North Shore Hospital report - New Zealand Doctor

Health and Disability Commissioneranother room at 1.45pm, and it was not reconnected until about 5pm. Ms Woodadvised that disconnecting lines for toileting and showering, then reconnecting, ispoor practice because it increases the risk of infection.The DHB responded that a needleless intravenous system is used in all the clinicalareas, to allow disconnection. It is used where patients require intermittent infusion ofantibiotics, but not fluid replacement. Once an infusion has been administered, thenurse disconnects the line and places the end of the intravenous tubing into a sealedconnection. When reconnection is required, the rubber bung is swabbed with analcohol swab and the connection made through the bung. This is standard practicewhere a needleless system is used.Ms Wood advised that regardless of the intravenous system used to administer fluidsand drugs to a patient, there needs to be regular review of the practice and the productguidelines. Ms Wood stated that before reconnection the bung must be cleaned andswabbed and left for 60 seconds, but this is often not done, which exposes the patientto the risk of infection.The DHB also advised that some patients are moved a few times because ward roomsare set aside for patients who need to be isolated in accordance with infection control.When Mrs E was moved, staff should have been courteous and offered hertransportation. Bed moves are usually done by health care assistants, who are notqualified to re-establish intravenous lines. It appears that Mrs E was moved to adifferent room around changeover time, which is a busy time. This may haveaccounted for the disorganised move and delay in re-establishing her intravenousfluids. The DHB accepts that the delay in completing the administration of theintravenous fluids did not meet the expected standard of care. This has been discussedwith the staff involved.The DHB made enquiries about delays in Mrs E‘s call-bell being answered on theward. Patients sometimes think there is a long delay when a health care assistantanswers a bell and relays the request to the nurse, especially when there are 35patients to three registered nurses. Delays are not intentional, but registered nursesmust, in circumstances when the ward is busy, prioritise their workload according toneed.Mrs E was concerned because the laboratory technician taking her blood reported thatthe absence of patient identification stickers on request forms was not unusual. TheDHB commented that it is possible that Mrs E had her identification bracelet removedwhen her intravenous luer was re-sited on 18 October. It also stated that the commentmade by the laboratory technician relating to the apparent lack of patientidentification stickers was inappropriate and unprofessional. The wards hold foldersthat contain a quantity of patient identification labels. When the labels run out, as theydo occasionally, staff ask the ward clerk to order a fresh set. The laboratory technicianshould have brought this matter to the attention of the ward staff.Mrs E is certain that no identification bracelet was removed because of the luer ―asthere never was one there‖.54April 2009