OFF TOPIC - the ladybug "lost" her mittens

Which is undoubtedly why there have been stricter standards of practice about this put in place. The handwashing thing is a big part of personnel orientation and regularly beaten into everybody now. Even in the staff bathrooms - huge signs all over reminding you about washing all the time. Regular courses you have to take on blood-borne pathogens, on HIPPA (privacy act), on contamination, etc.

A while back when I was doing my first medic clinical rotation at a local hospital, one of my partners was not very good about this. A firefighter doing the medic program - for the money - so to speak. Not a dumb guy, just kind of an idiot in personality at times. Anyhow - we were doing basic patient exams, interviews, assessments that term. One of the patients we were assigned (we'd just get a list of rooms/ beds to go and see) was in a single room - not a full quarantine - and as we did the interview it turned ou he had e-coli. This is extremely contagious by contact - not airborne. Anyhow - did the assessment, and my partner wanted to listen to something as well - which he did. First thing out of there I'm washing my hands, wiping down my stethoscope, etc. What do I see - my partner has trotted off down the hall to talk to his buddies - completely missing the handwashing stations all around. Not a happy guy when I yapped at him to go wash before he spends the next few days puking. His buddies were about to kick him for coming down to chit chat and not having washed up in particular after being with an e-coli patient.

ellice

Yes, there have been lots of actions taken. Unfortunately, it hasn't been successful everywhere. There was a major study out just a few months ago saying it was still a significant problem in far too many hospitals and one of the leading causes of nosocomial infections. I *completely* agree that it's essential, and that some hospitals have put very effective programs in place. Sadly, it's not universal yet by a long shot.

Best wishes, Ericka

Snipped for brevity

We have all of those same things here. The programme on Wed night was extremely interesting and did conclude that it would be best if the gel was placed in the room so the patient could see the doctor/nurse wash their hands.

Nonetheless, hidden cameras revealed over and over again, travesties concerning cleanliness. I have no reason to suppose your hospitals are not suffering from MRSA, C Difficile, and others, they would be unusual if so as the problem is just as bad in Europe.

The Netherlands was quoted as one of the better ones, they have tackled it by having no wards, only single rooms (we are nearly there) and by really teaching the dangers of improper hygiene to med students and nurses in training. They also drill patients that they should be demanding nursing staff wash their hands !

We are also moving here to advance to day surgery wherever possible (even with mastectomies) so that one spends the least possible amount of time in hospital - because it is a dangerous place to be!

I know that makes me sound stupid but I know from looking around at friends, it is so. I could cry because it didn't need to be this way if medical staff would have stayed with tried and true methods. Now I rather fear, the cat is out of the bag and it will not be easy to put it back in.

Speaking on behalf of millions of chronic pain patients ... they certainly have enough spine to deny *us* the pain pills we actually need.

I went to a lecture by a pain management specialist who pointed out that as little as 48 hours of untreated pain can cause structural changes in the central nervous system. He was not amused by doctors who refuse pain medication thinking that they're preventing addiction or building character.

No, in that case, if they had a spine they'd find a way to stand up to a system that creates trouble for docs who prescribe "too many" controlled drugs. Or some of them are just ignorant. Sadly, though, too many doctors who

Best wishes, Ericka

DBF's mother was supposed to be in a sterile room due to compromised immune system. It was a good thing he was there, because staff were constantly waltzing in without masks or clean gowns. Oh, yeah, they had just been in with the germy person in the next room, but they were only going in to check her blood pressure, were only going to be in there a second, no big deal. Yeah, they saw the sign on the door, they didn't think that meant them.

He had to sit at her door and enforce proper hygiene procedures because the staff seemed to think that the only time they needed to take protective measures was to protect THEMSELVES from what the patients might give THEM.

