Patient Restrictions Posting Fail = Write-up

[LillFilly]

So, Boyfriend's mother got in trouble at work the other night.

She was doing her rounds (Phlebotomist, draws blood and runs tests on it) and had to draw blood from a patient. She asked patient if she had an arm preference. Patient did not. She drew blood from patient's left arm, no issues. After she was finished, patient said it was funny that she drew blood from that arm because she had had lymph nodes removed from it and her doctor had said that arm should NOT be used to draw blood! There was no indication on the patient's chart or on the door that the arm was restricted. Boyfriend's mother went to the patient's nurse and informed her of the missing information. Boyfriend's mother then got written-up for drawing blood from that arm, never mind that she couldn't have known otherwise, the patient never said anything and that the information wasn't posted. She got the write-up even after explaining this; what do you want to bet the nurse reported her first and added the information after-the-fact saying Boyfriend's mom was lying? Sadly, the Phlebotomists at her hospital get very little respect.

[Geek King]

In a case like this, I'd kill the nurse with caution. Everytime I saw a patient with that nurse's name attached, go to the nurse and "double check" as a precaution. Drive the nurse crazy with protocol.

[Sapphire Silk]

That really sucks. Patients who are not supposed to have venipuncture on a specific arm should have a notice posted in the room to remind phlebotomists. There is no way they can remember the restrictions on every single patient.

The patient should have said something when the tourniquet was applied.

And after 10 years, that arm can be used again for phlebotomy and blood pressures.

BF mom should appeal the write up, and file a grievance according to hospital policy. What happened was not her fault.

[trailerparkmedic]

Are there new nurses on the unit?

The big thing for brand new nurses in the fancy schmany hospitals in my town is to have them do an evidence based project in their first 4 or 6 months. Basically, they find a problem and review journal articles for solutions which are then presented to management and implemented on their unit. This sounds like an awesome problem for a new nurse to be clued in on if management will listen.

[DeltaSierra]

That really sucks. Patients who are not supposed to have venipuncture on a specific arm should have a notice posted in the room to remind phlebotomists. There is no way they can remember the restrictions on every single patient.

The patient should have said something when the tourniquet was applied.

And after 10 years, that arm can be used again for phlebotomy and blood pressures.

BF mom should appeal the write up, and file a grievance according to hospital policy. What happened was not her fault.

I agree she should appeal the write up. This is just so wrong!!!!!!!!!! At the hospital where I did my clinical last summer, there were little boards beside each bed that had restrictions on it for stuff like that. How can one get written up for something they don't know - do they expect the phlebotomists to go to the nurse for every single patient they have to draw blood from to find out if there is a restriction??

[laborcat]

Maybe it's just me, but doesn't the patient have a role in this mess? Patient was asked and should have said don't use the left arm... sheesh. They obviously knew.

Now... my question is, why can't she use that arm??? If you can keep it simple, great, if not, no biggie.

[Bright_Star]

Maybe it's just me, but doesn't the patient have a role in this mess? Patient was asked and should have said don't use the left arm... sheesh. They obviously knew.
Now... my question is, why can't she use that arm??? If you can keep it simple, great, if not, no biggie.

I was wondering the exact same thing.

[csquared]

The nurse needs to be written up on two accounts. Failing to post the notice and lying to cover up.

[Teskeria]

Too bad all the Phlebotomists can't go to the head (charge? or is that the wrong word) nurse on whichever ward the lying nurse is, every time they have to draw blood on that ward, and ask ' are all the blood drawing restrictions listed properly on the charts?' After a time or two, when the head nurse asks why everyone keeps asking her they can them respond ' Due to a certain nurse on your ward, not posting the restriction, then lying about it and writing it in after the Phlebotomist brought it to her attention because the patient mentioned it, causing one of our people to be written up for your nurse's error, we require the assurance of the head nurse on that employee's ward that they have things under control. We can no longer trust the nurses on your ward to be competent." Double bonus if other nurses are able to hear, because they will all be angry at the one that screwed up and lied.

[trailerparkmedic]

Maybe it's just me, but doesn't the patient have a role in this mess? Patient was asked and should have said don't use the left arm... sheesh. They obviously knew.

Now... my question is, why can't she use that arm??? If you can keep it simple, great, if not, no biggie.

Patients are sent surveys after their hospital stays. Patient satisfaction scores affect how much Medicare pays each hospital. If your score is too low, you don't get the full amount. Since Medicare makes up a large percentage of most hospitals' reimbursement, and since most hospitals are competing for patients, some hospitals now pretty much say "The patient is never wrong." The first presentation I got during orientation was on the hospital's customer service philosophy. The CEO spoke second. There are a few extenuating circumstances around the idea of getting patients to continue to come to my hospital in the next few years, but customer service is a very big push for most of the local hospitals.

Panacea can certainly explain the arm thing better than me (and probably correct me ) but if you don't have lymph nodes in an arm, you're at higher risk for infection. Needle sticks are a potential source of infection and you don't want to take any chances on these patients. In addition, lymph nodes help drain fluid from the arm and without them, fluid can build up. I seem to remember this affecting blood draws somehow but I don't know why. This risk of fluid buildup is why you don't do blood pressures on that arm or put any pressure on it (even carrying a purse on that side)--you don't want to make it any harder for the fluid to drain from the arm.

[laborcat]

Patients are sent surveys after their hospital stays. Patient satisfaction scores affect how much Medicare pays each hospital. If your score is too low, you don't get the full amount. Since Medicare makes up a large percentage of most hospitals' reimbursement

Oh crap... maybe I shouldn't have tossed that survey the hospital mailed me. Oops. Though they did call me a couple days after I was cut loose and I told them then about my excellent care. Now I feel bad. I didn't realize that it would be that important.