Discreet signs

[ericdamiansean]

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Hey guys, I was wondering if anyone of you could share any discreet signs left in the hospital by nurses/doctors to inform others of a patient's disease status.

I've seen the hospital I'm attached to, small glasses with thermometers which indicate that the patient is HIV + or suspected of

 

[mikegoal]

i usualy discretly write it in the chart 😀

 

[Careofme]

we used the notation "0.41" or "441" to denote HIV+ when I was on Peds. Not sure if this is a hospital thing or national....

i usualy discretly write it in the chart 😀

 

[ericdamiansean]

we used the notation "0.41" or "441" to denote HIV+ when I was on Peds. Not sure if this is a hospital thing or national....

what's the significance of 0.41/441?

 

[patelakshar]

possibly 411 = information?

 

[Idiopathic]

We have a little method whereby we just say: "Hey, that patient in 438 has HIV/Hep C."

 

[Samoa]

not sure what 041 means, but 042 is the ICD 9 code for HIV infection. I just looked it up.

 

[ericdamiansean]

We have a little method whereby we just say: "Hey, that patient in 438 has HIV/Hep C."

and? what is tat? 😉

 

[Winged Scapula]

we used the notation "0.41" or "441" to denote HIV+ when I was on Peds. Not sure if this is a hospital thing or national....

Certainly not national, as it appears most of us haven't heard of it. Many hospitals have their own codes (ie, the local community hospital we rotate at refers to a Code Blue as "Case 1" - took me awhile to figure that one out).

 

[Winged Scapula]

We have a little method whereby we just say: "Hey, that patient in 438 has HIV/Hep C."

Yep, that's pretty much what we do (along with writing in it in the chart). Strange how direct information works best. Besides you shouldn't be talking about patients in an environment (ie, the elevator) which requires you using some code - if you restrict it to clinical areas and are discreet (ie, not talking loudly in the hallway near the visitors lounge) you should be able to use the appropriate terms.

 

[KatieOConnor]

For our stupid patients, we say, "room 403, not the brightest light in the harbor" or "room 302, not the sharpest tool in the shed"

For those patients not quite right in the head we say, "So and so has a few bats in the belfry" Or "room 452 is a few sandwhiches short of a picnic"

This way we can talk really loudly in front of family members, and they think we're talking boating, gardening, zoology, or a some outing we went on where we didnt have enough sandwhiches.

 

[jamie]

For our stupid patients, we say, "room 403, not the brightest light in the harbor" or "room 302, not the sharpest tool in the shed"

For those patients not quite right in the head we say, "So and so has a few bats in the belfry" Or "room 452 is a few sandwhiches short of a picnic"

This way we can talk really loudly in front of family members, and they think we're talking boating, gardening, zoology, or a some outing we went on where we didnt have enough sandwhiches.

No you don't.

My personal favorite was "CNS QNS [quantity not sufficient]"

 

[ericdamiansean]

No you don't.

My personal favorite was "CNS QNS [quantity not sufficient]"

 

[Pilot]

Member of the High Five Club. ( Hi V )

 

[EM Junkie]

On a related topic, a resident today taught me the trick to write narcotic prescriptions. If you have a feeling the patient may be apt to abuse them, prescribe an odd quantity (say 11). For all other patients, an even quantity (like 12). That way, when a pharmacy calls you for a refill on a patient you don't remember right away, you can just ask how many they were written for the first time. If it was an odd quantity, you will know not to refill it. Kind of like a little code to yourself.

Hey, I thought it was cool, at least....

-Scott, MS3

 

[EM Junkie]

Apparently the black rose on the door of a patient's room in Ob/Gyn means they lost their baby. Of course, nobody told me that. I went into a patient's room asking in my horrible Spanish, "Donde esta la nina?" Only to have the patient look at me with a confused look and start crying. Oops..... that's why these little "codes" suck so much!!

