Comments on Dr Rant: Oh how the government despises Nurses!

Sadly the point is being missed. The poor womans d...

2008-05-17T21:17:00.000+01:00

Sadly the point is being missed. The poor womans death should have been avoided, but nobody actually tried to kill her.The decision to deport her widower is calculated and is one of which I too am ashamed. Does anyone know if Politicains and NHS Managers are congenitaly incapable of shame, or do they go to some government centre to have neurosurgery so that the shame centre in the brain is ablated?

Thanks angry gasman - I'm always happy to listen a...

2008-05-12T12:38:00.000+01:00

Thanks angry gasman - I'm always happy to listen and learn.
And how could I have overlooked lidocaine (for arrythmias), that'll teach me for trying to be a smart arse ;o)

Angus - a very sensible policy, and one that has b...

2008-05-12T12:20:00.000+01:00

Angus - a very sensible policy, and one that has been brought in as a direct result of these dreadful tragedies. I don't do oncology but I suspect this is now standard practice, as the NHS can learn from mistakes.

However it would be even better to have a fail safe in the form of an incompatible connector too.

For something is catastrophic as IV local anaesthetic (ok, ok A+E CN
IV Bupivicaine), or intra-thecal vincristine, a belt and brace approach is justified IMHO.

A+E charge nurse - the difference between Prilocai...

2008-05-12T12:17:00.000+01:00

A+E charge nurse - the difference between Prilocaine and Bupivicaine is?

(clue, Bupivicaine is more cardiotoxic and has been linked to deaths in the US when used in Biers Blocks, Prilocaine is metabolised in the lungs and so even if there is cuff leakage the risk of systemic toxicity is low - but I suspect you knew than :-) ).

I quite often use small amounts of lignocaine IV as a pre-med to avoid propfol induced phlebitic pain. Lignocaine can also be used to treat resistant VF, although its not as good as that other "pro-arrythmic" anti-arrythmic drug Amioderone.

As Paracelsus said hundreds of years ago - "the dose makes the poison". Which I would adjust to "the dose and the route make the poison". Inadvertent IV local anaesthetic is potentially dangerous, giving the right dose of the right agent can be therapeutic.

Anyone who deliberately gives bupivicaine IV deserves to be shot. Accidental delivery can and should be avoided by sensible design of delivery devices.

angry gasman - under our daughter's leukaemia trea...

2008-05-12T12:13:00.000+01:00

angry gasman - under our daughter's leukaemia treatment protocol vincristine asn't allowed in the same room when she receives her introthecal methotrexate.

Apologies-when I first read it the way it was phra...

2008-05-12T06:01:00.000+01:00

Apologies-when I first read it the way it was phrased appeared to me to look like she put it into the arm because that's where she thought it went-I didn't realise it was done in error. I feel so bad for the family but also what a nightmare for that poor midwife. You would never get over something like that, it being a systems error or not.

angry gasman - we give local anaesthesia intraveno...

2008-05-11T23:01:00.000+01:00

angry gasman - we give local anaesthesia intravenously every week: Prilocaine for Biers block.

It wasn't that long ago that hospitals finally got round to locking away potassium amps - how many times did they get mixed up with a saline flush ?
Remember Phil Hammonds anecdote in Trust me I'm a doctor.

Spot on with the post Dr Rant team. It really is a...

2008-05-11T20:33:00.000+01:00

Spot on with the post Dr Rant team. It really is a nightmare for nurses on the wards in some areas (by that I mean staff Nurses and Sisters/Charge Nurses, though I am aware that alot of the discussion of Nursing within this-admittedly bloody brilliant-blog centres around the "quacktitioner" discussion.

Having been on a night shift where I had 16 patients under my care overnight (this is normal by the way), the large problem Nurses face is that often, we have so many patients within one location needing our attention with input that can be time consuming. For example, changing an incontinant patient, running a prescribed IV antibiotic, seeing to a patient with shortness of breath, checking morphine for an end of life care patient is normal to be met within a few minutes.

Nurses to not want sympathy, I knew when I became a Nurse this is what my job would entail. I also know that doctors are equally as busy (I had a patient who we had to sedate while the FY2 had a person who was in the same state on the other ward and another who had an early warning score of 6!). What would be better would be a better salary (I would say £25000 starting and at least £3000 rise every year). This sounds a lot, but to give people the incentive to a) join up and b) stay within the profession is a big thing.
Employing more Staff Nurses so that the end result is a close enough to 6:1 patient:Nurse ratio. It would give hospital patient more time, closer observation and raise the standard of bedside care.

More Doctors: Yep, I am a Nurse, a very good nurse. However, I am not trained in diagnostics, nor am I a prescriber of medication. More doctors would help the patient as well.

More bursary and university places for students so there are pleantly of future generations of Nurses.

Nurses are not lazy, they usually are too overworked to spend quality time with everyone! If only the government would listen!

Dr Jane Doe - you do realise you neatly proved my ...

2008-05-11T11:01:00.000+01:00

Dr Jane Doe - you do realise you neatly proved my point with your annecdotes?

I assume you are a well trained, competent doctor who would never normally dream of infusing local anaesthetic intravenously? I have no reason to believe that the midwife in question here was also well aware that local anaesthetic infusions are best given via the route prescribed.

What happened, or at least what I surmise happened, was a cognitive lapse where the midwife confused the epidural bag for an IV bag - its easy enough to do, they look similar. As you say yourself, its easy enough to do with the plastic vials of lignocaine/lidocaine.

One solution, that we use in my hospital, is to have epidural infusions in different containers from IV fluids - so it is harder to confuse the two. Even so this is not as good as incompatible connectors.

