Responcibility for sharps

[takecake]

Hello, I'm a recent change over to recovery room and I'm encountering a problem I have never had before. I work in a day surgery. One eye doctor "blocks at the bedside" on her cataract patients, meaning we take the patients into the PACU to give them a bed so she can injects local anesthetic into the patient's eye before going to surgery.

The problem is that she leaves her used needles everywhere. This is a recurrent problem that has been going on for the full 5 months I have been at my current job and didn't seem new even when I started. We have sharps boxes within two feet of her if not closer when she does this, but she still leaves needles in dangerous places - not just for us nurses, but for the patients as well. One day while I was assisting her, I had to write 6 incident reports for all six needles left in patient care areas: stuck inside a set of towels on the countertop, one hidden behind the oxygen set up, one on the floor underfoot, one right next to the sharps box, and, I am not sure which of these made me most angry: she had carried one over to the nurse's station and dropped the used syringe in the middle of the workspace, but later in the day, I was helping to clean up, and was clearing a stretcher of linens when the needle dropped out of the dirty linens, missing my foot by two inches.

This is a consistent issue that bothers everybody at work, and through sheer luck, no one has yet to be stuck that I know of - though at the rate we find uncapped needles in the beds postoperatively, I could not be sure the patients have not been stuck with their own needles while moving while half-conscious. Management thus far has simply stated that every time we find uncapped needles to write incident reports and they would take them to the board of directors.

The board of directors meeting was last week. And through the grapevine, the way it basically played out was that a few of the doctors were horrified, but the essential resolution was that we nurses would just have to be really careful, and always know where the needles are - like we can know ahead of time that needles are hidden in the sheets after the patients have been to OR and watch her like a hawk while charting, maintaining airways, and transporting patients.

Even if the words spoken in the meeting were not actually so pro burden-the-nurse, the fact is, no changes are going to be made. She luckily only works with us once a week, but each time she is there it feels like we're all being placed at risk to be poked with a hot needle. It's very fast-paced for recovery, and we've had so many close calls that I hate the days she's there because it might be the day I end up in the ER for blood tests because she left needles next to supplies or in beds or (as I found once) under the stretcher halfway beneath a patient's shoe.

So I'm wondering what I can do about it. Since no one has been hurt yet and because sharps boxes are all over the place, is this an OSHA violation? She's a known danger with a sharp paper trail a mile long, but do we have to wait until some one gets pricked with a hot needle before anything can be done to change this? Or are we going to have to keep playing Russian Roulette with this woman until some one finally gets hurt?

Any advice on how to improve this situation or legal information on workplace safety would be greatly appreciated. :heartbeat

[november17, ASN, RN]

Maybe one day someone will get angry enough to go off on her about it.

[Jdl2002]

You didn't mention it in your post, so I'll ask an obvious question. Has anyone talked to the doctor directly? If my own health were at risk I would remind the doctor to put her used needles in the sharps container every time I saw her with a one in hand.

[SharonH, RN]

You didn't mention it in your post, so I'll ask an obvious question. Has anyone talked to the doctor directly? If my own health were at risk I would remind the doctor to put her used needles in the sharps container every time I saw her with a one in hand.

Each and every time until this woman gets the message. Why suffer in silence? Why let her get away with that and then wait for the board or whoever to act to save you all? That's insane. Just tell her for goodness sake, she's not God. She keeps doing it because ya'll let her get away with it. Tell her and don't apologize either.

And if you're too chicken to tell her to knock it off, then yes this is an issue for OSHA.

[iluvivt, BSN, RN]

This is a horrible problem.First,I hope you are using a safety sharp,if not you need to make that change immediately. Next,you need to have an immediate policy change that every RN,MD. & Phlebotomist need to be responsible for their own sharps. Surgeons are used to having assistants and nurses cleaning up after them...OK I get that,but that is done in an organized systematic fashion and in an environment that is somewhat controlled. IN the pre-op holding area multiple care givers and patients and visitors and family members and housekeepers and any worker for that matter can be exposed.

So this women must be told that she is potentially exposing everyone to bloodborne pathogens such as Hep C and HIV ,just to mention a few. She should not walk away without someone saying "EXCUSE ME YOU NEED TO PUT ALL OF YOUR SHARPS IN THE SHARPS." I would also have the most recent copy of the statistics that that show how many Health Care Workers seroconverted or became infected so she can get a handle on the problem. I would also be ready to tell her,in case she barks at you,that her behavior shows a lack of regard for others safety and will no longer be tolerated. I think you are going to have to confront her. I would always try "nice" first and if that does not work you bring out some bigger guns. Let us know what you do. I also believe in the power of a BIG SIGN,ANYONE USING A SHARP MUST DISPOSE OF IT IN THE SHARPS CONTAINER. We tried for years to get radiology to fax us our PICC reports and we put up a note in the department and that solved the problem.

