Lessons Learned (3-16-2008)

Wow, what a day today was. Wasn’t it just last week I was journaling about having patients who don’t need my help?  The day began with focusing on ambulating my patient, who no matter how much encouragement I gave refused to get out of bed. She quite proudly informed me with a big smile on her face that she was having a lazy day, and was too tired to even get dressed. This made completing my interventions a little difficult, so I was invited to observe a catheter change on another patient. The procedure went smoothly until the new catheter was inserted and the patient had nearly 900 ccs of urine fill the bag within minutes. The urine was not only high in volume; it was thick, white-ish in color, and opaque. It was assumed that his previous catheter had been clogged and a call was put in to his doctor to inquire if a urine sample would be needed.  The same patient needed both a bed bath and dressing changes as well, (and my patient was now napping) so I stayed to help the other students with bathing and observe the wounds. As we gathered supplies and begun the patients bath I noticed that we had correctly pulled his curtains for privacy but his window blinds were still open. I wondered to myself if we should close the blinds for privacy, but I dismissed the thought and we continued with the task at hand. Only a few minutes later the aid came in to check on our progress and immediately scolded us for leaving the blinds open stating that if someone saw it, she would be in trouble. We closed them promptly. I should have paid attention to my instincts and closed them earlier.

 

“Ideas pull the trigger, but instinct loads the gun.” ~Don Marquis

During the wound change I noticed that one of the students assisting was brushing up against the catheter bag repeatedly as she went back and forth to retrieve the supplies. It occurred to me then that she might be pulling on the catheter tubing. Not wanting to disrupt the flow of the procedure I waited until she was not busy to say something. I didn’t want to seem accusatory but I wanted to make her aware of her proximity to the equipment so I asked her to check on his output level. She reported that it was fine and I felt I had addressed the situation by bringing it to her attention tactfully. Only a few minutes later while positioning the patient the catheter was disconnected and fell on the floor at her feet. Urine began to flow out of the tubing and on to the patient and our instructor. The wound care nurse quickly clamped off the catheter until we could finish changing his dressings and reinsert a new sterile one. My inaction may have contributed to a situation which caused the patient to undergo invasive procedures which would not otherwise have been necessary. I should have been more assertive and voiced my concern to the other student clearly rather than subtly. My concern should have been focused on the patients well being over the students feelings.

 

 

Happiness hates the timid! So does science!” –Eugene O’Neill

 During the reinsertion of the second catheter the student was preparing to deflate the balloon. She was unsure of which port to use and asked if she had the correct one, someone said yes and only a moment later she attached the syringe and proceeded to draw up 10 ccs of urine. I had known from the beginning that she was using the wrong port. When she chose that one and another student agreed with her, I questioned my judgment and said nothing to the contrary. I should have had confidence in my knowledge, spoken up and told her what I knew, rather than stand by and watch her perform a procedure incorrectly.

 As it turned out the ensuing events were complicated further by the clamped tubing which then became occluded. If we hadn’t been able to fix the problem a physician would have had to be called and the patient would have been put through even more unnecessary procedures. All of this was likely preventable and I certainly learned some important lessons about trusting my instincts and not being afraid to speak up.  

 

 “A great deal of talent is lost to the world for want of a little courage. Every day sends to their graves obscure men whose timidity prevented them from making a first effort.”

~Sydney Smith

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