Its the same as intra-thecal vincristine - a mistake which has happened far too many times. One can check and recheck, but the best way yo prevent this would be to have dedicated syringes for vincristine which will only attach to an IV, and ones for methotrexate which will only attach to a spinal needle.

The solution is simple, if a little expenseive. What price patient safety?

The problem is that the midwife would have mistake...

2008-05-11T02:02:00.000+01:00

The problem is that the midwife would have mistaken the epidural stuff for the iv stuff. It is a mistake one would only make rarely, but of course it happens from time to time.

As gasman says this is a very simply problem to fix. It has been known about for decades, and the only solution has been proposed (by doctors) for decades: change the connectors so that it is not possible to connect the wrong bag to the wrong catheter.

However, this costs money. Not a lot of money, but enough that the Suits don't want to pay for it.

It is simply cheaper to pay compensation to the odd stiff's family and have the odd unlucky nurse or doctor taken out and shot.

The market at work!

Feck it, gasman, I dunno. I'd say maybe it does ne...

2008-05-11T01:16:00.000+01:00

Feck it, gasman, I dunno. I'd say maybe it does need a little more training for midwives really. I have a lot of respect for the profession and by this I'm not intending to malign them as a group or anything, but how could someone whose entire training revolves around birth and pregnancy come out of that much training thinking epidurals go into the arm? I would think that this definitely needs to be examined further, not from a punitive, adversarial point of view like "no-one" would undoubtedly suggest, but from a "how did this happen? how can we prevent this?" point of view. And training of midwives might have to be reviewed to ensure that the vital information is being imparted, understood and put into practice. I feel so bad for that family-and the midwife, who undoubtedly will never get over this either. And overwork, stress and tiredness may have been influencing factors too-performance deteriorates with all of the above as everyone (except no-one) knows. But that level of knowledge is just-unbelievable. It's like that kid that got the wrong intrathecal chemo and died-that was scary stuff.
You do have a point about separating equipment and supplies though. Once, when I was an intern, I saw a colleague fill up an IV flush-with lignocaine! Very very stupidly the little 10ml vials of normal saline, water for injections and lignocaine were kept in three little identical buckets side by side. The lignocaine had a bright yellow label while the others were blue, and green respectively. A vial of ligno had obviously fallen on the floor or something and someone had just picked it up and tossed it into a bucket-the normal saline bucket. I grabbed it and showed it to him and he almost fainted. Then we moved the ligno bucket to the other side of the room and told the ward sister why. But actually, I've seen similar things happen a couple of times in other places too-I found a lignocaine vial not that long ago on the IV trolley-and where I work now they are not even a different colour to the saline ones! The ligno here is kept behind a shelf in the drug cupboard, but someone was obviously doing a procedure and just put the extra one on the trolley instead of back where it belongs. This is really scary stuff but easily preventable.

The error was catastrophically stupid - but utterl...

2008-05-10T23:27:00.000+01:00

The error was catastrophically stupid - but utterly preventable. It does not need more training for midwives, or double checks of infusion bags (both of which occur) but the simple addition of non-compatible connectors for epidural and IV infusions.

Why do we not have these? Simple -they would be more expensive than the current universal connectors. Presumably someone, somewhere thinks this cost is greater than the worth of the life of this unfortunate woman.

I'm really amazed that ANYONE could think an EPIDU...

2008-05-10T06:24:00.000+01:00

I'm really amazed that ANYONE could think an EPIDURAL goes into an arm???????
My 12 year old cousin watches a lot of tv, and she knows what an epidural is. And where was the anaesthetics person? Do midwives GIVE epidurals?? I-I-
speechless.......
I think I'm going to go have a TAH and BSO.

"No, doctors stopped being in charge years ago." ...

2008-05-09T19:54:00.000+01:00

"No, doctors stopped being in charge years ago." I am afraid I might have to agree with you slightly on that, but as a profession you still command significant clout.

I don't understand why doctors don't form more chambers, compete to run NHS trusts or open hospitals where they can control the pathway and the medical environment. If done correctly should translate into better care for your patients and a better quality of life for you.

Is my 'bad apple' theory of medical errors any dif...

2008-05-09T19:49:00.000+01:00

Is my 'bad apple' theory of medical errors any different than yours with regard to Politicians, Managers, Pharma Co's, NICE.......? Well its a very long list but I am sure you get the idea.

troll

"The inmates are running the asylum.............."...

2008-05-09T19:29:00.001+01:00

"The inmates are running the asylum.............."

No, doctors stopped being in charge years ago.

Thatcher, I think you will find, changed all of that.

20 minutes post-to-troll time.Not bad, No-One. I ...

2008-05-09T19:29:00.000+01:00

20 minutes post-to-troll time.

Not bad, No-One.

I see you subscribe to the 'bad apple' theory of medical errors: that people die from medical errors because the staff are inherently 'bad' or 'lazy'.

This is a popular right wing view, because it allows narcistic cunts who don't want to pay for a service to simply have a few serfs executed when funding cuts have the predictable, lethal, effects.

If I was a Utilitarian thinker I would have you, and all who think like you, killed on the grounds that you pose such a risk to the rest of the population.

As a Cantian, I await your next brilliant insight into medicine with baited yawns.

So the reason a patient was killed by NHS "profess...

2008-05-09T19:09:00.000+01:00

So the reason a patient was killed by NHS "professionals" and the family was deported is the patient and taxpayer? Seems to me if you idiots would take the time to do your job correctly and not kill people they would still be here. Do you self medicate? I bet you do.

The inmates are running the asylum..............