Not wearing protective personal equipment

[Piebaldi]

So I did not realize a patient was on isolation, there were no signs posted on the patient's door, and the gown cart was in a place I did not realize that was meant for that patient so unfortunately I did not wear the gown. Because I did not realize that the patient was on isolation, I did not wash my hands in the room but outside the room and also used sanitizer before that. I washed my hands immediately after that. Unfortunately the facility's surveyors were here at the time and now they are asking administration for my name and what not. Is this a big deal? I did not imagine it to be but now I'm getting concerned. Thoughts?

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[anonperson]

Make a pre emptive complaint about the lack of proper signage regarding the isolation status. Usually they should put a sign on the door that is hard to miss.

You may get a nastygram regarding this but it shouldn't be a major thing.

 

[Piebaldi]

Make a pre emptive complaint about the lack of proper signage regarding the isolation status. Usually they should put a sign on the door that is hard to miss.

You may get a nastygram regarding this but it shouldn't be a major thing.

Well today the nursing manager asked for the spelling of my first name, I gave it to her. Then I went to the administrator and said what's going on, is this a big deal, and she told me that the surveyors are making a big deal because "I'm a doctor and should have known better" So I actually went to the surveyor, explained that I had taken care of the patient on a different floor and did not realize when she returned from the hospital that she was on contact. I explained that I wore gloves, and then I used the sanitizer as I left the room andwashed my hands right away after leaving the room and told them it was an honest mistake on my part. I even looked at the door again today - there is NO signage in terms of isolation. It just has a tiny sign that says "Stop - ask nursing for directions' or something like that. The gown cart is there but is not directly in front of the patient's room.
The director of the facility tells me that supposedly they are going to cite the facility and now that she has to come up with a training plan and what not and the citations go wagainst the facility's rating. I am an attending. I don't see how this could really be that egregious. I was even told by an aide that someone else had not worned their protective equipment and I'm sure others don't either. It seems out of proportion to the mistake.

Additionally they made me sign (the administrator's assistance) some form stating something about receiving an 'in service' and when I asked - oh is there going to be an inservice? She said no, we are going individually to people telling them to wear protective equipment. That was the "in service'

 

[deleted480308]

It should go against the hospital ratings.....for not having appropriate signage. Not your problem

 

[Piebaldi]

It should go against the hospital ratings.....for not having appropriate signage. Not your problem

No but they are blaming me because I did not wear the PPE. The signage does not say "on contact isolation' - it just says "Stop - talk to nursing staff" or something like that. I even told the surveyor today that I did not see signage as I'm usually used to seeing signage on a patient's door and she said oh there is signage. I went to check literally a few minutes later and there is no mention of isolation - just a tiny magnet on the top of the door on the side that says "Stop"
Obviously I'm not going to worsen this by taking a picture and getting cited for all sorts of stuff but there is no signage re: Isolation.
This is a skiled nursing facility. How am I supposed to know that she is on contact isolation with no mention of "isolation"?
Can I be fired for something like this? They make it seem like something terrible has happened, and when others make the same mistake as well.
The administrator seems to want to blame me.

 

[deleted480308]

Other people doing it is a bad defense. I would drop that.

I’d focus on the facility not protecting you by having bad signage. They subjected you to a dangerous infection because they didn’t warn you appropriately about the contact precautions.

You don’t need to apologize. They need to get better at signage

 

[Piebaldi]

Other people doing it is a bad defense. I would drop that.

I’d focus on the facility not protecting you by having bad signage. They subjected you to a dangerous infection because they didn’t warn you appropriately about the contact precautions.

You don’t need to apologize. They need to get better at signage

Yes I certainly did not tell them "other people do it." I am just mentioning that here. But again the surveyor said "There is signage" Yes I am a doctor but I am not a mind reader. I already told them it was an honest mistake because I felt pressured by the administrator, but she is trying to make it seem like soething terrible has been done.

 

[deleted480308]

Yes I certainly did not tell them "other people do it." I am just mentioning that here. But again the surveyor said "There is signage" Yes I am a doctor but I am not a mind reader. I already told them it was an honest mistake because I felt pressured by the administrator, but she is trying to make it seem like soething terrible has been done.

