Physician Negligence

[Djadia]

We currently have a paraplegic on our unit with 2 extensive wounds on his left leg which are currently being managed with a wound vac. During one of the vac changes a few days the surgeon was present during the wound vac change and "took over" the wound care. He encountered difficulty in removing the foam dressing that was packed in the tunneling part of the wound. He picked up a scissors from the patients bedside table (which defineately was not sterile. It was used for cutting tape etc. not to mention - it probably had fallen on the floor several times etc.) and proceeded to make 3 large cuts within the wound to allow him access to the tunneling dressings. Granted this patient had decreased sensation in that leg but could feel pain the deeper one probbed. The surgeon didn't tell the patient what he was intending to do, nor did he ask the nurse to get him a sterile scissors. The issue I have is that I was not the nurse present who witnessed this surgeons actions. The nurse who was - refuses to report the surgeon seeing as though she works with him frequently. In my opinion this is ethically wrong, and it appalls me to think that this surgeon would have done this. It defineately makes me wonder what other things he may do that noone witnesses. Do I have an obligation to report this to our nurse manager or do I stay away from the entire situation seeing as though I wasn't directly involved. I already talked with the nurse who was involved and encouraged her to report the incident however, she declines to do anything further.

[psu_213, BSN, RN]

I realize that as a pt advocate you feel like you should do something. The problem is that you did not witness anything. It would be his word from his experience in the situation versus your 2nd hand word--you are going to lose that battle. If the nurse who was there refuses to say anything about the situation, that puts you in a place where you cannot do anything.

Not doing anything here is not an abdication of your duty. If you did say something not only would that not change anything (and it would not result in punishment for the physician), you would also be setting yourself up for distrust by this physician, possibly other physicians, and possibly other staff--"oh, watch it when he/she is around, he/she will tell on you for anything and make up things based on what others say." I'm not saying this is the truth about you, but it is what others may say.

It sticks to just say 'let it go' but there really isn't any good that can come from your getting involved.

[Djadia]

Given the increased infection rates and reimbursement based on new aquired infections while a patient is in a hospital, how can I just overlook this surgeons practice. If this patient would develop a new infection, I'd have a difficult time knowing what I know & not pursuing the issue. Reimbursement is a hospitals vitality.Medicare won't reimburse for infections aquired while a patient is in a hospital If this surgeon follows this same practice on other patients - Its the patient & nursing staff's burden not the surgeon. As nurses, we could be facing the repercussions not the surgeon. When does this vicious circle end?

[psu_213, BSN, RN]

Given the increased infection rates and reimbursement based on new aquired infections while a patient is in a hospital, how can I just overlook this surgeons practice. If this patient would develop a new infection, I'd have a difficult time knowing what I know & not pursuing the issue. Reimbursement is a hospitals vitality.Medicare won't reimburse for infections aquired while a patient is in a hospital If this surgeon follows this same practice on other patients - Its the patient & nursing staff's burden not the surgeon. As nurses, we could be facing the repercussions not the surgeon. When does this vicious circle end?

I don't disagree with you on it being a problem for nurses too. However, you were not there when this happened. What is someone tells you that another nurse did not use sterile technique when starting a Foley? or when changing a dressing on a central line? Are you going to report that nurse of 2nd hand info--after all the hospital will have to pay for tx of an infection that results? What if someone tells you that Dr. S has bad technique in the OR? You would have to report that.

If you see it, report it....if not, not much you can do. In the case of the wound from your first post, keep a close eye on it. Treat it, per order, if the infection gets worse.

[classicdame, MSN, EdD]

Agree that you cannot make a report but I would certainly contact Infection control so they can keep a watch on this patient. That could affect hospital risk if an infection develops. Poor patient!

[Guest343211]

Report it to the appropriate people (risk mgt and ID, etc) if you want; but realize you are going to get some backlash from it. You can't make a written report, since you didn't witness it; but you can voice what was shared and that it is of concern and should be investigated. Again, you will get backlash, but probably even more so b/c you didn't directly witness it. You can phrase it to risk mgt and ID as a concern, but that you did not witness it, and you don't know, if or to what degree, it is true. People report stuff that they merely have "heard" and not seen all the time in the hospitals. Geez there is so much of this without substantiation in nursing and the healthcare field, it's unbelievable. What's the status on the patient? That can make a difference too.

