Please stop! Little things that are just bad practice.

[JBudd]

Little things that are just bad practice.

Like looping IV tubing back into itself (against our policy, and they went to great lengths to hand out caps to carry in pockets). And not even cleaning off the port you looped it into!

Disconnecting a running IV to take a pt to the bathroom.. and just leaving the bare end hanging from the pole. Don't interrupt IVFs ! Take the blinking pump with you!

What are yours?

[No Stars In My Eyes]

This is the logic. I have a harder time with it because it's BMT. A lot of our patients get to know each other and will talk in the halls with other people's family members or even stop in their rooms. And a lot of family members from long distance all stay in local lodging facilities together. Also, it's not required for any type of isolation, not just contact.

We're already doing away with isolation for a lot of things. We don't isolate for VRE any more and MRSA is probably next on the chopping block. Our infection control department was looking at cultures and realizing that all of the strains we were seeing were different, so it's not spreading person to person, so much as people are all kind of showing their own dormant strain.

Interesting! Come to think of it, way back in time, isolation was more or less a privacy issue than de rigueur for certain diseases. I mean, even TB patients were housed in wards.

We never croaked from not using gloves (except for sterile procedures); it was considered to be wasting supplies. "Just wash your hands really well!" we were told.

I actually think my immune system is the stronger for it. Of course, we also didn't have all the antibiotic resistant strains of bacteria back then.

[Christy1019, ASN, RN]

I totally agree with you.

According to Tom Ahrens of Phillips Life Sciences, there is absolutely no research to support the validity and accuracy of taking the NIBP on the forearm or the thigh.

This another thing that is a bad practice.

What is the recommended site to use in dialysis pts with their new access in one upper arm, old access in other upper arm, or amputee, etc?

[EDRN1091]

Another please stop:

Please, when you have orders to hand irrigate a foley catheter, understand that this is a sterile procedure.

You can not reuse the same irrrigation set. Throw it out when you are done.

You need to put on sterile gloves and use a new irrigation set each time.

Please come give this talk to the urologist that was irrigating a 3-way in my ED bare handed using an already used basin filled with sterile water (not sterile anymore) and soaking my pts bed because he let it drain all over the sheets, THEN proceeded to place a garbage bin under the collection bag and leave it wide open to drain into.

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[Christy1019, ASN, RN]

Please come give this talk to the urologist that was irrigating a 3-way in my ED bare handed using an already used basin filled with sterile water (not sterile anymore) and soaking my pts bed because he let it drain all over the sheets, THEN proceeded to place a garbage bin under the collection bag and leave it wide open to drain into.

Sent from my iPhone using allnurses

Oh em gee!! I wish the phone app had emoticons so I could use the bug-eyed, jaw dropped one Lmao! He could've gone for the trifecta and used his own spit to lubricate the catheter for insertion, or secure the Foley to the leg with chewed bubble gum lol!

[nandosport]

I have pts do this way more than other rns. Quite a few frequent fliers will shut off the fluid, disconnect the line and shuffle off to the bathroom leaving the open end dangling.

I try to teach them but as chico marx said "they no a listen".

I'm just a pre-nursing student, but I've told my mother--showed her how--to cut off her IV and disconnect it when she had to use the bathroom. Why? When she didn't do it, she soiled her bed, room, and bathroom bc no one helped her go to the toilet despite having asked for assistance (those are CNA duties, right? *tisk*). THEN she had to wait until they could find a CNA to help give her a bath, change her sheets, and call house keeping to mop up the trail from the bed to the bathroom. My mother is 300+ lbs and in her 60s. Has an unsteady gait (arthritis & chronic pain= unable to carry huge, blue IV machine that's on opposite side of bed to bathroom). She's on a bunch of immunosuppressive drugs(for conditions including IBS & UC) & a few diuretics. She's been disabled since 2002; if she has to go, she has to go now. When she soils herself and has to wait for clean-up, she's: 1. embarrassed & 2. almost guaranteed a rash or some boils bc of her meds. Immunosuppressive drugs make for a slower healing time, so I'll be at the house doing patch work on her skin for weeks after her 5 day stay in the hospital bc someone couldn't help her go poo.

It's less of a hassle if she shuts off the IV--you can replace the entire thing. Sorry.

[Morainey, BSN, RN]

This is the logic. I have a harder time with it because it's BMT. A lot of our patients get to know each other and will talk in the halls with other people's family members or even stop in their rooms. And a lot of family members from long distance all stay in local lodging facilities together. Also, it's not required for any type of isolation, not just contact.

We're already doing away with isolation for a lot of things. We don't isolate for VRE any more and MRSA is probably next on the chopping block. Our infection control department was looking at cultures and realizing that all of the strains we were seeing were different, so it's not spreading person to person, so much as people are all kind of showing their own dormant strain.

