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...

[joseyjo]

Sorry, I am not familiar with a curio, but there wasn't anything extra on the hub- it was just a regular hub that was attached to the iv tubing until she unhooked it. Then it was just the catheter in the vein, a loop of tubing taped down, and a hub. This was one of the reasons I hesitated to say anything, I don't feel totally confident with IV's yet- next semester!

[JustBeachyNurse, LPN]

The loop of tubing is an extension. Some hubs are treated.

[Anna Flaxis, BSN, RN]

Then it was just the catheter in the vein, a loop of tubing taped down, and a hub.

The open end of the catheter that the loop of tubing attaches to is the hub.

The loop of tubing is an extension set (there are some angiocaths that are closed systems with the catheter and extension already connected).

The port on the end of the tubing can also be called a hub, but I don't hear this often. They're usually referred to as "caps" in my neck of the woods.

The reason to flush after medication administration in this case would be to push the medication through the extension. Failing to do so means that some of the medication remains inside the extension, and the patient is not getting the entire dose.

Edited to add:

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

Some could make a reasonable case that scanning the wrist band IS checking the patient's ID.

[annie.rn]

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 :)

Clinically you were definitely correct. The only thing I might have done differently is confront her directly instead of going to the charge nurse right away. However, I can understand that as a student you might have doubted if you were correct.

This nurse sounds very sloppy and I wouldn't have been happy either. I probably would have overlooked the identifiers and the scrub b/c I'm wimpy like that but the flush thing was way wrong. I think I would have said something like "don't you need to follow that with a flush so the medicine get's in there?" Kinda like a "gee, I'm not sure but it would make sense to me if...". If she still wouldn't flush it, I would have been more aggressive about it and flat out asked her to. If still a no go, I would have gone up the chain.

As a practicing nurse you will come across things like this often. With providers taking care of loved ones and with co-workers. There are some things I will overlook because no one wants a co-worker/pt. family member who is a know-it-all, calling out, tattle tale type.

However, there are some things I draw a line in the sand about. When I "correct" someone in those times I try to do it in a very non-confrontational way. If I later saw persistent dangerous behavior I would go up the chain.

You were first and foremost a mom so I can understand your need to advocate for your daughter.

You did good :-)

[joseyjo]

Thank you guys for all of your comments! I agree, it would have been better to just professionally ask her about it. I will do that if there is a next time. Thank you again!!

[klone, MSN, RN]

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®

If that were the case, I'm guessing the nurse would have mentioned it, instead of saying "everyone does it differently."

[klone, MSN, RN]

Some could make a reasonable case that scanning the wrist band IS checking the patient's ID.

Not really, particularly if the facility is surveyed by Joint Commission. ED is considered outpatient, and patient identification in the outpatient setting is name and DOB. Checking the wrist band only is not considered appropriate patient ID in ANY setting.

[That Guy, BSN, RN, EMT-B]

At least you didn't start an IV on her yourself

[LPNtoRNin2016OH, LPN]

At least you didn't start an IV on her yourself

lol I knew someone was going to say that.

[Karou]

I think you did the right thing by questioning the nurses practice. The worst thing (to me) was no cleaning of the hub. That's just lazy, and disgusting. She should have flushed, especially after. Even though she scanned the med, should have also asked name and DOB. I may not say anything about the flushing and patient ID, but would have about the cleaning of the hub.

[RunninOnCoffee]

This was my first thought too! Used swab caps at one place and now the curios caps. Personally, I much prefer swab caps

[Anna Flaxis, BSN, RN]

Not really, particularly if the facility is surveyed by Joint Commission. ED is considered outpatient, and patient identification in the outpatient setting is name and DOB. Checking the wrist band only is not considered appropriate patient ID in ANY setting.

Not really. Two patient identifiers can be name and DOB or name and MRN. Barcoded wrist bands have patient identifiers tied to the EMR encoded in them. Scanning the wrist band with the barcode scanner verifies the patient's identity.

In home health, once the patient is known to the caregiver, the two patient identifiers can be facial recognition and physical address.