Sacred cows that need to be laid to rest

[stevierae]

Here are a few of mine--they are things that no one who does them can explain the rationale for, other than justifying it with these 6 words, their mantra:

"We've always done it this way."

1. Putting down a "foot sheet" (usually a drape sheet; half or 3/4 sheet) before putting down the main drape (lap sheet, transverse lap sheet, split sheet or whatever--)

My question: WTF for? Do people not trust that the surgical drape companies have put time and money into researching just how thick the surgical drapes need to be to make them impervious to strikethrough or instrument penetration?

2. "Testing" the balloon on a Foley catheter before inserting it--

Again, what is the rationale? Do they somehow think that the balloon on a Foley is prone to failure to inflate--have they ever actually SEEN one not inflate?

When I put a Foley in, I insert it all the way to the hub, inflate the balloon with the full 10cc of H2O, then pull the catheter back--it stops on its own, proving the balloon is inflated.

Never once have I seen a Foley slip out because the balloon failed to inflate--and if it did, so what? Has any harm come to the patient? Of course not! Just get a new catheter and reinsert it.

I don't think that sterile items should be handled more than necessary--putting on gloves to "test" a Foley balloon, taking them off, doing another task, and then regloving to actually perform the catheterization--often announcing to whomever they think cares: "I tested the balloon earlier" is, to me, an unnecessary practice and one that can potentially contaminate the catheter and lead to a nosocomial UTI.

3. Double gloving for every single task--even patient transport

First off, I think it is a waste of gloves, but second--everybody keeps quoting "research" that says double gloving is "safer--" I even saw a recent AORN article that quoted someone as saying something to the effect that double gloving will reduce the likelihood of needlestick or other sharp object penetration by 50%--

Now, that sounds reasonable in theory, but is it actually true in PRACTICE? Has anyone actually SEEN this research, or is it anecdotal? Does this mean that if we triple glove, we wiil reduce the chance of sharp object penetration by 70%? Should we put on 4 pairs of gloves, thus reducing the chance of needlestick by 75%? Why not just wear 5 pairs, reducing the chance to... well, you get my point.

And, while we're at it, why not just put on 2 gowns and 2 masks--hey, if one is good, shouldn't 2 be better? Where do we stop and say, "Enough, already--this is just silly."

Again, I think that, just as with the example of the surgical drapes, the glove companies have a vested interest in making gloves that are strong and durable--why should they make a product that necessitates wearing two of for safety?

I have never double gloved, and I have only been stuck once in my career--by a sharp needle that would have penetrated 2, 3, or 4 pairs of gloves; double gloving would have served no purpose whatsoever--

If people feel the need for thicker gloves to make them feel "safe," ortho gloves serve that need just fine.

OK, I know I will get flamed especially for my double glove views, but I just think we need to use a little more common sense and not rely so much on outdated "policies" and practices that MAYBE made sense in the '50s--MAYBE--but maybe, even then, they were sacred cows--

Let's hear YOUR sacred cows!!! Bring 'em on!! Remember, there are student nurses out there reading this board who can learn from us; it will be nice to provoke critical thinking in the generation that will be providing our perioperative care, possibly sooner than we think---

[sharann, BSN, RN]

In RN school we were taught to NEVER empty more than 800 or so cc's of urine when doing an in and out cath or the patient could go into shock (from fluid shifts?). After being a nurse 3 yrs my co-workers finally de-mythed me. This is not true and was confirmed by several urologists.

[jnette, ASN, EMT-I]

Originally posted by sharann

In RN school we were taught to NEVER empty more than 800 or so cc's of urine when doing an in and out cath or the patient could go into shock (from fluid shifts?). After being a nurse 3 yrs my co-workers finally de-mythed me. This is not true and was confirmed by several urologists.

Yep... new urologist at my prn hospital recently jumped all over one of the nurses for not completely emptying the bladder... she could not believe they were only "partially" emptying... she was furious !

And "DOUBLE GLOVES" ??? Never even have HEARD of that in these parts !!!

