the vultures are circling

[CRNI-ICU20]

Hi Everyone,

I had an experience today in the ICU that I work at. One of my patients who was recovering first day post op from a AAA was given a SubQ infusion pump that delivers marcaine to the incisional area....it runs on it's own...it is called On Q....

Okay, here's the weird part....

Two drug reps show up on the unit, one introduces herself as "HI, I am nurse so and so....and I work with Dr. So and So...(the doctor who had performed the AAA) and I was wondering if I and my collegue here could go talk with your patient about his Sub Q pump to see how it's working for him....?"

I asked nurse So and So, "so, you work with Dr. So and So?" and she said yes...

So then I said, "and who is this person with you?"

And she admitted that the person with her was a drug rep from the company that supplies the infusions for this particular pump.

Then I looked at her name tag, and it had the logo of the company that makes the On Q pump on it....

So then I asked, "so...you work for Dr. So and So....did he give his permission for you to see this patient?"

She then got kinda nervous, and said, "well not really."

I said, "well, if you work with him, why wouldn't he know you are here, or give permission?" She then admitted to me that she was in fact, a medical device salesperson for ON Q pumps.....and she was gathering patient data on the pumps....efficacy etc....

I had a realllllllll problem with this....

First, she lied to me to gain access to the patient.

Second, she was SELLING her product in a patient care area...an ICU for pete' sake!!

Third: She had not cleared her access in accordance with hospital policy....

So, I take it to my supervisor after I told the sales reps NO!!

My supervisor, who I believe is clearly on another planet said, "Well, NO HARM DONE."

WHAAAAAT??

Okay...let me get this straight, you are allowing post op patients to be innundated by sales-vultures from drug companies now???

Are you freakin' kidding me????

So, I called the Doctor, whom I have a good professional relationship with.

He was INCENSED that someone would be allowed in the hospital, use his name to gain access to the patient, and then go interview the patient, which also included looking at the insertion site...ie, lifting his gown..exposing his private parts....to two female strangers....

Does anyone find this just appalling??? unethical? more than "No harm done?"

Has this ever happened at your hospitals?

ARe drug reps now coming in to see if their drugs are "going well" for the patients while in the hospital???

I am shakin' my head.....

CRNI:smackingf

[nursing 101]

My question is, how did the reps know there was a patient, much less who the patient was who had the On Q ??? Seems like a HIPAA violation to me.

:yeahthat: They had to find out by someone... I would get to the bottom of this... As a patient you get tired of everyone peeking and poking, most people tolerate because they know it's to make them get better but a drug rep... Pleeeaaazzzz!

[Gromit]

Depending on the device, a rep is usually notified by the doc or team thats installing it. Its not unusual to have a rep present during surgery, and or in the post-op stage when they test the device. Since upgrades and changes are always present (and complications can always crop up) they are there to assist the doc if a problem arises.

When I had my defibrillator put in, the rep was there when they went to test it -and it was the rep who actually programmed the 'box' according to the doctors' instructions (what settings he wanted).

For this sort of thing, its not out of the ordinary to have a rep involved -but for a rep to come on their own, and misrepresent themselves so they could access the patient or patients chart is completely unethical and probably illegal as well.

[banditrn]

In Oct. of '05, I had a Deep Brain Implant for my tremors - I had met the company rep before the surgery, he was present during the surgery to do the testing of the device after they put it in.

The same rep has been present at some of my follow-up visits, and again when I started having trouble with the device.

He never showed up in my hospital room.

I think the doctor should report this rep to the company - they should be out of a job!

[Cymy]

To those who had a rep there during surgery or afterwards, are you sure it was a sales rep and not a technician? It would be appropriate for a technician to be there to provide technical support, but a sales rep would be a completely different story.

[Batman24]

Good for you!! You are the kind of nurse I would want taking care of me. And it was also so nice to read about the doctor's outrage. I hope Risk Management or someone on that end calls anc complains to the drug company. They put your hospital at great liability with their lies. Thankfully you were there to protect your patient. Your supervisor also needs to be called into a meeting and told the procedure for circumstances such as these. Her response was very upsetting not to mention shocking.

Question-If you are having surgery and don't wish to have a drug rep present can you request that and would it be respected?! I would be leery of non-medical personnel looking at me.

[Multicollinearity, BSN, RN]

To those who had a rep there during surgery or afterwards, are you sure it was a sales rep and not a technician? It would be appropriate for a technician to be there to provide technical support, but a sales rep would be a completely different story.