The something terrible is them having crap signage and exposing you to infection

 

[Piebaldi]

The something terrible is them having crap signage and exposing you to infection

I agree but they are not seeing it that way - I am part of a private practice contracting to various facilities. I happen to be at this facility most of the time. But of course the facility does not want to own up to having garbage signage. If something had said "contact" of course I would have used a gown. I just want to know the true seriousness of this event.

 

[thumbz]

You're an attending? Pretty sure nothing is going to come of this and you're going to be just fine. Facilities pay big bucks to contract with PP groups and for them to risk losing your group over something as silly as this would be ridiculous. It'll all blow over as soon as the surveyors are gone.

Maybe as a medical student your school would be contacted, as a resident your PD would have had to tell you to remember to wear PPE. If you were a nurse that's probably where you could potentially have had a serious issue (think of all the HIPAA violations that read "11 nurses fired and 2 doctors fined for HIPAA violations).

 

[dpmd]

Did your clothing actually come into contact with any surfaces, or is this just about meaningless rule following? Because if all I am doing is talking to a patient I don't wear a gown into the room. If someone hassles me I educate them that gowns are for protecting exposed skin and clothing from the patient and environment and as such the absence of contact is protection enough.

 

[Piebaldi]

Did your clothing actually come into contact with any surfaces, or is this just about meaningless rule following? Because if all I am doing is talking to a patient I don't wear a gown into the room. If someone hassles me I educate them that gowns are for protecting exposed skin and clothing from the patient and environment and as such the absence of contact is protection enough.

My clothing did not come into contact, and I wore gloves and I used sanitizer and washed my hands after leaving the patient's room. I also did not come in any way shape or form with the patient's wound. This is about meaningless rules following because the surveyors/accrediting people were there. I am a new attending so don'twant to go into war with anyone. She made it seem like it was a capital offense!! Again I am happy to follow the rules if they are clear. Everywhere essentially where I have worked has a sign that says "contact precautions" -

 

[GoSpursGo]

You're worrying a lot over something that probably won't be a big deal, and even if it is worrying about it here isn't going to change anything.

Keep telling them they need better signage. There is nothing else to do at this point.

 

[Piebaldi]

You're worrying a lot over something that probably won't be a big deal, and even if it is worrying about it here isn't going to change anything.

Keep telling them they need better signage. There is nothing else to do at this point.

Well what if the facility does indeed get cited? Although I don't see how they could get cited for one event. I am making a big deal essentially because the administrator made it seem like a big deal which I did not think it was.

 

[dpmd]

Well what if the facility does indeed get cited? Although I don't see how they could get cited for one event. I am making a big deal essentially because the administrator made it seem like a big deal which I did not think it was.

They should get cited since they don't have appropriate signage to ensure everyone can tell who is on precautions. Imagine that was a droplet room you went into and then you got whatever they had. That's on them not you though. I would never have begged forgiveness like you did about your "honest mistake", nor would I overexaggerate the risks for poot signage with this patient (who is probably on contact for a stupid reason like recent hospital admit) but I would have been repeatedly blaming them for not having standard signage.

 

[Piebaldi]

They should get cited since they don't have appropriate signage to ensure everyone can tell who is on precautions. Imagine that was a droplet room you went into and then you got whatever they had. That's on them not you though. I would never have begged forgiveness like you did about your "honest mistake", nor would I overexaggerate the risks for poot signage with this patient (who is probably on contact for a stupid reason like recent hospital admit) but I would have been repeatedly blaming them for not having standard signage.

I did say several times that I did not see any signage. I did not beg for forgiveness I simply said it was an honest mistake because I felt pressured by the administrator and currently life is in a big state of flux and odn't want issues. I don't think the surveyors are worried about the signage. And yes it was a recent hospital admin and she was not on contact before she went in. But it's hard to be the one being thrown under the bus when I work there - essentially as I said I am part of a group, it's not like it's my practice or anything.