Huh! This is interesting to me. We recently had a patient who was the husband of a staff member who dutifully wore her gown and gloves every day, and I couldn't help but think, why? When they go home together they're not going to be on precautions. This one has always stumped me. I understand the idea behind not giving all the patients ROs but what about family members who are full time caretakers for that person who are visiting only that patient?

[icuRNmaggie, BSN, RN]

What is the recommended site to use in dialysis pts with their new access in one upper arm, old access in other upper arm, or amputee, etc?

The topic is little things that are a bad practice.

A cuff on the wrist of the arm with the non functioning shunt will not be accurate due to the arterial diversion.

If this person is critically ill he needs an arterial line in the femoral artery on the side of the non amputated lower extreminity and a triple lumen IJ or subclavian.

If this person is septic and a full code, this should be done immediately.

Obviously you would do NIBPs on the popliteal until the Aline was obtained.

I would not allow an ICU nurse to titrate vasoactive meds on my family member based on a popliteal NIBP.

Why - because there is no evidence to support the accuracy of taking a blood pressure on the wrist or the thigh.

In a stable patient I would clear it with nephrology before doing popliteal NIBPs.

.

[MunoRN, RN]

The topic is little things that are a bad practice.

A cuff on the wrist of the arm with the non functioning shunt will not be accurate due to the arterial diversion.

If this person is critically ill he needs an arterial line in the femoral artery on the side of the non amputated lower extreminity and a triple lumen IJ or subclavian.

If this person is septic and a full code, this should be done immediately.

Obviously you would do NIBPs on the popliteal until the Aline was obtained.

I would not allow an ICU nurse to titrate vasoactive meds on my family member based on a popliteal NIBP.

Why - because there is no evidence to support the accuracy of taking a blood pressure on the wrist or the thigh.

In a stable patient I would clear it with nephrology before doing popliteal NIBPs.

.

The AHA recommends the wrist as the first alternative to the upper arm, thigh measurements are only recommended if the bother upper and forearms cannot be used since the thigh is the least accurate of the three.

Representative of device manufacturers can't recommend use that the devices was not evaluated for during it's FDA approval process so a Phillips rep cannot suggest you use the forearm. But there actually is a fair amount of evidence on upper arm vs forearm vs thigh vs calf measurement accuracy.

[caliotter3]

I often wonder why toilet paper is such a hot commodity that it has to be locked in its holder and in some far away closet when a replacement is needed. Do people walk off with extra rolls or something?

It is quite common for people to steal toilet paper.

[michigansapphire]

Huh! This is interesting to me. We recently had a patient who was the husband of a staff member who dutifully wore her gown and gloves every day, and I couldn't help but think, why? When they go home together they're not going to be on precautions. This one has always stumped me. I understand the idea behind not giving all the patients ROs but what about family members who are full time caretakers for that person who are visiting only that patient?

If the wife is a staff member, she is probably trying to keep from spreading her husband's organisms to any patients she might encounter in the course of her job. Plus, she's setting a good example!

[PMFB-RN, RN]

Please come give this talk to the urologist that was irrigating a 3-way in my ED bare handed using an already used basin filled with sterile water (not sterile anymore) and soaking my pts bed because he let it drain all over the sheets, THEN proceeded to place a garbage bin under the collection bag and leave it wide open to drain into.

I would have never allowed that to happen. I would have put a stop to it immediately.

[VivaLasViejas, ASN, RN]

I'm just a pre-nursing student, but I've told my mother--showed her how--to cut off her IV and disconnect it when she had to use the bathroom. Why? When she didn't do it, she soiled her bed, room, and bathroom bc no one helped her go to the toilet despite having asked for assistance (those are CNA duties, right? *tisk*). THEN she had to wait until they could find a CNA to help give her a bath, change her sheets, and call house keeping to mop up the trail from the bed to the bathroom. My mother is 300+ lbs and in her 60s. Has an unsteady gait (arthritis & chronic pain= unable to carry huge, blue IV machine that's on opposite side of bed to bathroom). She's on a bunch of immunosuppressive drugs(for conditions including IBS & UC) & a few diuretics. She's been disabled since 2002; if she has to go, she has to go now. When she soils herself and has to wait for clean-up, she's: 1. embarrassed & 2. almost guaranteed a rash or some boils bc of her meds. Immunosuppressive drugs make for a slower healing time, so I'll be at the house doing patch work on her skin for weeks after her 5 day stay in the hospital bc someone couldn't help her go poo.

It's less of a hassle if she shuts off the IV--you can replace the entire thing. Sorry.

Why on earth don't they do the smart thing and get your mother a bedside commode?? This is not difficult. That way she can get up and do her thing without having to disconnect the IV. It's more dignified than forcing her to wait and make a mess on the way to the bathroom, and certainly less likely to be an infection-control problem because the IV isn't repeatedly being disconnected. Next time she's in, suggest it to the staff.....they don't seem to be able to figure it out for themselves.