[takecake]

I thank everyone for their replies, but I guess I did not give enough information initially. Whenever I have told her she needs to put her sharps up, there's variable results. If she's not in a bad mood, she'll say, "Oh - okay," if she's already angry because she is in a hurry or the patients are late or for any other reason, she says, "I will," like I'm or the other staff is an idiot for even suggesting she wouldn't.

The problem is, she has been hounded and no actual change has occured.

My issue is with management more so. I've gotten to the point that I know she doesn't care about us or our health, and my immediate supervisors have chastised her before with no effect, but when higher management was involved, they essentially condoned her actions.

I know that the company is responsible once I have been stuck, but what can I do to prevent is legally (besides quit). When I checked the OSHA site, it was convoluted and I couldn't find any information besides that there needed to be engineering controls to prevent unnecessary injury, but nothing about individuals who consistently endanger. Or if I can file a claim if nothing has yet happened.

It didn't have a lot of information which was why I came here. I'm also wondering that, since the doctor has privileges to work at the facility but is not technically in my chain of command, how is she made responsible on a legal standpoint? Does her insurance raise because she hurt somebody even if that person is not a patient. Does she get reviewed by her licensing board?

So I guess my questions really come down to:

1. Is my company responsible for her consistent safety risk (in such a way we can prevent ourselves as employees from getting hurt, not after the fact). Especially now since it has gone all the way to the top, and they are not concerned.

and

2. How is she legally (not ethically. I think everybody but her agrees she ethically responsible) responsible for her sharps, and again, in a way that we can curtail her before she hurts one of us.

And I would again, like to thank everybody for your replies. It is a relief to finally feel like me and my coworkers are not going insane when it comes to this issue.

It's destroying the previously congenial view I have of my supervisors and the doctors I know who are on the board who have sat by and done nothing in wait because - as we all learned in nursing school - choosing to do nothing is a choice.

[Altra, BSN, RN]

Whenever I have told her she needs to put her sharps up, there's variable results. If she's not in a bad mood, she'll say, "Oh - okay," if she's already angry because she is in a hurry or the patients are late or for any other reason, she says, "I will," like I'm or the other staff is an idiot for even suggesting she wouldn't.

I wouldn't give a rat's ass whether or not this idiot thinks I'm an idiot. I would care that she is creating potential harm for my patients and for me. I would ask her every single time, "Have you put all of the sharps that you used in the sharps container so that they're not left around patients? Thanks."

[lunden]

i'm sorry, but there is no way in hell i would put up with that nonsense. that is horrible practice, and i don't care what kind of hurry you are in, it only takes a second to drop a sharp in the sharp's container. that is very selfish, uncaring,rude and DANGEROUS!!!!!!!! but obviously you all are not fed up enough or i guess someone needs to get stuck one good time for this nonsense to come to an end. HORRIBLE INDEED!!!!!

[Pepper The Cat, BSN, RN]

Have you gone to her surperior? The Chief of Surgery, for example.

Also - have you involved Occupational Health? - I was complaining non stop to my manager that our oxygen tanks weren't stored propery and were constantly being knocked over. Finally I sent a message to Occ Health and the issue was dealt with the next day.

Perhaps you can get a sharp box and put in RIGHT IN FRONT of her so that when she does procedures she doesn't have to walk ALL THE WAY over to a sharp box. (poor thing). Or stand right next to her and the minute she finished injecting say - now put that in the sharp box. If she objects to being treated this way, just tell her straight out - Your actions are junvinille and are a threat to all the staff. When you can show responsibility and proberly dispose of your sharps, we will stop treating you like a child.

Finally - maybe its time to switch to the new safety needles that are available now. Of course - she would have to actually use the safety device!

[Straydandelion]

I am wondering if the failure of management to insist on safe practice would be against OSHA standards?

http://www.osha.gov/SLTC/bloodbornepathogens/standards.html

[nickos]

If saying it to her and going above her doesn't solve the problem, is it possible for someone to stand there while she injects, and to ask her to hand them the needle and they put it in the sharps container? I suppose that isn't much safer, but if I were her and that stinkin lazy I might be annoyed enough at having someone hover over me to put it in the sharps for me that I would change my ways.

[shodobe]

I guess I have been around long enough to just clean up after them. Why you wonder? I then know everything is put away and disposed correctly. I have surgeons and anesthesia which will cleanup after themselves and others who don't. I don't make a big deal of it. I come from an era when the MD walked onto the floor you stood up and gave them your chair, you put all of their charts on a cart and made rounds with them. I know, it sounds so archaic! To each their own.