 

[dpmd]

I did say several times that I did not see any signage. I did not beg for forgiveness I simply said it was an honest mistake because I felt pressured by the administrator and currently life is in a big state of flux and odn't want issues. I don't think the surveyors are worried about the signage. And yes it was a recent hospital admin and she was not on contact before she went in. But it's hard to be the one being thrown under the bus when I work there - essentially as I said I am part of a group, it's not like it's my practice or anything.

I think you are stressing too much about this like it was your fault when it isn't. They will sense your weakness and make life more difficult than if you stick up for yourself.

 

[evilbooyaa]

I did say several times that I did not see any signage. I did not beg for forgiveness I simply said it was an honest mistake because I felt pressured by the administrator and currently life is in a big state of flux and odn't want issues. I don't think the surveyors are worried about the signage. And yes it was a recent hospital admin and she was not on contact before she went in. But it's hard to be the one being thrown under the bus when I work there - essentially as I said I am part of a group, it's not like it's my practice or anything.

It's not a mistake. Stop calling it that. YOU did not make a mistake. If you admit to making a mistake then they can force you into a remediation plan or some other nonsense. If a person walks into ANY room that is contact isolation where the appropriate signage has not been put up to reflect that, it is not YOUR fault as the person who walked into the room. It is either the fault of the facility, or the fault of whoever was supposed to put up a bright 'contact isolation' sign.

You had no way of knowing that the patient was on contact isolation.

For you to be reprimanded for this is silly because it's on the facility. For you to be fired arguably opens the hospital for a wrongful termination and (maybe) unsafe workplace lawsuit.

Take a chill pill. Nothing is going to come of this. I am generally suspicious of when people I don't know ask me my name and ESPECIALLY if they have me sign something that I'm not expecting. We get so programmed to just sign, on command, whatever piece of paper people put in front of us. I'm fine to do that with my co-workers I interact with daily and trust, but not some random administrator person.

 

[siliso]

On the positive side, they may want to discuss your experience to make systems improvements rather than to personally crack down on you. This would actually be best practice for patient safety improvement.

 

[Piebaldi]

It's not a mistake. Stop calling it that. YOU did not make a mistake. If you admit to making a mistake then they can force you into a remediation plan or some other nonsense. If a person walks into ANY room that is contact isolation where the appropriate signage has not been put up to reflect that, it is not YOUR fault as the person who walked into the room. It is either the fault of the facility, or the fault of whoever was supposed to put up a bright 'contact isolation' sign.

You had no way of knowing that the patient was on contact isolation.

For you to be reprimanded for this is silly because it's on the facility. For you to be fired arguably opens the hospital for a wrongful termination and (maybe) unsafe workplace lawsuit.

Take a chill pill. Nothing is going to come of this. I am generally suspicious of when people I don't know ask me my name and ESPECIALLY if they have me sign something that I'm not expecting. We get so programmed to just sign, on command, whatever piece of paper people put in front of us. I'm fine to do that with my co-workers I interact with daily and trust, but not some random administrator person.

Well I am an attending so there is no remediation or other nonsense. But the surveyors keep insisting that there is signage. I disagree. But taking a picture will likely have me cited for all sorts of things. So I am annoyed ugh. I have thought about the wrongful termiantion issue - if they try to fire me i will sue them for millions

 

[anonperson]

Well I am an attending so there is no remediation or other nonsense. But the surveyors keep insisting that there is signage. I disagree. But taking a picture will likely have me cited for all sorts of things. So I am annoyed ugh. I have thought about the wrongful termiantion issue - if they try to fire me i will sue them for millions

No one's going to fire you.

This is not a major deal.

Don't take a picture.

If you are that worried, make a formal complaint about the inadequate signage through the appropriate channels.

You think an orthopod or general surgeon would even care? They would probably take a leak in the corner of the room to mark their territory.

 

[dpmd]

No one's going to fire you.

This is not a major deal.

Don't take a picture.

If you are that worried, make a formal complaint about the inadequate signage through the appropriate channels.

You think an orthopod or general surgeon would even care? They would probably take a leak in the corner of the room to mark their territory.

