Why didn't I know this?

[jmejo]

So, I've been a nurse a little over a year now. I work in LTC. I've had patients with MRSA but I've never been the nurse to recieve the labs stating this patient has MRSA. Well I recieved that fax the other night during night shift. I feel like a real dummy because I didn't do anything about it. I faxed the results with the patients allergies to the Dr. like we do all our other labs. It didn't even occur to me that it was saturday and the dr wouldn't see it until monday. When the day nurse came in we were at the nurses station with other residents around so i pushed the lab to the other nurse and said this came in last night, assuming she looked at it and seen what it said. Well, I should already know NOT to assume anything. The day nurse didn't read it and this resident with MRSA was all over the nursing home like normal. I, for some reason, had NO idea we were supposed to put them on precautions ASAP. After word got around that this res had MRSA I went to my DON and told them what had happend. They explained the "procedure" to follow when a res has MRSA. I just wish I would have known this sooner. I keep asking myself, why didn't I know to do this? I feel as if I am a pretty strong nurse and now I question this. Was it just my duh moment or what? I have now researched MRSA online and found some very helpful information about it. Sometimes I wish there was a rewind button!

[2bnursekemmie]

I just been a nurse for a week. LOL!!!! But everybody makes mistakes. You shouldn't question your abilities as a nurse. At least you went to your DON. You had the courgage to say I made a mistake. Good luck and cheer up!!!

[GrumpyRN63, ADN, RN]

I don't understand how you have taken care of many pts with MRSA and not known they are on contact precautions, I don't understand the protocol in LTC and faxing whatever to the md, seems to me if you got the result, you should just put the pt on precautions regardless if the md knows

[jmejo]

The other 2 residents I had werent put on precautions, thats why I didn't realize it was needed. And reporting it to the MD is to begin them on ABT's ASAP not for the precaution order. I work nights and all my days are the same to me, so it being saturday didnt even cross my mind.

[GrumpyRN63, ADN, RN]

I guess what your saying is the other pt's had a past hx of MRSA, not active infxn, BTW, what are ABT's ( I'm unfamiliar with that- is it a LTC thing) ?

[jmejo]

antibiotic

[xoemmylouox, ASN, RN]

Just take it as a lesson learned. You will never forget it. Shoot if that is the worst thing you have made a mistake on your darn near perfect

[jmejo]

and one of the residents had MRSA in their urine, but had a foley. The other one had a wound on their face that had active MRSA. I had asked about precautions with this resident and a nurse that has been there for 20+ years said no, i dont recall the reason she gave me but thats why it didnt click that this is a MUST with MRSA. I know now, but I'm upset with myself that I didnt do more.

[sasha2lady]

I think its different in every facility. Some things you would think would just be common sense...and others not so much. I have seen in my facility more times than I can count....a resident would have mrsa and wouldnt even be put on any kind of precaution or isolation UNLESS they were already in a private room. Now...do I agree with that ? No. But....Im too low on the totem pole to get anything done about it. And honestly, If every person resident wise and employee wise that works in LTC got a nasal swab done for mrsa...I bet the majority would come back positive just from having been unknowingly or knowingly exposed to it at some point in time. My facility actually was STUPID enough a few years back to take a TB patient! We dont have negative pressure rooms or masks required to take care of a TB patient. Our MD was HOT about that one and wanted that pt out of our facility but of course the upper management people over rode him and the pt stayed. Granted he wasnt having active TB but still...that was one that made me super nervous to be around. I had a positive PPD 2 yrs ago and I got a little freaked out but my CXR was negative and the human resources woman told me I needed to be on anti TB drugs from the health dept. I dont think it was a true positive...Im almost certain it was an allergic reaction to the TB test itself because they had switched manufacturers.

[GrumpyRN63, ADN, RN]

antibiotic

\

OOOOHH :) We have always used ATBX's, I couldn' t figure it out from ABT

[Thornbird]

On the night shift, if a report comes in with any communicable disease, err on the side of caution and put them on precautions. In most facilities, either the Infection Control Nurse, DON or the Medical Director have the final say on who is and isn't on precautions. It also depends upon the site. A skin infection with MRSA that is covered by a dressing only warrants the standard precautions we always use. Many patients have "colonization" with MRSA and don't need precautions. But that's somebody else's problem to decide. You learned a lesson the hard way, but that's how we all grow :)

To sasha2lady: Your patient with TB that is not active has the same thing you did. He tested positive and has to take the meds in case he has latent TB. This doesn't warrant any precautions either.

[rn/writer, RN]

Don't waste a lot of time bemoaning what you did (or didn't do) wrong. Use your energy to look ahead. You won't make this same mistake again.