Needlestick policy related nonsense

[Thanatos]

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So I was closing last week and stuck myself really good in the hand....not like oh did you break skin but damn thing bleed for 10 minutes type of stick. Which sucks, but it happens and is not really the most disturbing part of my story.

We rotate at several different hospitals, this happened at our county where I have not previously been stuck. So our circulator tells me I need to go to our employee health clinic to get my blood drawn and source tested and all that....of course this office is in a completely different building. So I get some blood from the patient and trek over to this health clinic, and the receptionist is tells me "we close in like 5 minutes, you'll have to go the ER instead." The fact that we stay late in clinic to evaluate lipomas but they couldn't see me for a needle stick does bother me a little...but whatever. I go the ER and fill out paperwork and drop off blood and the usual...they tell me to call the health clinic in the morning to get my results.

That seems like an unnecessarily long time to wait, but I was on call and getting destroyed anyway so time flew right by. The next morning we round and I was helping out our interns on service by doing some phlebotomy. Our county hospital is notorious for losing our blood draws in the tube system, so I walk the blood I draw to the lab myself because I hate re-drawing blood somebody else should have drawn in the first place (classic county hospital).

By this point I had called over to our employee health clinic for my results a few times and got transferred around, hung up on accidentally, or they just don't answer the phone at all. So I'm in the lab dropping off blood draws when I have this brilliant idea....I'll just ask the people in the lab for my results and cut out the middle man.

I find the guy that runs the rapid HIV (or not so rapid in my case) and tell him my situation, he picks up a folder and looks in it and says "oh yeah we ran that sample and the results are back, just go over to the employee health clinic to get your results." I tell him he can just, you know, help a brotha out and tell me if it was positive or not seeing as how the results are literally in his hand[ But he won't do it....he tells me I will have to walk all the way back over to the clinic and wait. Maybe its the post call thing...maybe I'm just an ******* but this really pissed me off. I told him if he needs emergency surgery he better crawl his ass to another hospital.

We call people in for transplants and get HIV results in a few hours and it took me all day and night to get mine and I ****ing work there! In an odd way I'm not even as worried about the outcome as I am just angry at the run around I get from all my "fellow" healthcare workers.

 

[SLUser11]

I told him if he needs emergency surgery he better crawl his ass to another hospital.

I hope you didn't really say that to him, as it seems he's just doing his job. A lot of places have pretty strict rules about how you can notify a patients of their HIV test results. For example, many places won't do it over the phone, regardless of the results.

Anyway, I'd be more worried about Hep C than HIV.

 

[igap]

As frustrating as this is (actually I went through almost the exact some thing a while back), you have to learn to accept whatever mediocrity you encounter in these type of situations. Choosing to become angry, and then taking that anger out on the apathetic functionary who just happens to be in front of you at the time will bring nothing but trouble to you.

Unfortunately as a resident/student rotating through a county hospital, there is nothing that you can do that will change the way that county employees operate. Further, if one of those employees that you treat badly complains about you, you will be the one in your program director's office having to explain your behavior. Trust me on this one, this is a no-win situation. The best thing you can do, is learn to balance your chi, and remind yourself periodically that being a student/resident is a phase of life that ends eventually and you will get to move on to greener pastures.

Also, you will find that during your residency you will learn many shortcuts for getting things done. You will build up great friendships with a lot of the hospital players (nursing staff/clerks/janitors/administrators/the little old lady in the medical records office/IT support staff) and you will find that by the middle of your residency, anything can be done with a phone call or two. Getting test results will be a piece of cake.

 

[dpmd]

Sucks. Each time I have been stuck I just looked up the source patient's results in the computer. I was one of their physicians after all. As far as the other nonsense, sounds like typical county attitude (although my first time was totally out of character for a county facility-someone brought the paperwork to me and filled a lot of it out for me, then they drew my blood as well as adding the source patients tests on to the blood they already had, this might have had something to do with the fact it was a scalpel cut not a needlestick and I was bleeding enough to require tying off a bleeding vessel in addition to closing the wound)

 

[maxheadroom]

I hope you didn't really say that to him, as it seems he's just doing his job. A lot of places have pretty strict rules about how you can notify a patients of their HIV test results. For example, many places won't do it over the phone, regardless of the results.

Anyway, I'd be more worried about Hep C than HIV.

Agree on all three points.

 

[tussy]

that sucks, but unfortunately seems to be the norm if you go thru the "proper channels". When i was a resident i got a bad stick (big chunk of my finger removed with the dirty needle) in a fairly high risk patient. It was at the end of the day on a friday of the long weekend and bloodwork wouldn't come back until the following tuesday. I just paged the on call infectious disease staff. He went to the lab, ran the HIV and Hep tests himself and called me with the results and hour later. Otherwise, i would have had to go on prophylaxis for the weekend.

Now I just order the bloodwork on the patient and check the results on the computer - it's not the proper way to do it, but works better most of the time.

