Proper protocol - nurse error while with daughter in ER

[joseyjo]

Not sure I handled this properly... I was in the ER today with my 21 year old daughter who has kidney stones. Shift change happened while we were there and the new RN came in to give IV pain meds. She didn't check pat identifiers, didn't clean the IV hub, and didn't flush before or after.

I am a nursing student- have 3 semesters left of my BSN. I have not worked in the medical field yet. I was taken aback and thought I must have miss-seen something, but when she came back in with nausea meds she did the same thing. My daughter looked askance at me about it and I told her I would find out (this was in front of the nurse ). The nurse asked it there was something wrong and I said maybe, and asked her about cleaning the hub. She said, "oh, well everyone does it differently. "

I asked for the charge nurse and talked to her about all of it. She asked if I was a nurse and I said no. She apologized and said the nurse would be talked to.

So, did I handle this right? I feel "yucky" about the whole thing and think maybe I didn't. I would like to work at this hospital, and maybe even this dept as a tech next semester, and as an RN in a couple of years...

[SwansonRN]

Well, it does feel kind of weird to call out someone of your own (soon to be) kind, but you're a mom and you did what you had to in a reasonable way. Nurses get busy, occasionally take shortcuts and even get sloppy, they're not perfect. Just use it as a learning opportunity for the future!

[Anna Flaxis, BSN, RN]

This is concerning behavior, and I think you handled it appropriately.

To play a little Devil's Advocate here, I will say that often, I am the one who triages the patient that I end up being the primary RN for (I work in a small ER), and so I am familiar with their story and their face, and I am often the one who places their ID band on, asking them to check the name for proper spelling and verify that the birthdate is correct, so that by the third or fourth time I've been in the room to medicate, I am no longer asking them to verbally repeat two patient identifiers- I am looking at the wrist band, scanning it with the barcode scanner, and checking it against the MAR that I have open at the bedside. I tell them what medication I am giving them and what it is for. So, I may not be asking them to repeat their name and DOB, but I most certainly AM checking the five (or six, as it were) rights- but, I am so practiced at this that to the untrained eye, it might appear as if I am not checking.

As for flushing before and after, think about what the rationales are for this. Flushing before is to ensure patency, and flushing after is to ensure both medication delivery (since some of the medication will remain in the extension set if not flushed) and to maintain patency. If you are pushing medication into a compatible running solution such as NS, then there is no need to flush. If I just used the IV a few minutes ago, and I'm delivering a non-vesicant medication and I'm pressed for time, I might skip the flushing before, as there are other ways to check patency such as aspirating for blood return or assessing for resistance. However I will definitely flush after, as some of the medication will remain in the extension set, and thus the patient will not receive the entire dose, without a flush to push it through.

Failing to scrub the hub is the most concerning piece here. My practice is to scrub the hub for about 30 seconds using generous friction before accessing the port- but so long as the port does not touch anything (my finger, the patient's skin, the bed linens, etc.), I do not scrub between each step. Just the once is adequate so long as you maintain a no-touch technique. If the hub touches something during the process, then of course you scrub again.

[roser13, ASN, RN]

I think you did the right thing. Yes, we all may have our own ways of doing things but everyone's ways should include appropriate practice. Had the nurse looked embarrassed and said "oops! You caught me in a shortcut" (regarding no hub scrub) that would be one thing. To not acknowledge the shortcut was pretty brazen, I thought.

[JustBeachyNurse, LPN]

Does she have a port, PICC or a peripheral IV. Scrubbing the hub is most important for central lines. There are also caps that do the scrubbing. You were still right to voice your concerns to the charge nurse.

[Pangea Reunited, ASN, RN]

I never flush before or after when compatible IV fluids are running at an acceptable IV push rate (not KVO @ 10ml/hr, of course). The only people who seem to have a problem with it are IV drug users who want their medication "slammed". I always scrub the port, though!

[ProgressiveActivist, BSN, RN]

You were correct to report this nurse for her lazy and dangerous practice.

[joseyjo]

This was not the admitting nurse, and it is a large city hospital. She did scan her band, so that was good at least :)

The IV did not have any fluids running. It was hooked up to NS, but the bag was empty. She unhooked the NS tubing, gave the Fentaynl, then left the tubing off. She came back about 10 minutes later and gave zofran for nausea. She never flushed, not before or after either med.

I actually don't get checked off for IV's myself until January so I wasn't absolutely sure on the protocols or I would have just flat out called her on it. I didn't want to be a nursing student telling an RN what to do and to be wrong to boot! I also don't want to get a reputation for being hard to work with. I go to clinicals at this hospital and want to work there, but I also want my daughter to be safe.

Is there a better way I could have addressed this that would have been more professional?

Thanks for all the answers guys :)

[Anna Flaxis, BSN, RN]

Was there an extension set attached to the catheter, or was the port connected directly to the hub?

Edited to add: I think you did just fine.

[ProgressiveActivist, BSN, RN]

Is this hospital out of alcohol preps and flushes?

Then why aren't you using them?

[NanikRN]

Was there a curio on the hub? Those soak the hub in etoh and technically don't require scrubbing if used immediately after taken off

Curos® Port Protectors - Passive Disinfection Cap for IV devices | Curos®

[joseyjo]

There was not an extension set.