Nah, I mark my territory with blood soaked bandages or drains. That I often remove without gloves on unless my skin isn't intact because washing afterwards is good enough for most stuff. Got a letter that a nurse ratted me out for this and asked me to comply with policy in the future. I chucked the letter in the trash without consequences.

 

[Ironheme]

Well what if the facility does indeed get cited? Although I don't see how they could get cited for one event. I am making a big deal essentially because the administrator made it seem like a big deal which I did not think it was.

It's called petty tyranny.

 

[NotAProgDirector]

My take / advice is somewhat different.

First, most medical errors are systems problems. Good people make mistakes because the system allows them too. Making the system better is the right answer, and if signage isn't good then that's an easy step to take to try to prevent these sorts of things.

But

This was an external accreditation visit. This isn't just an internal safety officer issue, the entire institution could receive citations over this, and that could be very painful for them. The stakes could be very high. Anything the OP can do to help mitigate that is in everyone's best interest.

The OP mentions that they are not an employee of the institution, but rather an external contractor who works there. The institution could simply say they no longer want this person working at their institution. There would be no right to a "fair hearing", and as long as it's not an illegal discrimination issue there really isn't anything the OP can do. Their actual employer could then assign them somewhere else, or do whatever else they wanted to do.

Most likely, nothing will happen. Blaming other people will almost certainly end up with a bad outcome for the OP. Submitting a complaint, after the fact, will look like retaliation / CYA.

Did your clothing actually come into contact with any surfaces, or is this just about meaningless rule following? Because if all I am doing is talking to a patient I don't wear a gown into the room. If someone hassles me I educate them that gowns are for protecting exposed skin and clothing from the patient and environment and as such the absence of contact is protection enough.

I used to think similarly, and have been convinced otherwise. This has been shown to be inaccurate. Contact precautions are usually not for the physician or nurse -- they are to protect the other patients in the hospital. C Diff transmission is markedly decreased with contact precautions. You won't get it -- we're trying to prevent the next patient you see from getting it. Whether you touch the patient or not doesn't matter -- once the patient has been in the room for awhile, the spores get all over due to the patient moving around, other people touching the patient and then other surfaces, etc. Out general rule of thumb is "swing of the door" -- if you stand in the doorway and talk to people in the room within the swing of the door, then that's fine. Any further into the room than that, and you gown/glove/wash.

 

[Piebaldi]

My take / advice is somewhat different.

First, most medical errors are systems problems. Good people make mistakes because the system allows them too. Making the system better is the right answer, and if signage isn't good then that's an easy step to take to try to prevent these sorts of things.

But

This was an external accreditation visit. This isn't just an internal safety officer issue, the entire institution could receive citations over this, and that could be very painful for them. The stakes could be very high. Anything the OP can do to help mitigate that is in everyone's best interest.

The OP mentions that they are not an employee of the institution, but rather an external contractor who works there. The institution could simply say they no longer want this person working at their institution. There would be no right to a "fair hearing", and as long as it's not an illegal discrimination issue there really isn't anything the OP can do. Their actual employer could then assign them somewhere else, or do whatever else they wanted to do.

Most likely, nothing will happen. Blaming other people will almost certainly end up with a bad outcome for the OP. Submitting a complaint, after the fact, will look like retaliation / CYA.



I used to think similarly, and have been convinced otherwise. This has been shown to be inaccurate. Contact precautions are usually not for the physician or nurse -- they are to protect the other patients in the hospital. C Diff transmission is markedly decreased with contact precautions. You won't get it -- we're trying to prevent the next patient you see from getting it. Whether you touch the patient or not doesn't matter -- once the patient has been in the room for awhile, the spores get all over due to the patient moving around, other people touching the patient and then other surfaces, etc. Out general rule of thumb is "swing of the door" -- if you stand in the doorway and talk to people in the room within the swing of the door, then that's fine. Any further into the room than that, and you gown/glove/wash.

I tried to mitigate things, although I don't think it's entirely my fault. If there would have been a sign saying - contact precautions - it would have been more reasonable. Having a tiny sign at the top of the door that says "stop see nurse" seems ridiculous. And yes I did not blame others, but I was told by another aid that my same "mistake" was done by others. They also never did an inservice really so they should have explained that that was a contact isolation thing. Sigh.