-Scott, MS3

 

[Dr.Evil1]

Somebody on rounds a couple of days ago used the phrase "no toxic habits" which was a loose translation of something he used in Spain. I guess it means no IVDA and no trading drugs or money for sex.

As far as posting things outside of rooms for HIV status is concerned I believe this is really wrong ethically and possibly legally. Here in Michigan we have to get a whole big packet signed to even test the patient for HIV and then the patient alone decides who to reveal this info to. I know it isn't legal to test the patient without consent, it is even illegal to run a CD4 count or another indirect idicator of HIV status if the patient hasn't consented. I think that it gets much more complicated when the patient is a sources for exposure though.

 

[Idiopathic]

Somebody on rounds a couple of days ago used the phrase "no toxic habits" which was a loose translation of something he used in Spain. I guess it means no IVDA and no trading drugs or money for sex.

As far as posting things outside of rooms for HIV status is concerned I believe this is really wrong ethically and possibly legally. Here in Michigan we have to get a whole big packet signed to even test the patient for HIV and then the patient alone decides who to reveal this info to. I know it isn't legal to test the patient without consent, it is even illegal to run a CD4 count or another indirect idicator of HIV status if the patient hasn't consented. I think that it gets much more complicated when the patient is a sources for exposure though.

Certainly not ethically wrong to have a way to let the nurses, techs, aides, RT's, docs and students know that a patient is a confirmed carrier of a viral illness that is potentially contagious, especially when if a contamination were to take place, treatment is available. I wouldnt think twice about it. This does not supercede the standard of universal precautions and taking care not to come into contact with any patients blood, regardless of their infectious state.

I think that Hep C is a greater concern, since the viral load required to infect is very low, and mucous membranes and eyes have been postulated as openings for transmission.

Never fail to take any opportunity to protect you and your co-workers, and balance this with the patient's need for privacy. It can be done.

 

[ericdamiansean]

We have to protect ourselved first, we are of no use if we get infected ourselves, and let me tell you from personal experience, being exposed is no joke, 6 months of living hell before you are cleared

The black rose thingy is pretty good..at least we can be more sensitive

 

[Spiff]

Certainly not ethically wrong to have a way to let the nurses, techs, aides, RT's, docs and students know that a patient is a confirmed carrier of a viral illness that is potentially contagious, especially when if a contamination were to take place, treatment is available.

Sure. This is called the chart. Besides, if a contamination occurs, then every hospital has a procedure in place to check the patient's status and get the contaminated person some treatment.

This does not supercede the standard of universal precautions and taking care not to come into contact with any patients blood, regardless of their infectious state.

If it doesn't supercede any precaution standards and shouldn't change the way you handle the patient, then why would it be necessary?

Talking about potentially sensitive matters (like drug use/cancer etc.) around the patient (i.e. on rounds) is a different story, but IMO, but this business about posting "codes" in the chart or on doors is nonsense. We have people roll through th ER/Wards/OR all the time whose Hepatitis/HIV status is unknown. It doesn't change how they get handled, because EVERYONE ought to be treated as if they have some potentially transmissible agent. If you are treating someone differently or behaving differently yourself because you happen to know they have HIV then, IMO, you are doing something wrong. For the cases where the patient has something requiring extra protection for staff, then this is usually posted directly outside the room along with a box of gowns/masks and gloves... i.e C. Diff, Tuberculosis, MRSA, etc.

I can sort of see the case about the stillbirth, but wouldn't that information be found much more easily by doing a quick chart review before seeing the patient? Again, IMO, it is not a good idea to go into a room blind when you have information available. If you have no other choice but to go in blind, then just do your best and don't feel guilty about what you couldn't possibly have known. But seriously, how do you most people would feel about having some "black spot" on their door marking their room as the one with the stillbirth? Even if you can rationalize this kind of thing ethically, how do you think most patients would feel if they knew that "codes" alerting everyone about their condition are posted for all to see... especially people not directly involved in their care? How do you think a judge would feel when deciding whether or not to hand out a HIPPA fine?

