scared...

[Onlyhuman]

I just heard from my coworkers that a patient that we once had discharge had surgery because his old iv site became infected. I remember him clearly because he told me that he sued someone before was able to get money. Now he had a meeting with the hospital administrators and I'm scared because I discharged him. I remember specifically that the night shift nurse endorsed to me that he didn't have an IV access because he said he was going home in the morning. When I came on the shift and assessed him, he didn't have an iv access and I asked him if i could put one in. He said no because the doctor stated that he was going home today and he didn't want to get poked again. We have computer documentation and it automatically documents that the patient has an iv site and it autimatically documents what the previous nurses have put unless you discontinue or "click off" the assessments that did not apply. So because I was in a hurry I wasn't able to discontinue the part there that says that the patient says he has an iv and that it is red. I did not discontinue the iv because there was no iv to discontinue. however there is no documentation that the iv was discontinued except for when I had him. The previous nurse had left the iv part blank, so no assessment was done on the iv site (i'm assuming because he had no iv site). I'm scared. How can I defend myself if my documentation is going to bring me down? Any advice please... Thanks...

[justmanda]

As an FYI...

INS standards don't say that IV sites should be changed q 24 hours.

INS standards say that you should change your sites q 48 hours unless you can prove that your phlebitis rates are less than 5%, than you can change them q 72 hours ( Of course all of this is in the absence of any complications)

In our hospital, IV sites can stay in for 96 hours (if no complications). They rarely last that long though.

[murph]

Thanks so much for the responses... I'm really thankful... Please pray for me... I'm still trying to find my way in nursing...

Not just for this case but for every possible case, get and keep up your malpractice insurance! I see the need for malpractice insurance as a positive thing, the public knows that we do have a major impact on care and that nursing is separatre from medicine.

[Binkey, BSN]

Justmanda,

Yes, I'm aware that many don't follow INS standards, however if called into a court of law for any infusion related practice, It's INS standards that the courts will look at to see if a deviation from norm occured. INS standards should be the benchmark for everyones P&P.

In our hospital, IV sites can stay in for 96 hours (if no complications). They rarely last that long though.

[ChangeAgent]

I remember him clearly because he told me that he sued someone before was able to get money. ....

Everyone added great comments so I will try and not repeat. If the site was red etc. - then I wonder if the nruse filled out an incident report. Typically their is a section that states tx - it probably states the IV was removed.

Your quote from the patient is interesting - and it would be something I would repeat in a deposition. It is not a normal comment to make - perhaps he was trying to intimidate. I probably would have written it in the chart. The plaintiff counsel will also ask if you discussed the situation with anyone. Email and list servs are discoverable.

I heard before that Medicaid patients sue more frequently.

I wish you the best...Good luck...hard lesson.

[sirI, MSN, APRN, NP]

[b]

i was thinking about this throughout the day yesterday. what interests me the most about it is the electronic charting. but, to get to your question. . .the iv site was already noted as being reddened. it establishes that phlebitis was already there. once phlebitis is there, it's there.

based on what you've written. . .i don't see that you did anything wrong as far as nursing care goes. you checked to see if he had an iv and he said nothing to you about his old site bothering him. you defend yourself by telling the truth. . .i forgot to unclick the iv when i charted. don't make any more out of this. you are not responsible for this guy getting phlebitis.[/b]

however, in the future, i would make it a point to ask the patient to point out to you where the iv was just to take a quick look at the old site. i used to run my thumb or the flat of one of my fingers across the sites very lightly to see what kind of response i got from the patient. sometimes, redness clears as soon as a cannual is removed, but the phlebitis is still present in the deeper tissue. make it a point to chart on iv sites, wounds, drainage tubes, and any other devices coming out of a patient that aren't natural. and, fyi, iv sites really should be changed after 24 hours (infusion nurses society standard). once they get to 48 and, got forbid, 72 hours there is usually a phlebitis going on even if you can't see it. it's hard to convince patients that you would like to change the iv site because it is usually such a trauma that it got put in in the first place. but, it's for their own good if you can convince them. i was an iv therapist for 6 years and certified with ins so i know a little about this. you cover your butt by charting that the iv site is xx hours or days old, appears a little red, and is tender to light pressure, patient was advised that iv should be discontinued and restarted in another site because of the danger of developing an inflammation in the vein, but refused. but you have to do it with a lot of concern in your voice, not in a commanding way. what i found was that the patients stewed on this for awhile and finally broke down and called for the iv to be changed. psychology, you gotta love it. :wink2:

also, read up on the inflammation response. anytime a tube or catheter is placed in the body, our system recognizes that something is there that shouldn't be and goes into action, the inflammation response. in veins, it becomes phlebitis, but you've seen urticaria on the skin, i'm sure. an -itis can occur at the site of any tube coming out of someone's body, so just be aware of it and look for it, note it, and report it. your iv patient had the misfortune to also develop an infection with the phlebitis somewhere along the way so he got a double whammy.