That is just bad. The local hospitals here have the quarantined rooms pretty well marked with closed doors and big signs on them with warnings, etc. If someone on staff sees some other person, or an aide, etc going in without doing the protective gear thing they would be stopped, reprimanded, and after a few of those incidents it's cause for dismissal. But I'm sure it happens.

ellice

Things do happen. A staggeringly high number of people now hire private nurses for their loved ones who are in the hospital, at least for the times they can be there, because there are just too many things that can happen. When my grandmother was in the hospital, we had someone with her around the clock, and there were quite a few near misses that could have been problematic if someone hadn't been there to speak up. I don't think that hospital staff are ill-intentioned by any means, but there are just so many opportunities for mistakes and sometimes staff are overburdened.

Best wishes, Ericka

Part of the problem may well be that the hospitals in small and/or rural areas aren't the same as those in or near big cities. I was shocked at the level of care in my local hospital, and this is a city of 150,000.

I believe that a major part of the difference between those I was used to in New York and the ones here is that the hospitals I was familiar with were all big, well staffed teaching hospitals, affiliated with major medical schools, and even there they had problems recruiting good nurses. Here they're privately owned and mostly use LPN's with perhaps one RN to oversee the entire floor. It seems that most of the advanced degree nurses have wisely gone into being Nurse Practitioners or Physicians Assistants and work in private offices.

Lucille

Well, yeah, DBF's mother was in a low-population area (as in they have the only mall for 100+ miles around).

But there's a hospital in big-city San Diego where nearly every patient came out with some hospital-acquired infection (staph, TB, etc.). It's in a low-income neighborhood, and apparently "those people" should be grateful they get any medical care at all. So what if the hospital kills them off? It went on continuously the 10 years I lived there, and last I heard, it was still going on.

Ericka Kammerer ,in rec.crafts.textiles.needleworkwrote: and entertained us with

Which reminds me of another thing said that was, always ask what medication you are about to take, be familiar with what has been prescribed to you. IOW - you're the boss of you and challenge everything if you know what's good for you ! That way, no harm will be done. The stats for wrong meds were scary.

It isn't always the size of the city that makes the difference. Sometimes it's whether or not they are affiliated with a university.

It's very sad, but true that often the most vulnerable people are victims. Fortunately, now more and more people are starting to be aware and are working towards a change. I hope that change actually comes in my lifetime.

Lucille

"Lucille" ,in rec.crafts.textiles.needleworkwrote: and entertained us with

Also the old attitude of the 'doctor is always right' has gone - a good thing to a large degree. I believe in having faith that your doctor is the best, but I know mine is not infallible. He himself has said that when a person has a condition such as migraine, you likely will know more about it than him because you read everything and look for everything written on the subject. He just couldn't do that so thoroughly with all conditions.

Absolutely. The protocol for meds now is you are supposed to check 3 times with the patient. There is something called the "6 Rights" of medication which are essentiatlly - patient, administration mode, time, drug, dose, route. And now you must check the patient's id when you go in the room, ask the patient verbally, check it again, check the med for name, etc. If doing narcotics especially in some hospitals they've gone to witnessing for id check. Honestly, sometimes it's easy to forget if it's a patient you know - you just forget to ask them. But, the drill now is walking into the room, asking them if they're Ms. X, check their wrist band, check the chart, check the meds, before you draw up or give the med.

There are a lot more controls now on the floors and in hospitals in general WRT pharmacies and how meds are dosed out. I was amazed a couple of years ago how this has become. All kindds of locked and computer locked cabinets

- some with little drawers for every separate bed on the floor that get stocked by the pharmacy, etc. Some places almost everything comes in sealed individual doses - including syringes (unless it's a med that must be drawn up just prior to administration). Nothing foolproof - but there seems to be a lot of things being done to try and get that way.

ellice

Or how the county/city money goes and what they have to spend on healthcare facilities or care to, and attitudes about them.

It costs less to hire a pca with a couple of lpns supervising than it does to have a staff of rn's and most of the RN'S didn't have much choice about whether they wanted to continue working in patient care or go into other lines of work (at least here in Alberta). LPN's have taken over the role many RN's used to play, with perhaps a couple of RN's supervising on the ward. And more PCA's are being used to provide direct patient care.

