Tagging HIV status in chart?

begalli · Jun 8, 2005

As far as I'm concerned, all patients are have hep c or are hiv+. This, among other reasons, is exactly why we use universal precautions - which, to me, is the same as being "extra careful."

What is "extra careful" in your view, calicamper? I'm genuinely asking.

We just pass it on in report if someone has something communicable. It's just part of their history, but we don't have a special place for it to be displayed in the chart like code status and allergies.

fergus51 · Jun 8, 2005

I'm with Begalli. The reason we tag certain things like MRSA is because they need extra precautions. HIV doesn't. It's the basics only so there is no reason to tag it unless the nursing staff is cutting corners in their work.

pricklypear · Jun 8, 2005

We have these stupid cardexs on the chart (they are not stupid in theory, just how they are used at this institution). We always use a red pen to mark anything like MRSA, HEP or HIV. Although, I'm with you guys - I don't see why HEP or HIV, and I can't see any other precaution I would (or should) take with an HIV pt that I don't with all patients. Then again, some of us are not always as careful as we should be (maybe starting an IV w/o gloves on a tough stick), and would use "extra" care if we knew someone was HIV+. I think I just contradicted myself!

imn2nursing · Jun 8, 2005

I think knowing makes a person more nervous. One of our PCP's recieved a stick after drawing blood from an AIDS patient. Nothing like this had ever happened to her. I think she was nervous. I agree with the others. Treat everyone as though they have it. Even the little ole ladies. Incidences of HIV are becoming prevalent in the nursing homes. Can you believe it?

begalli · Jun 9, 2005

I am much, MUCH, MUCH more afraid of being exposed to hep c than I am hiv. It's very difficult to contract hiv in our work.

About a year and a half ago I went for my annual check up with bloodwork. For some reason my liver enzymes were elevated so the doc ordered a hepatitis panel.

HCV came back positive. I was devastated. I couldn't for the life of me figure out how this happened - I was not a high risk at all, never a needlestick, no exposure that I could think of - BUT I am a nurse who works in a very bloody ICU. She ordered further quantitative tests and everything came back negative. We retested and all was negative again.

We concluded that the initial elevated enzymes and hcv qualitative test must have either been a false positive or was a mixed up sample. When the hep c came back positive I was tested for hiv too - my doc called me on a saturday night to say it was negative.

I learned a lot about hep c during that unforgivable scare and month from hell.

Did you know:

The risk of sero-conversion of hiv after a single needle stick is:

~0.3%

The risk of sero-conversion of hep c following a single needle stick is:

1-10%

Of course many factors influence those outcomes but generally for one to contract hiv from a needlestick exposure the concentration of the virus in the contaminated needle has to be humongous - it's very unlikely to happen.

On the other hand, hep c is substantally easier to contract.

Just practice safely following universal precautions AT ALL TIMES, NO MATTER WHAT, and you will be fine.

unknown99, BSN, RN · Jun 9, 2005

As far as I am concerned, universal precautions should be used with ANY patient you come in contact with. that way, you are protected regardless what disease the patient may have.

imn2nursing · Jun 10, 2005

I am much, MUCH, MUCH more afraid of being exposed to hep c than I am hiv. It's very difficult to contract hiv in our work.
About a year and a half ago I went for my annual check up with bloodwork. For some reason my liver enzymes were elevated so the doc ordered a hepatitis panel.
HCV came back positive. I was devastated. I couldn't for the life of me figure out how this happened - I was not a high risk at all, never a needlestick, no exposure that I could think of - BUT I am a nurse who works in a very bloody ICU. She ordered further quantitative tests and everything came back negative. We retested and all was negative again.
We concluded that the initial elevated enzymes and hcv qualitative test must have either been a false positive or was a mixed up sample. When the hep c came back positive I was tested for hiv too - my doc called me on a saturday night to say it was negative.
I learned a lot about hep c during that unforgivable scare and month from hell.
Did you know:
The risk of sero-conversion of hiv after a single needle stick is:
~0.3%
The risk of sero-conversion of hep c following a single needle stick is:
1-10%
Of course many factors influence those outcomes but generally for one to contract hiv from a needlestick exposure the concentration of the virus in the contaminated needle has to be humongous - it's very unlikely to happen.
On the other hand, hep c is substantally easier to contract.
Just practice safely following universal precautions AT ALL TIMES, NO MATTER WHAT, and you will be fine.

