Yes, today I was that aide that caused more work for the nurse instead of less. But that's not even the worst of it, because my mistake put a patient in danger.
My patient was in respiratory distress and on a bipap, being fed continuous tube feedings through an NG tube. This patient has two chest tubes, both with air leaks and the doctor wants to do a procedure this afternoon to try to seal them up. The nurse wants me to do the patient's bath before all this happens, so she offers to help (pt is total care and can't turn) later in the day after I get my other baths done.
So I go on with my day, get the other seven patients bathed and fluffed, thinking I'm doing such a good job etc etc. Well, it comes down to about an hour before the procedure and the nurse is running around like a chicken with her head cut off, plus the fact that it's shift change and she's trying to get things done before that happens. Doc decides to show up early (figures, right?) and suddenly I have several nurses (offgoing, oncoming, and charge) and the doc on my case about getting this person a bath. They're all genuinely busy, so I decide I'll just go and give him a partial spongebath right quick to the places I can reach by myself.
I'm a bit irritated at the situation and the several people telling me to do something I can't do alone but not offering to help. Focused all on me and not the patient.
I forgot to turn the NG tube feeding off when I laid the patient flat.
The NG tube had become dislodged earlier apparently and come out just enough that the feedings were going right into the lungs, made even more serious by being laid flat. Patient aspirates, O2 sats go in the tank, all kinds of nastiness.
Pt eventually got stabilized, but lots of animosity directed towards me from the nurses for the rest of the shift. Especially from that morning's nurse that had to stay four hours after her shift was done to try and fix the patient up. And I completely deserve it, I know. I feel horrible, especially since this whole thing could have been avoided had I been focused and paying attention. It was negligent on my part and I'm having a hard time dealing with that.
I know it's a mistake I won't make again, and the patient is fortunately fine, but I'm not sure how to mend things with my coworkers, or with myself. I've been an aide for three years, but this is by far the biggest mistake I've ever made, and it was so easy to make it that it scares me a little. My faith in my ability to be a safe caregiver is a little shaken. I know that it will take time for my confidence to build back up and that I will be more careful in the future.
I guess the advice I'm looking for in the midst of this "confession" is, as nurses, what would you want an aide to do the next time you worked with them after something like this? How could they show you they were really a good aide with their heart in the right place? Any advice/suggestions would help.
How bad did the poor old guy smell that the doc was going to wait on a bath to go in there and do what needed to be done?
But hey, anyone that says they haven't made a mistake, more likely just hasn't made a mistake that they know about. Important thing is, you've learned, and life goes on!
You sound like a great worker. We all make mistakes at one time or another. We own up to them, and see what we can do next time to improve. Although, the bath should have been a lower priority in this case. Really, you sound like you had a hectic day and are a fantastic worker. Actually, it was the nurse's responsibility to see that NG tube was off prior to your bathing him. Please don't dwell on this. I know that it is easier said than done. I have a habit of beating mysellf up for mistakes, too. But, really, you are a great aide. It really shows in your post. Please cheer up. :nuke:
Once i lost a scalpel blade, could not find it and the other nurse in the OR made a comment that i deserved to be shot.
Wow, that was a really *helpful* comment from that nurse, now wasn't it? I'm sure that helped you find the scalpel right away. NOT!
Even if she was really, really annoyed, she could have used the 10-second rule. I do this myself all the time. I think a nasty thought, and then wait 10 seconds. That allows me time to realize that verbalizing my nasty thought will only make the situation worse, and will make me feel guilty afterward. I'm sorry you had to take that kind of verbal abuse from a co-worker. :angryfire
I agree. Why was the bath so importnat on such a busy day? Why was the Doc concerned about the bath? 30 years of nursing.. i have never seen a Doc worrying about a patient's bath. Give yourself a break, you won't make the same mistake again. Next time things are this hectic forget about a bath on a citically ill patient, that is in more need of a procedure than a bath.
Specializes in Critical Care, Capacity/Bed Management.
PepperAnneCNA one thing that I have learned from working as a Nurse's Assistant is that when you have a critically ill patient like that always ask the RN to come with you to do care.