LPN's are generally very well trained and standards have been set for some time. They don't follow a standard curriculum, but certification is overseen pretty closely by their professional body. And I assure you that they cover handwashing technique, as well as the five rights of medication administration. It comes up in their clinical as well as their academic work.

PCA's (or HCA's) in Alberta vary. I don't think they had a professional body until recently (I could be wrong on that), and have had a standardized program of study for only a year or two, whatever its flaws. Until recently many care attendents were trained on the job, mostly in long term care institutions, and weren't really required to have any certification. Of course, if someone is trained 'on the job' there is no control over the skills that they learn, or don't learn. That is changing here, but it takes time. For those already working in health care, given the shortage of health care workers, many got equivalency in certification, which involves both clinical and knowledge assessment. In some cases it required partial or complete retraining. I'm more inclined to believe that they would have 'knowledge gaps' which might lead to improper technique in day to day practise. (The testing situation might be a bit different, of course.)

I'm not sure, on reflection, whether a PCA, or an LPN going for equivalency, will actually be flunked if they don't wash their hands during the clinical assessment. I'm inclined to believe the evaluator would note it, tell the applicant, and pass them if they did everything else right. I should ask about that.

So I know the training standards are going up, but I believe that is mostly established at the provincial level, so there is some variation across Canada. Dora

I'd have to ask my friends in the nursing program, but I'm pretty sure that in any clinical test not following BSI (body substance isolation) is an automatice fail. One of my friends is in the her 2nd semester of the RN program now (we took A&P together a couple of years ago) and she said that about half her lab/clinical class group failed for not following proper sterile techniques, etc. Couldn't do the sterile gloving drill. I know for a fact that in all the EMS (EMT basic thru paramedic) certification testing (national standards) that if you do not state/do BSI before touching anything in a test scenario - automatic failure. Similarly - in the tasks that require you to be gloved - aside from doing the BSI, you must have gloves on before doing that step which requires them (as in inserting an IV, or giving an injection, opening the sterile pack for an Endotracheal Tube).

People fail all the time by forgetting the BSI thing in their Basic exams. It is drilled into you all the time.

So, I'm pretty sure that for nurses it's the same as for us, that in doing registry practical exams you must follow the BSI and other gloving or handwashing protocols. There is for all these registry test stations a sheet that states all the tasks that must be done in order for the evaluator to check off, and then at least on ours - at the bottom - the automatic failure things. Such as failure to follow BSI, failure to glove prior to veni-puncture, allowing a patient to go unventilated for over 30 secs (on intubation tests - and I've had examiners sitting with a stopwatch).

Really? I'm surprised that there isn't a national standard as well. Here, for EMS types, you can register at the state level for basic, but all the paramedic (more advanced levels) are a national registry, with for EMS the stnadards - even if it's the state exam - are a federal standard. I think for other healthcare workers there is some national standard of minimums but states, their licensing boards can add to that - but not lessen.

Ellice

Not entirely. I've taken many a dressing-down from medical people in other groups for daring to think that I know more than the doctor. I'm sorry, but if I've been diagnosed by TWO specialists, I do not think it is the place of the PCP to unilaterally decree them wrong and substitute his own diagnosis (which does not even fit the symptoms).

But according to them, he's the doctor and he is right (even if every other doctor I've had says he's wrong).

Yep. A friend works in a hospital pharmacy, and every few hours, they send up a sealed container marked "Mary Jones, Room 201" containing everything she needs to take in the next couple hours, each dosage in an individual sealed wrap with her name and room number on it. If she's supposed to take her red pill at the same time as her green pill, they are packaged together to make sure that happens.

When they make their next delivery, the messenger is supposed to have meaningful dialogue with the head nurse for that floor if there are any pills left in the earlier containers. Sometimes there's a good reason, like she's allowed a pain pill every 2 hours but didn't ask for one. But it cuts down on "oops, I forgot!" and if someone did forget, that gets corrected pretty quickly.