Skills
Went in for a foley inservice this morning, mandatory. A lot of hostility from RNs who, like me, can count the number they have put in by hundreds and thousands. But I figure, well, you never know what you might learn.
And, I did. New research, due to unexpected numbers of urinary tract infections in people who have had foley bladder catheters inserted. What they found was unlicensed staff doing the procedure - which surprized us, and is no longer allowed. Medical assistants and aides, which seemed to me particularly risky. It's not a difficult skill, but it does take a pretty thorough understanding of the anatomy and sterile techniques. The other big risk is after care on the floor, which we all assumed was the real problem.
In addition, the type of cleanser for the area makes a difference. The kits come with everything provided in a sterile pack, and they use a rather useless betadine solution. They provide cotton balls to swab with - and cotton fibers from these have been found in the urethra from their samples. Plus, the entire area needs to be cleaned, not just close in to the insertion site (am I being delicate, or at least clinical enough not to offend?) And not using any of the prep solutions we already have on hand. Instead, we will get packaged skin prep wipes. Eventually, the kits will be updated.
Then we have to keep the drainage bag off the floor, simple enough, but we don't always. And either remove the catheter, or secure it to the leg, before leaving the OR. Not to mention only inserting these at all if it is really necessary.
All in all, it makes good sense. Most of the problems no doubt stem from them being left in too long, mishandled on the floor, or put in by inadequately trained personnel. A few precautions on our part will make a difference.
Mostly, though, it's because what a floor nurse calls "sterile" an OR nurse might consider reasonably clean. And, watching some of the floor nurses passing off on the skill on the models (plastic ones, not people) made me realize that making all the RNs do this training probably was necessary.
We, of course, would like them to extend the research to exonerate us. This is not going to happen.
And I'm just glad they had enough people that they didn't need me today. Feeling better, but my head is still very congested. Cannot pronounce a nasal consonant yet. Maybe tomorrow I'll be less drippy.
And, I did. New research, due to unexpected numbers of urinary tract infections in people who have had foley bladder catheters inserted. What they found was unlicensed staff doing the procedure - which surprized us, and is no longer allowed. Medical assistants and aides, which seemed to me particularly risky. It's not a difficult skill, but it does take a pretty thorough understanding of the anatomy and sterile techniques. The other big risk is after care on the floor, which we all assumed was the real problem.
In addition, the type of cleanser for the area makes a difference. The kits come with everything provided in a sterile pack, and they use a rather useless betadine solution. They provide cotton balls to swab with - and cotton fibers from these have been found in the urethra from their samples. Plus, the entire area needs to be cleaned, not just close in to the insertion site (am I being delicate, or at least clinical enough not to offend?) And not using any of the prep solutions we already have on hand. Instead, we will get packaged skin prep wipes. Eventually, the kits will be updated.
Then we have to keep the drainage bag off the floor, simple enough, but we don't always. And either remove the catheter, or secure it to the leg, before leaving the OR. Not to mention only inserting these at all if it is really necessary.
All in all, it makes good sense. Most of the problems no doubt stem from them being left in too long, mishandled on the floor, or put in by inadequately trained personnel. A few precautions on our part will make a difference.
Mostly, though, it's because what a floor nurse calls "sterile" an OR nurse might consider reasonably clean. And, watching some of the floor nurses passing off on the skill on the models (plastic ones, not people) made me realize that making all the RNs do this training probably was necessary.
We, of course, would like them to extend the research to exonerate us. This is not going to happen.
And I'm just glad they had enough people that they didn't need me today. Feeling better, but my head is still very congested. Cannot pronounce a nasal consonant yet. Maybe tomorrow I'll be less drippy.
Posted by Zhoen on Wednesday, January 09, 2013
7 comments:
an interesting course, and although what they've found seemed obvious it can get missed when busy?
Good to have something to do even though you are bunged up. Hope it eases very soon
x
gz,
Was to us. But we could see how it could happen, it doesn't seem like that critical a procedure at first glance. Untrained people don't know that they haven't got enough training to do it safely - just that they can do it. Crotches are not clean places at the best of times. Patients are not always cooperative. Taping the tube is irritating to leg skin. It's not as simple as it seems.
The prep solution thing was not obvious, had to be based on research. The alternate of hibiclens we figured would work, but they've shown it to be irritating and not to help. And when a kit comes with certain things, we tend not to question it. Should, usually don't, often because there aren't alternatives.
I think it would take considerable effort for you to write something that would make me feel uncomfortable.
Sometimes the broad swath is so much simpler to manage little thought is given to exceptions.
Mend well.
Re: discomfort - I'm sure I didn't mean you, Phil.
Mending.
All this 'on the floor' activity creates some interesting images for the medically semi-literate!
I found that extremely interesting. Though I take RR's point...
Yeah, The Floor in this case means in areas with patients staying overnight or longer. Anyplace in the hospital that is not in (or going into, or just coming out of) the OR, or clinics. Out on The Floor is what most people consider being in the hospital. Jargon. I just can't think of a more generally understood term. Would on the wards be correct? Wards are gone, it's all rooms - which is even less descriptive. You'd think there would be a term, but I don't think there is one.
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