include using the incentive spirometer, rating their pain, using the PCA correctly and things like that. I educate patients about what they need to know and are responsible for.

[Morganalefey]

I would not comment to the pt that something should have been days earlier. How does that make your facility look if you do that?

The other night I came across a 6 day old peripheral IV. Yikes. Our policy is they need to be changed after 4 days, so several people dropped the ball on this one.

I changed out his site, charted it, and passed it on in report that he had a brand new IV. No reason to involve the pt on it.

[netglow, ASN, RN]

Yeah, I mean what would you plan to do?

Tell a patient who is totally dependent on others, they are being neglected, but not by you, shaking your head all the while, then come back in at shift end and say "bye-bye I'm leaving you now, you're on you're own until I get back because I'm the only one who doesn't want to kill you?" How evil are you anyway?

If you replace a dressing or change a line, etc. Just chart that you did it and let those who shoulda done it know, and then your chain of command if needed. You do otherwise then you need to sit down and give yourself a psych consult - because doing the other thing, is just creepy.

[KelRN215, BSN, RN]

When I worked inpatient, I used to find stuff like this all the time. Our IV tubing specifically was 96 hrs... if I found one that was older than that or unlabeled, I threw it away and replaced it with a new one. I did not say to the patient/the patient's parent "Oh this IV tubing is old and should have been thrown away. I can't believe people have been using this for 2 days past its expiration date." If it was something that the family needed to know... like "your child got a triple dose of medication last night" or "your child missed several doses of his IV antibiotics because of an error in the computer", then I did let the family know.

[rksgray13]

I agree the alert oriented patients DO need to play a part in their healthcare. After all it is their welfare.

Evil? no I'm not evil. And I was just thinking how many things go by without notice. My questions would be "when was your dressing changed last?" if not noted on the site itself or unable to be read. "This is something we should clean and redress." Explain sterile to them and port of entry etc. Me, as patient without any knowledge, I want to know what could harm me and how I can play a part in my own care. I know when to keep quiet with sue happy follks but do know when to report.

I wouldn't wave my arms around and go ballistic or say the day nurse had responsibility for this. That's harsh. I have first reactons or even without knowing I'm making a face with debriding a wound frolm last week (for example). I saw something somewhere that a central line dressing hadn't been changed in around 2 weeks and started thinking. I was thinking about home health and how things can go bad without proper patient awareness, rght?