 

[45408]

Sucks. Each time I have been stuck I just looked up the source patient's results in the computer. I was one of their physicians after all. As far as the other nonsense, sounds like typical county attitude (although my first time was totally out of character for a county facility-someone brought the paperwork to me and filled a lot of it out for me, then they drew my blood as well as adding the source patients tests on to the blood they already had, this might have had something to do with the fact it was a scalpel cut not a needlestick and I was bleeding enough to require tying off a bleeding vessel in addition to closing the wound)

Here, if a patient or employee gets an HIV/hepatitis test because of an exposure, it goes in the employee safety records, not the patient's medical record. Obviously, I don't have access to that.

 

[dpmd]

Here, if a patient or employee gets an HIV/hepatitis test because of an exposure, it goes in the employee safety records, not the patient's medical record. Obviously, I don't have access to that.

Do they do that instead of informing the patient or the incident and asking permission to test? Would make sense if that is the case. Ours go in the same system as the rest of the labs. We are supposed to ask the patient permission to test, but if they aren't awake or alive as for two of my sticks (ED thoracotomies are a high risk procedure ) it gets run anyway. Haven't ever heard of someone refusing, but I guess they legally can in this state. Not sure what would happen then.

 

[Thanatos]

I hope you didn't really say that to him, as it seems he's just doing his job. A lot of places have pretty strict rules about how you can notify a patients of their HIV test results. For example, many places won't do it over the phone, regardless of the results.

Anyway, I'd be more worried about Hep C than HIV.

I see what you're saying, and you're right. But I'm getting tired of hearing that from people....sorry I'm just doing my job (or its more popular flip side: sorry, thats not my job).

This particular policy or whatever you want to call it, along with many others, makes my life more difficult for really no reason. And this guy who is "just doing his job" is upholding this policy....for really no reason either, and he realizes this but decides to just be a pain in my ass anyway. I can see why they won't give them over the phone, but it agitated me that this guy is gonna make me jump through hoops to get my results. We can put somebody on ****ing ECMO faster than this, with less paperwork!

So in the spirit of Darth Vader, I've decided to start beating on people who uphold hospital policies WE ALL KNOW are full ******....because you should never go full ******.

 

[ESU_MD]

Some institutions have it written in the consent that if someone gets stuck, they automatically can draw and test the blood.
also know that some surgeons routinely draw hep/hiv tests as a part of the elective preop testing. presumably for "risk stratification"
this is really nice. my personal feeling is that if the preop hiv/hep is negative and I get stuck, I dont think its useful to go through the paperwork, testing etc.. barring getting a direct hit.

What is everyones threshold for reporting an exposure anyway. Most surgeons get quite a few needlesticks, blood sprays etc.. How many times do you take off your glove and see blood on your hands?
Does it really change your outcome anyway?

 

[ESU_MD]

I see what you're saying, and you're right. But I'm getting tired of hearing that from people....sorry I'm just doing my job (or its more popular flip side: sorry, thats not my job).

This particular policy or whatever you want to call it, along with many others, makes my life more difficult for really no reason. And this guy who is "just doing his job" is upholding this policy....for really no reason either, and he realizes this but decides to just be a pain in my ass anyway. I can see why they won't give them over the phone, but it agitated me that this guy is gonna make me jump through hoops to get my results. We can put somebody on ****ing ECMO faster than this, with less paperwork!

So in the spirit of Darth Vader, I've decided to start beating on people who uphold hospital policies WE ALL KNOW are full ******....because you should never go full ******.

the problem is that you expect that these idiots will treat you with the courtesy which should be provided to healthcare providers, especially physicians. Much like if one of the nurses gets surgery, they get to be 1st case, private room, more attention, etc. of course if the lab result guy needed surgery, he would drop the "i work at the hospital" card to get some kind of better treatment.

I personally think that physicians and other healthcare providers should get preferential treatment to some degree as a professional courtesy. Like when the cops dont write their buddies speeding tickets.

now I cant justify moving around the transplant list in your friends favor (or steve jobs)

 

[kirurg]

I know how horrible county/city hospital employees can be. They're basically robots who memorize every page of the procedure manual but have no critical thinking skills or even common sense. Of course rotating residents are at a disadvantage- we only spend a few months a year at the hospital and we're too busy to read 100s of pages of rules & regulations.

To play devil's advocate, however, it probably makes sense that the dumb-*****, lazy lab techncian who loses all of your specimens should not be the same person to tell you if you are at risk for contracting a deadly virus. I believe these discussions are usually carried out by *professionals* in a controlled setting to make sure you don't commit suicide you learn that you may have HIV/HCV. (When I got stuck, I just checked the computer system though.)

I hope everything turned out well for you!

I see what you're saying, and you're right. But I'm getting tired of hearing that from people....sorry I'm just doing my job (or its more popular flip side: sorry, thats not my job).

This particular policy or whatever you want to call it, along with many others, makes my life more difficult for really no reason. And this guy who is "just doing his job" is upholding this policy....for really no reason either, and he realizes this but decides to just be a pain in my ass anyway. I can see why they won't give them over the phone, but it agitated me that this guy is gonna make me jump through hoops to get my results. We can put somebody on ****ing ECMO faster than this, with less paperwork!

So in the spirit of Darth Vader, I've decided to start beating on people who uphold hospital policies WE ALL KNOW are full ******....because you should never go full ******.