Oh my goodness. I had no idea of these chances. I'm glad you are O.K.

calicamper · Jun 11, 2005

Here's what I was thinking about when I querried about communicating HIV status to nurses.

I found that another nurse agreed with me on this. What we felt was that when a patient's HIV status is first determined, the status is communicated in report between nurses. However, after about two weeks, sometimes this communication fades away until it is no longer passed along in report. Thus the status is no longer passed between nurses. At our hospital, it is sometimes very difficult to find HIV status. It may or may not be buried in the chart somewhere. Otherwise, it might be burried in the computer data. Some of the patients are here for months and it is difficult for the nurse to know if it is no longer being passed along nurse-to-nurse. There is no cardex on our unit where this information would be put.

What we were thinking was that it would be helpful to have one sheet in the chart that showed all infectious diseases, like a table to be filled out, as results are found. It coud have HIV status, Hep B, Hep C, status, MRSA, etc; it could have the date of the result, for MRSA, the date of the last culture. We have some patients on the unit who still have contact isolation carts by their doors who haven't been cultured for a few weeks (maybe it should be easily available to know when they were last cultured? Cause they might not need to be on contact anymore).

I understand the point of having more needlesticks with HIV patients because of nervousness. I'm not sure how to work around this. Also, it has been brought up to me that patients with infectious diseases get worse care. For example, the pt on TB isolatation gets less nursing care because the nurse does not want to go in the room.

However, I think that the nurse really does have the right to know and that it might cause the nurse who does not don gloves for the IV insertion to do so. I know everyone should use universal precautions, but I still think that nurses should be given this information, or that it should be more easily available, for their safety because of some people's ignorance about always using universal precautions.

Thanks to everyone who answered my post. I appreciate it.

Cali

allnurses Guide · Jun 11, 2005

We have these stupid cardexs on the chart (they are not stupid in theory, just how they are used at this institution). We always use a red pen to mark anything like MRSA, HEP or HIV. Although, I'm with you guys - I don't see why HEP or HIV, and I can't see any other precaution I would (or should) take with an HIV pt that I don't with all patients. Then again, some of us are not always as careful as we should be (maybe starting an IV w/o gloves on a tough stick), and would use "extra" care if we knew someone was HIV+. I think I just contradicted myself!

I think you are right about "some" of us starting IV's w/o gloves sometimes. I've even seen a CRNA do it all the time.

steph

fergus51 · Jun 11, 2005

My problem with it is too many nurses are ignorant about HIV. They are judgemental and have no idea how it is actually spread. I hate to say that, but I've seen it over and over again. If you are following basic protocols, you'll be fine. If you aren't, you're taking a risk with every patient you come into contact with (because a HUGE percentage of people with HIV and Hep C don't even know they are infected) and this will only provide you with a false sense of security. You already have the knowledge to protect yourself without some special flag in the chart. If you or your coworkers don't use it.... well that's another issue.

As far as starting IVs without gloves.... I know I'm going to get flamed for this, but unless you have some open wound on your hand, simply touching HIV tainted blood isn't going to infect you. If you think you have any possible open wounds on your hand you should be wearing gloves to protect the patient from you.

pricklypear · Jun 11, 2005

I found that another nurse agreed with me on this. What we felt was that when a patient's HIV status is first determined, the status is communicated in report between nurses. However, after about two weeks, sometimes this communication fades away until it is no longer passed along in report. Thus the status is no longer passed between nurses. At our hospital, it is sometimes very difficult to find HIV status. It may or may not be buried in the chart somewhere. Otherwise, it might be burried in the computer data. Some of the patients are here for months and it is difficult for the nurse to know if it is no longer being passed along nurse-to-nurse. There is no cardex on our unit where this information would be put.
Cali

You know, Cali - this is so true. And furthermore - wouldn't having it noted somewhere (a cardex or list of infectious diseases tested) be more conducive to the patient's privacy? We do report in the nurse's station on my unit, and I know of other units who do this. I don't know about anybody else, but our visiting rules are not always strictly enforced, so there may be visitors around at times. It seems like passing it along verbally 2 or 3 times a day would be inviting trouble. I think your idea of a sheet with everything listed is a great idea.