Sometimes the sales reps do both. They have the necessary technical knowledge and are the only one from the company in a large geographic area.

But about this particular story...outrageous!

[SICU Queen]

Question-If you are having surgery and don't wish to have a drug rep present can you request that and would it be respected?! I would be leery of non-medical personnel looking at me.

A lot of the times the rep IS a medical professional, but even if they're not, sometimes they need to be present to test the device, or tell the doc how to place it. A lot of surgeons learn the technique that pertains to a particular device from the rep. Most times their presence is necessary.

[CRNI-ICU20]

To those of you who are voicing the situations where a device rep assists a doctor during a procedure, ie stent placements, or orthopedic devices, pain pumps, pacemakers, defibrillators, etc....I totally agree that their knowledge is very helpful to the doctors....HOWEVER, when those reps come to the hosp. to assist with insertion or operating a device, they are to be cleared by the doctor doing the procedure, AND the administration/materials management dept. who will be supplying and re-ordering

the devices/implants.

This was not the case here...

The doctor was not at all giving his permission for these two reps to even see his patient....they were there to "collect data" directly from the patient, without consent of doctor, patient, or the hospital...

Had I allowed them to enter that patient's room and gather data, I could have been held accountable for aiding a breach in HIPPA rules.

This would be tantamount to me leaving a chart open for someone who has no medical reason to read the patient's chart....same difference.

I don't know what Risk Management will do with this; my guess is that these two reps will be banned from coming into our hospital ever again.

Implanting a device is much different than entering a patient's room in ICU post op and checking to 'see how it's doing' without a doctor's or patient's consent....

I had another concern about this, as I thought about it and that is:

What if drug reps go in to a patient's room, and monkey with a device, without the doctor or nurse being aware, and a bad thing happens to the patient because of it....what if they adjust a dose of something, and because they are not authorized to "chart" on the patient, just don't record what they did anywhere....or what if they increase the threshold on a pacemaker, and don't tell someone....

See, if they will lie to gain access, do you think they can be trusted with our very vulnerable patients????

Sometimes, it just takes the wind out of me....truly.

[Ophelia78]

We had a similar incident at my last hospital. A nurse on our unit noticed a person in plainclothes reading through her patient's chart. She asked him who he was, and he replied he was a medical device rep doing patient research. Did he have permission from the patient, the doc, or the hospital research committee? Nope. He was escorted off the property by Security and banned from returning. That is definitely a HIPAA violation...Good for you for protecting your patient!

[oramar]

To those of you who are voicing the situations where a device rep assists a doctor during a procedure, ie stent placements, or orthopedic devices, pain pumps, pacemakers, defibrillators, etc....I totally agree that their knowledge is very helpful to the doctors....HOWEVER, when those reps come to the hosp. to assist with insertion or operating a device, they are to be cleared by the doctor doing the procedure, AND the administration/materials management dept. who will be supplying and re-ordering

the devices/implants.

This was not the case here...

The doctor was not at all giving his permission for these two reps to even see his patient....they were there to "collect data" directly from the patient, without consent of doctor, patient, or the hospital...

Had I allowed them to enter that patient's room and gather data, I could have been held accountable for aiding a breach in HIPPA rules.

This would be tantamount to me leaving a chart open for someone who has no medical reason to read the patient's chart....same difference.

I don't know what Risk Management will do with this; my guess is that these two reps will be banned from coming into our hospital ever again.

Implanting a device is much different than entering a patient's room in ICU post op and checking to 'see how it's doing' without a doctor's or patient's consent....

I had another concern about this, as I thought about it and that is:

What if drug reps go in to a patient's room, and monkey with a device, without the doctor or nurse being aware, and a bad thing happens to the patient because of it....what if they adjust a dose of something, and because they are not authorized to "chart" on the patient, just don't record what they did anywhere....or what if they increase the threshold on a pacemaker, and don't tell someone....

See, if they will lie to gain access, do you think they can be trusted with our very vulnerable patients????

Sometimes, it just takes the wind out of me....truly.

Yes, it is not impossible that someone respresenting drug or equipment company could be involved in patient surgery. However, that would all be set up before the proceedure and all consents would be signed and nursing staff would be aware of special circumstances. I second all the people that say that recognizing the situation and calling them on it was a real standup bit of nursing advocacy.