 

[dpmd]

My take / advice is somewhat different.

First, most medical errors are systems problems. Good people make mistakes because the system allows them too. Making the system better is the right answer, and if signage isn't good then that's an easy step to take to try to prevent these sorts of things.

But

This was an external accreditation visit. This isn't just an internal safety officer issue, the entire institution could receive citations over this, and that could be very painful for them. The stakes could be very high. Anything the OP can do to help mitigate that is in everyone's best interest.

The OP mentions that they are not an employee of the institution, but rather an external contractor who works there. The institution could simply say they no longer want this person working at their institution. There would be no right to a "fair hearing", and as long as it's not an illegal discrimination issue there really isn't anything the OP can do. Their actual employer could then assign them somewhere else, or do whatever else they wanted to do.

Most likely, nothing will happen. Blaming other people will almost certainly end up with a bad outcome for the OP. Submitting a complaint, after the fact, will look like retaliation / CYA.



I used to think similarly, and have been convinced otherwise. This has been shown to be inaccurate. Contact precautions are usually not for the physician or nurse -- they are to protect the other patients in the hospital. C Diff transmission is markedly decreased with contact precautions. You won't get it -- we're trying to prevent the next patient you see from getting it. Whether you touch the patient or not doesn't matter -- once the patient has been in the room for awhile, the spores get all over due to the patient moving around, other people touching the patient and then other surfaces, etc. Out general rule of thumb is "swing of the door" -- if you stand in the doorway and talk to people in the room within the swing of the door, then that's fine. Any further into the room than that, and you gown/glove/wash.

Yeah, but unless the spores are jumping off of surfaces, if you don't contact the patient or surfaces you won't move them to another room

 

[rokshana]

Yes I certainly did not tell them "other people do it." I am just mentioning that here. But again the surveyor said "There is signage" Yes I am a doctor but I am not a mind reader. I already told them it was an honest mistake because I felt pressured by the administrator, but she is trying to make it seem like soething terrible has been done.

ask them what signage? there is nothing that says contact and there is supposed to be...and what exactly IS the contact? MRSA in the nose? or an actual infection?

don't let them put this on you...put them on the defensive for exposing you to something and not having the proper signage...something that says "stop" is not proper signage.

 

[NontradICUdoc]

Relax. You are fine. If you feel like it, talk with the chief of staff

 

[Piebaldi]

ask them what signage? there is nothing that says contact and there is supposed to be...and what exactly IS the contact? MRSA in the nose? or an actual infection?

don't let them put this on you...put them on the defensive for exposing you to something and not having the proper signage...something that says "stop" is not proper signage.

Correct, there is no statement that says contact, and yes MRSA but on a wound that is covered.
This is a skilled nursing facility. Again this was the administrator. What do I do - say hey your signage sucks? I am not sure what to do now. I don't want to get blamed per se but I also don't want a huge issue. I think they do need better signange and I did tell them that I did not see any signage. But if they insist that something terrible was done I might go down this road. I would assume that by law they have to have something that says contact no? "stop" could be anything really. And isn't an isolation cart supposed to be labelled as such?

 

[Piebaldi]

Relax. You are fine. If you feel like it, talk with the chief of staff

There is no chief of staff. this is a SNF. And Like aPD pointed out, I am worried because it's one of the surveyor type of things that accredits the facility not some random check and stuff. But I agree with you all that the signage should have been better

 

[d2305]

If the patient had ebola, I might be concerned, don't worry about the trivial. It's not a sentinel event. I once got stuck with the job of infection control. I had signs everywhere. I even payed for color copies of more signs before the joint commission did their wandering act,

 

[Piebaldi]

If the patient had ebola, I might be concerned, don't worry about the trivial. It's not a sentinel event. I once got stuck with the job of infection control. I had signs everywhere. I even payed for color copies of more signs before the joint commission did their wandering act,

No ebola

 

[Apollyon]

No ebola

I think you missed the joke.

 

[Piebaldi]

I think you missed the joke.

Perhaps