Who Knows What Really Happens?

Hey You,

Hey, you behind the big wooden desk.  Do you really know what goes on at the patient’s bedside?

When I arrived at the emergency room and visited with the billing department at 6:00 in the morning while the patient was brought into the emergency room, I was greeted by two women who were of another culture.  In between my conversation with one of them doing the billing, they spoke their native language to each other.  It probably would not have affected the patient’s care, but were I the patient, it surely would make me feel uneasy as this is my first impression.

A small community hospital, I was glad to be with a patient using a facility that I would probably use for myself.  Though they don’t have all the trauma needs as a much larger hospital just a short distance away, the fact that it is small, staff are known to be “nice” and this wasn’t a trauma case, I was confident all would go well.  No suspense, it did go well but what I witnessed anyway was still unsettling.

I was asked to sign that I received an admission packet, advanced directives and about 10 items on the list.  When I questioned that we received none of that, the woman handed me a Patient’s Rights manual and explained that everything else on the list is only for Medicare patients.  I wrote “not received / for Medicare only” and signed the bottom information of the form.  It was my impression that the woman handing me the forms to sign may have never read what I was signing.

When I arrived at the patient’s bedside, the nurse treating the patient  was using the light on her phone to check the patient’s throat.  When I commented on this she smiled as she threw her long hair back behind her shoulders and then ran her hands through her hair.

The area between patients was very close.  I can hear what was happening next to us but until the curtain was pulled back could not see.  I do know that next to us was a patient who was preparing to leave.  When she did leave, the curtain was fully pulled back.  The nurse pulled off all the bedding, lifted a nearby bin with her hand and placed the bedding in there.  She then threw over the bed the clean sheets, tied them in the back put a folded blanket on the bed and put equipment out -probably for an IV.  She straightened the bed table and walked away to escort a new patient to another bed, also close by. 

The bed was not washed, the rails were not wiped and the tray table was not cleaned.

I then watched as another nurse pulled bedding off another bed, discarded it and went behind the curtain with another patient.  A pattern I soon realized was quit disheartening.

Still in plain view I watched the nurse go about her duties, never to wash her hands.   I noticed that two sinks on our side of  the room, one right next to me, were dry.   In the short time I was there, they were never used.  As the new patient finished changing into a gown, the same nurse put on gloves, opened the wrapper for the IV and tied off the woman’s arm but before she started the IV she lifted off an IV obviously left from the last patient, opened a bin (I assume this was the garbage) using her foot and hand and dropped it in.  Same gloves, she went back pulled the curtain open and started the IV.

When my patient was ready to leave and was to get a shot, the nurse explained that it will hurt for the day and gave him a shot in the arm that he needed to work with.  She said “I hope you’re not right handed, I should have asked”. She giggled and walked away.

These may not be life threatening conditions.  This may even sound minor, silly or not worth discussing, but it only takes a small amount of germs to cause an infection.  It only takes a small amount of carelessness to start bigger problems and it takes one person to set an example for others.  When one, two or three people in an emergency department let their guard down, we are in for bigger problems.  I'm not sure that the people who are in the corporate offices, make the policies, write the checks and go to the patient safety conferences even know how to start watching for this breach of conduct.   I’m not sure I would feel safe there, and now I don’t know where I would go.