i have a lot of criticisms about the kind of electronic charting your hospital is using. it's too easy for something to slip by as you now know. however, armed with that knowledge, i would take my charting very seriously and read each line item very carefully being satisfied with what i was putting my electronic signature to.

i bet this is going to work out ok. nursing, gotta love it!

and, kiddo, i've had my moments too. i had a patient put her side rail down, fall and break not one, but both hips. i thought my career was over. nothing ever came of it.

i disagree. if the electronic charting stated there was an iv and the site was reddened, then that is a fact. if there was no entry made narrative or by the electronic means that there was no iv and the site was clear, then this not a fact. clearly the op stated she did not make an entry to state there was no iv and did not indicate what the site looked like.

when this chart is reviewed, these "fact" will stand alone. it appears the patient is seeking litigation due to an infected iv site. the medical record will be scutinized regarding if there was an iv, when it was dc'd, the appearance of the site, etc. forgetting to "click" about the iv on the electronic charting is not a defense. this statement is probably honest, yes, but, lapse in memory can be viewed as dishonesty as well. and an attempt to cover up the truth. no, she probably is not responsible for "giving" this patient phlebitis, but, it can be viewed as contributing to the infection due to neglect. and, failure to inspect the site and initiating interventions to reduce the s/s of phlebitis were clearly not carried out in this matter.

just my humble opinion.

i wish the op all the luck in the world. i would put a retainer for an attorney now. obviously the patient intends to seek some type of retribution.

siri, crnp, clnc, rlnc

[Nancy2]

Thanks so much for the responses... I'm really thankful... Please pray for me... I'm still trying to find my way in nursing...

I ws involved in a legal case some years ago. I consulted an attorney who advised me to document everything I could rmember about the issue and mail it to myself so it had a post mark to verigy the date and keep it in a safe place in case it ever went to court. It never did. The hospital settled out of court and I never needed the documentation, but I think it was great advice.

I know you feel unsettled and only time will take care of that. I bet you are a lot more careful about your charting from now on!!

Time also fades memory, so I'd write that document soon! Like now if it is not already done1 Writing can also be cathartic.

Best wishes!

[barefootlady, ADN, RN]

Did you chart on the absence, site appearance, patients demeanor,behavior, or any other information on your discharge sheet. Here we must fill in some info on IV, either not present, removed, condition of site, and patients condition. It is automatic, if left blank, it comes up in reminder, so we chart it. Think, there is usually some place to address this on discharge.

[NurseRatchetSr]

Unlikely that this patient can sue for an infection. 1. Infection cases are notoriously difficult to work up and 2. Even though the patient stated that he had an IV, he would have to prove that he had it taken out at a later date, with that healthcare provider documenting what was taken out, what the site looked like, etc. Obviously, if the IV had been taken out prior to being dc'd from the hospital, probably the only hassle you would run into would be that whomever dc'd the iv, didn't chart that it was dc'd. Don't sweat it...at least being sued. You may have to sweat it if the administrators freak out about no docum,entation being done when you dc'd the patient. But then it will be a CQI issue especially regarding the discharge charting.

I just heard from my coworkers that a patient that we once had discharge had surgery because his old iv site became infected. I remember him clearly because he told me that he sued someone before was able to get money. Now he had a meeting with the hospital administrators and I'm scared because I discharged him. I remember specifically that the night shift nurse endorsed to me that he didn't have an IV access because he said he was going home in the morning. When I came on the shift and assessed him, he didn't have an iv access and I asked him if i could put one in. He said no because the doctor stated that he was going home today and he didn't want to get poked again. We have computer documentation and it automatically documents that the patient has an iv site and it autimatically documents what the previous nurses have put unless you discontinue or "click off" the assessments that did not apply. So because I was in a hurry I wasn't able to discontinue the part there that says that the patient says he has an iv and that it is red. I did not discontinue the iv because there was no iv to discontinue. however there is no documentation that the iv was discontinued except for when I had him. The previous nurse had left the iv part blank, so no assessment was done on the iv site (i'm assuming because he had no iv site). I'm scared. How can I defend myself if my documentation is going to bring me down? Any advice please... Thanks...