Why did this have to happen?!? ARGHHGHG

[watermen]

---

Members do not see this ad.

d) Physical examination IS part of the whole psy exam, so you do need to know what a heart/lung sound is, and you always have to rule out medical/surgical illnesses

Don't worry about that, in the US...most psychiatrist really don't know how to listen to heart sound...there is such a thing call "consult"...and psychiatrist always like to use it....they like to consult for small little thing....

 

[ocean11]

Of course, if you're sticking someone pretty often then you should be getting an audit. The standard should be zero needle sticks, regardless of how hazardous the operation is, how fast you are that your nickname is "Flash" etc, it should always be avoided at any costs.



I have always thought of psyh as very hazardous in comparison to the other specialties.
a) In some parts of the world, psy patients are kept in normal wards, except that you would notice that the windows and doors are grilled, and there is a security officer stationed at the entrance. The hospital where I did my psy rotation, the psy unit is detached away from the main hospital, the patients are always kept away from the doctors/nurses. The experience is ALWAYS worse for the women, they get flashed, harrassed...even from afar..
b) In one of the hospitals in the UK, students carry an alarm. If the patient attacks them, they hit the button on it and the guards come running. (They don't use it in other rotations)
c) In medicine/surg/obgyn, you might get pricked with a needle. In psy, you might get stabbed (Come to think of it, it's probably better especially if the knife was not used to stab another guy with HIV/Hep, but I'm sure that you would have other things to worry about)
d) Physical examination IS part of the whole psy exam, so you do need to know what a heart/lung sound is, and you always have to rule out medical/surgical illnesses
e) In no other rotation, if you were to walk past the psy wing, you would automatically look up to see if anyone's going to jump off and land on you
f) I like taking my history knowing that the patient won't suddenly lunge at me and start choking the hell out of me because "You look like the person who killed my grandmother's father's uncle's second cousin's son"

Thus, with all these reasons, I would suggest that you consider opth or dermato👍

That's really hilarious, you're 100% right! perhaps I should consider derm... hoping the patient dosn't have any pathologically infectious skin fungus or bacteria 🙂

LOL

OCEAN11

 

[Tired]

In two months on Psych, I never once saw an attending or resident do a physical exam.

 

[Winged Scapula]

Me neither (see Psychiatry do a physical exam). While it is accepted that they do have to rule out medical causes for their patient's symptoms, in most cases, this is done via lab tests and radiology rather than a PE involving a stethoscope.

Would tell funny story here about surgery consults from Psychiatry which involved no one ever examining patient and just assuming they had a surgical need, but am afraid of being chastized for doing so...

 

[SLUser11]

Me neither (see Psychiatry do a physical exam). While it is accepted that they do have to rule out medical causes for their patient's symptoms, in most cases, this is done via lab tests and radiology rather than a PE involving a stethoscope.

Would tell funny story here about surgery consults from Psychiatry which involved no one ever examining patient and just assuming they had a surgical need, but am afraid of being chastized for doing so...

In defense of psychiatry, many of us surgical residents have little knowledge of their field, and I've seen my share of BS psych consults from surgeons. I'm sure that they share their own ridiculous stories, and say things like "not once have I seen a surgeon do a MMSE or depression screen!" Or some other routine psych thingie I'm not familiar with......

I guess I always think it's funny when a patient is depressed because their health currently sucks, and I hear "Mr. Johnson seems kind of depressed. Maybe we should get a psych consult." (disclaimer: this doesn't happen too often where I'm currently training) The psychiatrist shows up, does an assessment, and then says "Yep, they're mildly depressed. Let me know if you need anything else." Outside of being acutely psychotic or suicidal, there's not a lot of situations where the psychiatrists do alot for our surgical patients....

 

[caroladybelle]

As others have noted, most anyone in a field which does procedures involving sharp objects has been stuck before. Sometimes its not even your fault - I got stuck by an attending while we were both sewing abdominal wounds closed.

However, SLUser1 is right:

1) don't blame yourself; you should have been more closely supervised or at the very least had someone else gloved and available to help. Most IC departments actually require it...I can recall an ID fellow "training" us on the new central line kits (which included gowns, hats, full body drape, etc.) and talking about the "assistant". Even the attendings laughed, knowing that most of the time the residents were doing the lines unassisted, without even the patient's nurse in the room.

2) even outside of the OR, you should have Betadine readily available. There is no reason that even a floor nurse can't go get some for you to scrub vigorously with - its on the shelves in the supply closet, in the Pyxis, etc. Even on MEDICINE floors.

3) do NOT ever think about not reporting it if you are stuck again. Should you, God forbid, test positive for Hep C or HIV, you may be denied any work related benefits or the ability to claim workman's comp. Besides, YOU need to know if you are positive - for YOU, your family and of course, your future patients.

4) finally, if you are fearful of reporting a mistake for fear of a reprimand or a bad evaluation, your RESIDENT should be the one embarassed. You are there to learn and mistakes happen. Part of a resident's job is to teach - albeit to give you some independence, but if your resident team reprimands you or punishes HIS/HER faulty teaching with bad student evals, that resident needs to be written up.

A couple of things:

Many floors do lack betadine as hibiclens/chlorahexidine is becoming the preferred agent in many places. It is also more effective in most cases, with fewer problems associated with it. However, ALL floors should have one or the other, if not both.

And to reiterate, always report a sharps stick, and do not hesitate for fear of reprimand. You owe it to your health and safety.

Carolina (who received contaminated transfusion blood, but is still negative)

 

[caroladybelle]

also i was wondering if it mandatory for a nurse or someone to tell you the patient has HIV or Hep C, etc..before you do a procedure. Im a phlebotomist/ER tech and have sometimes not known they have it. Sometimes i think its better that i dont know anyway because it's not in the back of my head.