[shodobe]

I only test the foley to check that it will "deflate". I have had one instance in the past where I could not deflate a foley balloon. I even tried to cut the one nozzle and it did not go down, had to call the Urologist. I never double glove because my hands go to sleep if I did. The "snoring" bothers the surgeon. We have alot of staff and surgeons who do double glove and it is because they feel "safer" for it. To each their own. Mike

[Spidey's mom, ADN, BSN, RN]

Changing IV tubing q whatever hours to prevent infection (seems like everyone's protocol for days is different) would be my sacred cow.

Every since the first time I changed tubing at the IV catheter hub, I've thought this was a silly way to keep it from getting infected.

Opening up the hub to change the tubing just seems senseless to me.

Speaking of double gloving . . I was taught to do that when having to do anything rectal. I did a rotation in a nursing home and we all double-gloved when having to help someone have a BM. Now, that seems smart to me.

steph

[stevierae]

Originally posted by stevielynn

Opening up the hub to change the tubing just seems senseless to me.

steph

EXACTLY!!!!!! Why open a closed system if you don't have to--all that does is increase the potential for bacterial contamination.

[Rapheal]

12 am an 4 am vitals on stable A&O patients. These people need to sleep. I would much prefer nursing documtation that these patients are sleeping with unlabored and even respirations.

[Tink RN]

I did see one foley malfunction (in 13 years) in which the balloon apparently was defective and would not inflate. We were working on a trauma and the other nurses were giving the nurse that put it in grief about, "Why didn't you check the balloon before you inserted it?!?" Ofcourse that was the least of this poor guys worries, BUT it only takes a couple of seconds to check the ballon and this does not contaminate anything - however, removing and reinserting another foley definately increases the risk of infection. Another poster posed an interesting point I didn't even think about! It would suck if the darn thing wouldn't deflate!

[oramar]

I remember putting tongue depressors at the bedside of everyone who had a seizure disorder. In addition we also padded their bed rails. I remember being taught in LPN school many, many moons ago that this was proper proceedure. I have witnessed many seizures and never saw a situation where they were of any use. I think I heard somewhere that the need for these precautions were debunked by some study.

[Spidey's mom, ADN, BSN, RN]

Originally posted by Rapheal

12 am an 4 am vitals on stable A&O patients. These people need to sleep. I would much prefer nursing documtation that these patients are sleeping with unlabored and even respirations.

Yep, yep, yep. I work 3 a.m to 3 p.m. and waking up stable patients at 4 a.m. to stand up on a scale, do vitals, etc., just seems counterproductive to getting well.

But how do you get your initial assessment done if you don't wake them up?

Fortunately, our docs are pretty reasonable and let the nurses decide whether to wake them up or not, if they are stable. Also, some of our docs write on their orders NOT to wake for VS. Pretty cool of them.

Of course, we go in and make sure they are breathing.

steph

[VivaLasViejas, ASN, RN]

Turning patients q 2hrs around the clock. I learned from an expert in long-term care that this gold standard was NOT set by using any scientific data proving its efficacy at preventing pressure sores, but by the length of time it took military doctors and nurses to make full rounds of their wards!

On the other hand, there is PLENTY of evidence relating to behavior problems created by, among other things, frequent sleep interruptions! Imagine never, ever having a night when you weren't awakened every 2 hours......you'd have behaviors too. Naturally, if a pt. has skin breakdown you don't want to leave them in one position---especially if they're wet or soiled---for the whole night, but turning EVERYBODY on a set schedule "because that's the way it's done" is counterproductive, and may even cause some of the agitation and acting-out we see in LTC facilities and hospitals.

[grouchy]

Taking a pt who is on a specialty pressure relief bed for a Stage 3-4 pressure ulcer, and Hoyering them out of it (no physical therapy benefit) to sit in a chair, where they are usually left for several hours, doing God knows what to the circulation to their poor coccyx, because "it's good for them to be up out of bed"!