IDK. You're in a bad place. You can only report it as secondary information, and then let the appropriate people follow up on it.

About the whole scenario you described. . .Major yuck! Surprised the patient didn't say anything to the doc, regardless. Wasn't he watching at least?

Eeewwww, so nasty.

Also agree with classic above; but I would express concerns to RM too.

[itsmejuli]

Pick your battles wisely.

[tewdles, RN]

My experience is that docs do this sort of thing WAY too often. Sometimes they drag scissors out of their lab coats to cut sterile dressing supplies. Unbelieveable.

You cannot report hearasy.

Keep your eyes open and advocate for your patients by calling docs out on this poor practice habit.

[echoRNC711, BSN]

Focus on the care you are giving.I do not condone the surgeon's action .However, if any nurse was video taped for a day would there be anything on that tape that someone might consider sub standard?

I see in nursing, myself included ,we seldom address the person directly concerned. If you felt strongly ,the time to speak up was there and to him directly. If we do not have the courage to speak up then taking the more passive aggressive route of "I am going to tell on you" will unlikely yield the results sought after. Do you really think the surgeon will ever even hear the complaint?

I have worked in the OR with excellent surgeons and complete jerks that I would have loved to fling a few instruments their way . What I take from this lesson is this, Doctors stick together they address things directly. Nurses complain,do not see themselves as a cohesive unit. That's what needs to be changed. Stop being "nice" the truth is a much better gift. Then perhaps when we are faced with issue that concern us deeply we are strong enough to speak up and say in a way that works "Oh Dr. Those scissors fell on the ground. Can I get you a fresh STERILE pair? Now..Was that so hard? Or.... would we rather,write him up, tell everyone about it.Get annoyed when the manager doesn't respond? Hmmm....is that time well spent?

We need to stop making Dr's God. Behavior continues if we allow it. Nurse's- We really need to value ourselves and each other more. We need to judge less and build more, in particular each other. Aren't we done yet with complaining,back biting and reporting each other's weakness because we lack the courage to tell the truth.

Yes, there are nurse's who speak up I do see that too but the culture of complain and report does not serve us. I personally made a commitment to myself sometime ago to be part of the solution. There really is a better way to be heard.

[KelRN215, BSN, RN]

What would you report if you were to make a report? "Suzy, RN told me in the backroom that Dr. G did not use sterile technique while doing xyz?" You didn't see anything. In what capacity did she tell you? Are you her supervisor? You have encouraged her to file a report. That's all you can do.

[Kooky Korky, BSN, RN]

Wasn't the wound already infected before this event?

Too bad dirty scissors were left lying around available like they were.

What would you think about talking directly to the doctor in private. Just say you were confused about ________ and wondered if the patient could feel the cutting/probing and did it matter if the scissors weren't sterile? No confrontation, just you were confused. The doctor might become so scared that someone saw what he did that he might at least wipe off dirty scissors with an alcohol pad before using them like that. And he might give a little anesthetic.

Just consider it, don't jump to do it.

If you were the one receiving a report like this, what would you do about it?

Just some things to think about.

[fastwalkslowtalk]

I'm not understanding what the problem is here. Those actions of the Surgeon clearly fall under the categories of Abuse and Neglect. The witnessing nurse made a statement of allegation of potential abuse and negligence.

Is there not a state or county agency to make your report to outside of your clinical setting? Are you not a mandatory reporter? A paraplegic is by legal definition a disabled person who is protected under the mandatory reporter law.

Mandated reporters are required to file a report whenever there is reasonable cause to suspect or believe any resident of a care facility has been abused or neglected by a staff member of a public or private institution or facility that provides care. Whenever the results of an investigation leads to the conclusion that there is reasonable cause to believe that that there has been abuse or neglect perpetrated by staff, then the institution, school or facility must provide records concerning the investigation to the appropriate investigating agency and/or to the agency that licensed the facility.

Your State should have a Adult Protective Services, Department of Human Services, or a Seniors and Adults with Disabilities agency where you could file a report anonymously to. Also, your State Board of Nursing should also have provisions as well.

In most states, if not all, failing to report abuse is also a criminal offense.

It is your duty and obligation as a Health Care Professional to protect the safety and well being of your patients. It is not your obligation to conduct an investigation or gather evidence.