In most places, it is considered an inappropriate breach of HIPAA, to notify various staffers of HIV/HEP status, unless they need to know it to give appropriate care. If the care of the patient would be compromised by staffers not knowing this status, then they are notified.

As phlebotomy and techs are supposed to use universal precautions and those will protect you, unless there is a contamination where BB disease is a factor - there is no need "to know". Thus many facilities will tell you that it is a HIPAA violation.

Recently, I took care of a patient that was dying. After he passed, and we did postmortem care, we had to mark the toe tag. In the well known and regarded teaching facility, we could mark that the patient was VRE/MRSA/TB positive. But we were not permitted to write the HIV status.

As a nurse, I am not even given the right to know these things, UNLESS it directly affects the proper care of the patient. I have had numerous ER nurses send me patients and I find that they are HIV+ after they get to the floor. Usually it comes when I review their meds or see the bags of IV Bactrim/Pentam.

But then consider, most of the HIV+ people in the hospital do not know it themselves as they have never been tested. I have had plenty of young people admitted for Burkitt's...then find out that they have HIV.

 

[45408]

3) do NOT ever think about not reporting it if you are stuck again. Should you, God forbid, test positive for Hep C or HIV, you may be denied any work related benefits or the ability to claim workman's comp. Besides, YOU need to know if you are positive - for YOU, your family and of course, your future patients.

During orientation week, we got a horror story. Some surgery resident stuck herself, and went in to get tested. The patient came back negative, but the resident turned out to have Hep C. She had a previous stick that she never reported/got tested. Now she couldn't get workman's comp for it, and according to the occupational health person telling us this, she may have a hard time getting insurance or a job as a surgeon with a known case of Hep C.

 

[Tired]

As a nurse, I am not even given the right to know these things, UNLESS it directly affects the proper care of the patient. I have had numerous ER nurses send me patients and I find that they are HIV+ after they get to the floor. Usually it comes when I review their meds or see the bags of IV Bactrim/Pentam.

Obviously I don't work in your facility, but I find this "HIPPA" explanation highly suspect. Any staff nurse caring for a patient has an implicity 'need to know' HIV status, and since you have full access to the patient's entire chart, obviously they're not trying to restrict your access to that information. Intuitively, I would think that even ancillary staff who could potentially come into contact with the patient's body fluids would seem to have a "need-to-know" since they may choose to take extra precautions beyond standard universal precautions.

I would be curious to know if anyone has any familiarity with this issue beyond word of mouth (I don't).

Regardless however, any physician/resident/med student has every right to know this information, and you can easily find it by looking at the chart.

 

[Winged Scapula]

A couple of things:

Many floors do lack betadine as hibiclens/chlorahexidine is becoming the preferred agent in many places. It is also more effective in most cases, with fewer problems associated with it. However, ALL floors should have one or the other, if not both.

I have yet to see that happen in the hospitals I have worked in during residency, fellowship and while moonlighting, and in the ORs if I ask for hibiclens it becomes a bit more of a chore to find it (but MUCH MUCH easier than if I were to ask for it on the floors or the units).

Some of the newer central line kits have chlorahex sponges instead of the Betadine, so it may be only a matter of time to see what you're experiencing (ie, replacement of Betadine) on a larger scale.

 

[Winged Scapula]

Obviously I don't work in your facility, but I find this "HIPPA" explanation highly suspect. Any staff nurse caring for a patient has an implicity 'need to know' HIV status, and since you have full access to the patient's entire chart, obviously they're not trying to restrict your access to that information. Intuitively, I would think that even ancillary staff who could potentially come into contact with the patient's body fluids would seem to have a "need-to-know" since they may choose to take extra precautions beyond standard universal precautions.

I would be curious to know if anyone has any familiarity with this issue beyond word of mouth (I don't).

Regardless however, any physician/resident/med student has every right to know this information, and you can easily find it by looking at the chart.

I don't have much more familiarity with the issue, but I have heard the HIPPA reasoning used time and time again for patients with infectious disease. Since everyone should be using Universal Precautions, there is no reason to inform healthcare workers of someone's HIV status - if you get stuck, you get tested - it doesn't matter what the known or unknown status of the patient is. As noted above, most HIV and Hep C + patients don't know their status.

I have not heard of a policy requiring healthcare workers to be told of a patient's status.

 

[Tired]

I have not heard of a policy requiring healthcare workers to be told of a patient's status.

Agreed. But I also have yet to hear a policy preventing health care workers from being told. I have heard the HIPPA rationale used, but usually second-hand from staff members, rather than in the form of an official policy. And like everyone else here, I've done a billion hours of HIPPA training, and have never been taught anything that supports this.

I get a little suspicious because of all the misinformation about HIPPA out there. If only I had a dollar for every time I was told by nursing or ancillary staff that I shouldn't see the chart, write a note, talk to the patient's family, print out computerized notes, etc because it's "against HIPPA".

 

[Bertelman]

I agree that HIPAA has become a scapegoat for basically any undesirable task in a hospital. It gets thrown around much too often. As far as the OPs example, however, it really does not behoove a phlebotomist to know HIV status any more than the patient's blood pressure medications. At best, a phlebotomist should know if the patient has an A/V graft, hx of mastectomy, etc.

From my interpretation, healthcare providers are only to disclose medical info which is relevant to the care of the patient. If a nurse is giving report to another nurse, clearly HIV status is relevant. One could argue, however, that there is no need for a phlebotomist to know this. As discussed several times above, many patients are unaware of their own status. Thus, the most prudent practice is to follow universal precautions on all.

--to all the insomniacs, check this out for instant relief...

http://www.hhs.gov/ocr/hipaa/