The RN should be present to observe any abnormal signs during care and it help them better assess their patient for wounds, bowel and lung sounds.
You should not beat yourself up over this because it is not only your patient but the RN's as well, she should have been present with her.
Good Luck, and when you go to work next time act as this never happened because A. everyone makes mistakes B. It is not their business and C. you are a professional and so you must conduct yourself as one.
I am a CNA also,and I have forgotten for a minute to turn off the feeding.It sounds like your day was a bit hurried and rushed.When things go badly,it is when we are rushed and trying to do a good job.
It was a mistake.....forgive yourself but don't forget it.Hugs to you.
Seems to me that the tube feeds should have been held as soon as they knew they were going to do a procedure. A bipap patient getting a procedure to correct the air leaks in his chest tubes is an intubation waiting to happen, and having the stomach empty decreases the risk of aspiration.
Still can't figure out why the stinkin bath was so important...I've never seen a doctor hold up a procedure for a bath...maybe a surgical prep...when s/he's there and ready, you start, dam*it, unless you are missing a necessary drug or piece of equipment.
Oh, yeah, I know, 'cause all the baths are given on day shift, right?:chuckle I've worked on one of those floors too...
My background is ICU, and truthfully, I don't want anyone, other than another RN, touching any of the vital equipment in my patient's rooms (IV pumps, tube feeding pumps, etc) with the exception of the RT or pulmonologist/intensivist touching the vent or bipap/cpap. Certainly not unlicensed assistive personnel. I've seen RNs tell unit techs to turn on or off a drip, hang a new bag of IVF or tube feeds, turn up the O2 on a vent or bipap and many other things that should not be delegated.
If you'd forgotten to turn the tube feeds back on, the RN would have been responsible. The RN was responsible for the misplaced feeding tube...it happens a lot, and it's something that has to be checked periodically.
If the patient was so critical, the RN should have been there with you. Don't beat yourself up. If the feeding tube was dislodged, the patient probably aspirated anyway before you laid him flat, especially with the bipap forcing air through his mouth and nose and into the lungs.
Accept that you are human and made a mistake, apologize for your part, if you feel the need and move on.
To the best of my knowledge--It is NOT your responsibility as an aide to be starting or stopping infusions or feeds of any kind!
That being said, good for you for owning up to the whole mess.
P.S.
Is it policy at other facilities for aides and techs to be touching ANY kind of pump? I don't doubt their competence, but I'm just curious what the rules are. I was always under the impression that one was NOT to delegate these kinds of tasks to aides.
If the policy at this facility states only nurses are to adjust feedings, the aide in question was stuck between a rock and a hard place. Either a.) violate P&P and touch the pump, or b.) get the bath done asap and risk the aspiration.
Thanks everyone for your comments! I went back to work and had that chat with my supervisor about the whole thing and found out why that bath was THAT important.
Apparently, many complaints have been made by the patients on my floor to both nurses and doctors (anyone who comes in the room, basically), that they aren't getting baths. Sometimes for days at a time. The doctors have not been happy about this and have taken it higher up, so basically we're been watched very closely. We do have a few of real "That" Aides that won't do baths when they're supposed to. After explaining this, my super said how much she appreciated that I wasn't one of the problem aides and how sorry she was that I got caught in something that I really had no part of.
Still, it probably wasn't worth delaying a procedure over, but at least it is *a* reason. The patient did end up expiring the morning after the incident, but the super assured me that it probably wasn't related to the mistake, since this patient was pretty critical even before. I'm trying to make myself believe that, but it's difficult. It's just so hard to know for sure, you know?
sounds like your human. not that everyone will admit to it we all learn. At the LTC facility i work at cna do not turn on or off the tube feedings we the nurses have to. (just a side thought) I always tell my staff. A nurse is only as good as her worse aide whos on her best day. so you cnas are what makes good nurses thanks for all the hard work:yeah:
leslie :-D
11,191 Posts
God bless you, sweetie.
i would have likely messed up too, amongst all that drama over a bath.:icon_hug:
i'd be honored to work alongside you.
leslie