My question is about patient safety. Nursing students are taught to use a filtered needle or a "straw" to draw up meds in a glass ampule that we've had to break up. The theory, obviously, it to minimize the chance of injecting small bits of glass into the patient. Earlier this week, while working in the ED, I saw a doctor break open an ampule of lidocaine to give to a patient in preparation for a chest tube insertion. The doctor did not use a filtered needle or a "straw". After the procedure, I politely asked him about it and he dismissed the practice as unnecessary. I'm curious as to your thoughts on this matter and how best to approach handling these incidences.
Dear How to Deal,
There's no doubt that using a filtered needle to remove medication from a glass ampule is recommended by the Infusion Nurses Society and the American Society of Health-System pharmacists. Glass ampules do pose a risk of particulate contamination, but in reality, using a filter to draw medication from an ampule doesn't always happen.
Compliance with the use of filter needles is spotty. Some hospitals use them; others don't even stock them.
You are dealing with Reality Shock: What's taught in nursing school versus the reality of practice in the real world. When conflicts present, you have to choose which battles to fight, and how best to fight them: ) Doctors are notorious for not embracing practice suggestions by nurses, although, who knows, you may have planted a seed for thought.
A good example is found around hand hygiene. It is appropriate to remind all healthcare team members to use hand hygiene in an atmosphere of collegial accountability, and it sounds as if you had that same respectful approach.
You can ask your nurse manager to provide filtered needles. If you open an ampule and it shatters, waste the medication and start over.
And keep asking those good questions (one reason why I love new nurses).
I definitely feel overwhelmed at times with "real world" versus what I learned in school. Especially because different nurses will have different opinions as to what matters and what doesn't. I'm not sure what the solution is to this except that, if nurses in the "real world" are not following standards of practice, than we as a profession need to adjust the standards to reflect the reality of practice, or adjust our practice to reflect patient safety and known evidence. I'm sure that is wishful thinking, but it at least feels good to say it.
I also agree that current status is that you almost have to research best practice yourself to be sure. Do we have a communication problem? Nursing leaders not placing enough emphasis on updating policies and procedures?
What you are experiencing is a wealth of EBP book knowledge fresh in your head and a plethora of nurses who have been out of school a long time and don't (or can't) keep up with it. Stick with magnet hospitals if its important to you because the smaller ones will drive you mad with that stuff.
Nurse Beth, MSN
145 Articles; 4,528 Posts
I also agree that current status is that you almost have to research best practice yourself to be sure. Do we have a communication problem? Nursing leaders not placing enough emphasis on updating policies and procedures?