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...

[klone, MSN, RN]

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..

Except that there is always the possibility that the wrong wristband was put on the patient, which is why the nurse is supposed to ask the patient their full name and DOB *while* verifying it with the wristband before administering medications. Yes, MRN can take the place of DOB, however most patients do not know their MRN.

I speak with full authority, that if the facility is surveyed by JC, then they are required to verify the patient's name and DOB (or MRN) before administering medications. This verification must be done by the patient providing the information to the nurse verbally. Looking at the wristband is not an acceptable substitute.

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

This thread is not about a home health situation, though. I've never worked home health, and don't presume to know the regulations regarding patient ID in that setting.

[Anna Flaxis, BSN, RN]

Checking the wrist band only is not considered appropriate patient ID in ANY setting.

I never said it was.

ED is considered outpatient, and patient identification in the outpatient setting is name and DOB.

Not true.

This thread is not about a home health situation, though.

No, it's not. But you made a statement that was an absolute, so I was simply pointing out that it's not so black and white.

I speak with full authority, that if the facility is surveyed by JC, then they are required to verify the patient's name and DOB (or MRN) before administering medications.

1) Not every facility is surveyed by the JC. There are other games in town.

2) Scanning a barcode​ in which patient identifiers are encoded *is* verifying patient identity.

[Dranger]

My patients are sedated and intubated so I scan the wrist band, it's always right. How the hell else do you expect me to verify?

Not scrubbing the hub on a new peripheral line is not best practice, but its not going to kill her. Central lines are much more concerning.

Not flushing after is kinda odd even if both meds were diluted with 8-10ml of NS. Honestly, everyone has cut corners once in a while but doing all three wrong is kind of odd.

[klone, MSN, RN]

What you said is that one could argue that "scanning the wristband is checking the patient's ID". It's not, with a verbal patient or next of kin who can identify the person. We're not talking about an ICU setting. We're talking about ED. With an A&O patient and her mother.

Yes, it is true that ED is considered outpatient. And it is true that NPSG #2 specifies two patient identifiers. The patient needs to state them. You cannot just take them off the paperwork or ID band. That defeats the purpose of getting the patient identifiers if you're not going to actually verify them with the patient.

When I spoke of the"outpatient setting" I was referring to ambulatory care or ED. Sorry if that was unclear. I was not referring to home health, with which I have no experience.

I realize not every facility is surveyed by JC, which is why I made a point of saying "Particularly if they're surveyed by JC". If you know of any surveyors that accept *looking at the ID band* as an acceptable identification, without asking for verbal confirmation from the patient, I'd love to hear about it.

No, scanning s barcode is not acceptable verification without also asking for confirmation from the patient. It just isn't. Wristbands can be mixed up and put on the wrong patient.

[Anna Flaxis, BSN, RN]

By "scanning", I was referring to scanning the barcode with a barcode scanner.

And yes, it is true that the wrong information can be on the wrist band, which is why we confirm that the information is correct at the time we place it on the patient. If the patient cannot speak for themselves, then a family member verifies the information is correct. If the patient cannot speak for themselves and there is nobody who can verify, then the patient is still given a wrist band, and if they have no ID, then they're given a temporary identification until we can figure out who they are. Trauma entries are almost always like this, because we need to create an account to link to the EHR before we even know who the patient is.

If it is unacceptable to administer a medication without verbal verification of two patient identifiers, then how are we to medicate those who are not able to provide this verbal confirmation? Again, you're speaking in absolutes, and it just not like that.

[klone, MSN, RN]

No, I'm not speaking in absolutes. I'm speaking about this particular situation, which is an A&O adult patient, with an A&O parent.

One of the five rights of med administration is asking the A&O patient their ID info. Every single time. Not just going off paperwork or wristband.

[Anna Flaxis, BSN, RN]

Maybe in your head you're thinking about this specific situation, but your written verbiage contains a lot of generalizations that read pretty absolute to me.

I don't want to argue with you. I like you. But I'm afraid we're going to have to disagree here.

[blondy2061h, MSN, RN]

I don't ask for additional ID after scanning the band, typical. I might if I worked in an ED. I don't know, because I don't. I work in a unit where my patients are for weeks. Real world nursing is different from ivory tower school nursing.

[roser13, ASN, RN]

Maybe in your head you're thinking about this specific situation, but your written verbiage contains a lot of generalizations that read pretty absolute to me.

I don't want to argue with you. I like you. But I'm afraid we're going to have to disagree here.

Please use the quote function so we can understand to whom you're replying.

[klone, MSN, RN]

Please use the quote function so we can understand to whom you're replying.

She's replying to me.

Real-world nursing - once I've IDed them (name, DOB), I typically don't do it again when giving their med. I work in a clinic, though. I see one patient at a time, over a 10-15 minute period.

The OP did not specify if this nurse who gave the meds without IDing the patient was someone who had been working with the patient the entire time, or was new to the case, just walked in to give the med. I can see the argument for her not asking for 2 patient identifiers before giving a med if she had been working with the patient the entire time she was there. If it was a new nurse, definitely she should have asked for 2 identifiers, at least the first time.

[hppygr8ful, ASN, RN, EMT-I]

There has been a lot of confusion at our facility about how to disinfect inject sites and IV ports. WE were told that the World Health Organization no longer recommends the use of alcohol swabbing on injection sites, finger sticks etc so they (my Employer) would be ordering less of these as they really weren't necessary. I'm the curious type so I went and looked up the info and found that alcohol swabbing was not recommended for injection sites, how ever it was still recommended for IV ports and PICC and Midlines. It also recommends that such ports be cleaned for a minimum 30 seconds as just a simple wipe is not an effective means disinfection. Still I always keep a pocket full of swabs and almost always clean injection sites despite my employer. The patients fell better about this and we all know we want happy patients :)

Hppy

[Dranger]

She's replying to me.

Real-world nursing - once I've IDed them (name, DOB), I typically don't do it again when giving their med. I work in a clinic, though. I see one patient at a time, over a 10-15 minute period.

The OP did not specify if this nurse who gave the meds without IDing the patient was someone who had been working with the patient the entire time, or was new to the case, just walked in to give the med. I can see the argument for her not asking for 2 patient identifiers before giving a med if she had been working with the patient the entire time she was there. If it was a new nurse, definitely she should have asked for 2 identifiers, at least the first time.

To be fair, the clinic is a lot different than acute care, just like you stated.

If I am giving meds all night my one rotaproned patient who has 10 drips running and a million medications I am just going to scan the band and leave it at that. No to mention the 10-20 times or more I change a drip rate without scanning (we can do that on most infusions-rate/dose change then manually changing in MAR).

I think I know who my 1 patient is.