 

[EM Junkie]

I can sort of see the case about the stillbirth, but wouldn't that information be found much more easily by doing a quick chart review before seeing the patient? Again, IMO, it is not a good idea to go into a room blind when you have information available. If you have no other choice but to go in blind, then just do your best and don't feel guilty about what you couldn't possibly have known. But seriously, how do you most people would feel about having some "black spot" on their door marking their room as the one with the stillbirth? Even if you can rationalize this kind of thing ethically, how do you think most patients would feel if they knew that "codes" alerting everyone about their condition are posted for all to see... especially people not directly involved in their care? How do you think a judge would feel when deciding whether or not to hand out a HIPPA fine?

FYI, there was a clerical error, and my patient (who had a normal, healthy baby) was supposed to be in the room where the mother of the stillborn infant was. They had very similar names and the nursing staff switched their paperwork.

Good comments from all though.....

 

[GeneGoddess]

Apparently the black rose on the door of a patient's room in Ob/Gyn means they lost their baby. Of course, nobody told me that. I went into a patient's room asking in my horrible Spanish, "Donde esta la nina?" Only to have the patient look at me with a confused look and start crying. Oops..... that's why these little "codes" suck so much!!

-Scott, MS3

Our hospital uses a red paper rose on the patient's door.

 

[Dr.Evil1]

Certainly not ethically wrong to have a way to let the nurses, techs, aides, RT's, docs and students know that a patient is a confirmed carrier of a viral illness that is potentially contagious, especially when if a contamination were to take place, treatment is available. I wouldnt think twice about it. This does not supercede the standard of universal precautions and taking care not to come into contact with any patients blood, regardless of their infectious state.

I think that Hep C is a greater concern, since the viral load required to infect is very low, and mucous membranes and eyes have been postulated as openings for transmission.

Never fail to take any opportunity to protect you and your co-workers, and balance this with the patient's need for privacy. It can be done.

The whole basis of universal precautions is that they are UNIVERSAL and that you should use them with every patient. Signaling that one patient is more risky then another is bad because it encourages complacency when dealing with unmarked patients. When additional protection such as a respirator then it is appropriate to state the needed equipment but still to have some kind of code that denotes someone has TB is wrong.

I will still assert that this is wrong on a ethical level as well. If you label a person by their disease status then you are encouraging discrimination. Your previous post basically states that you would treat someone with HIV or Hep C different than someone who was though to be "clean". The legality of this is also suspect. Despite the frustrations it seems to cause HIPPA was put in place for a reason, people value their privacy.

If someone knows that having HIV would make people discriminate against them it would discourage them getting testing and teatment. HIV patients can live great lives for MANY years with diagnosis and treatment. Labeling people with diseases does not do us any good and actually can be quite harmful.

 

[EUA]

Sure. This is called the chart. Besides, if a contamination occurs, then every hospital has a procedure in place to check the patient's status and get the contaminated person some treatment.



If it doesn't supercede any precaution standards and shouldn't change the way you handle the patient, then why would it be necessary?

Talking about potentially sensitive matters (like drug use/cancer etc.) around the patient (i.e. on rounds) is a different story, but IMO, but this business about posting "codes" in the chart or on doors is nonsense. We have people roll through th ER/Wards/OR all the time whose Hepatitis/HIV status is unknown. It doesn't change how they get handled, because EVERYONE ought to be treated as if they have some potentially transmissible agent. If you are treating someone differently or behaving differently yourself because you happen to know they have HIV then, IMO, you are doing something wrong. For the cases where the patient has something requiring extra protection for staff, then this is usually posted directly outside the room along with a box of gowns/masks and gloves... i.e C. Diff, Tuberculosis, MRSA, etc.

well put and i totally agree.

as an aside i do believe it is illegal to put some sort of code in a chart/room to signify things like HIV status. i'm sure no one could ever be prosecuted for such a thing like a thermometer by a cup, but it's tacky and inappropriate nonetheless. not mention childish.