iluvpink
Pearl Clutcher
Posts: 4,291
Location: Michigan
Jul 13, 2014 12:40:31 GMT
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Post by iluvpink on May 11, 2021 15:48:26 GMT
DD is 21 and has rheumatoid arthritis along with other health issues. She's doing very well now, but still gets a monthly infusion medication for her arthritis. She sees a rheumatologist at a University hospital. They have their own pharmacy that sends out the medications/supplies and arranges the nurses that they send out to our house monthly.
Her infusion for this month was set for yesterday. At the end of last week they called and said they would no longer be sending out their own nurses but are contracting them out from different home nurse agencies from around the state. They gave me the name and number of the new company, told me they are experienced with home infusions, the medications etc. Someone from that company called me a day or so later and told me that Suzy would be out on Monday afternoon as scheduled. Great.
Suzy gets here yesterday and is going through the supplies that the pharmacy sent and they had not sent enough of a couple of the items. So she could not do the infusion yesterday. She called the pharmacy who said they would send a courier that evening to send the rest of the items. Meanwhile she would come back this morning to do the infusion. The items did arrive last night.
This morning a totally different nurse shows up and she seems to have no clue what she is doing (and no social skills either). Since dd is 21 and I am working from home, I was upstairs working. I came downstairs a few minutes after she arrived to see it's a different nurse. One who seemed to think she was infusing antibiotics. Dd told her no, it's an infusion med for RA. She was totally confused on how to mix it up. She was reading the orders and seemed so confused. So I called her company and told them she didn't seem to know what she was doing. They said they would call her. I'm upstairs trying to work and dd is freaking out. I called back again as they never called her. They asked to speak to her and explained things and she said she understood. I went back upstairs. DD then text me as the nurse still seems unsure of things. Back down I went. We had to tell her that she needed to take dd's temperature and blood pressure. She said she would do that while the infusion was happening. No it needs to be done before as if she has a fever, she can't get these meds. So she did that. I went back upstairs. DD later said she never washed her hands, didn't wipe down the vials or iv tubing connectors with alcohol swabs. FYI I don't know why dd didn't say anything, she's usually very good at self advocating, but she was kind of nervous working with a new nurse and her anxiety is up for a few other reasons. But then to top it all off the infusion is supposed take about a half hour. But this nurse ran it through at a different rate so it only took less than ten minutes.
I have called dd's doctor, the pharmacy that used to send out the nurses, but now contracts out and the new home health company to register my concerns. I just can't believe the incompetency.
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Post by craftedbys on May 11, 2021 16:01:03 GMT
Oh my goodness! I am so sorry for your DD. I totally understand being anxious or overwhelmed and not being an effective advocate for yourself. Has happened to me many times.
You are understandably pissed and have every right to be pissed. Quite frankly, I would let everyone know you are pissed and why.
I would start by calling back the office that sent her and raising all kinds of holy hell as well as calling the district or national office if they have one.
I would also contact the hospital and tell them what crappy service that agency gave you (also mention it to the agency that you will be reporting them to the hospital).
The whole situation is completely unprofessional and this is on instance that you need to be the squeaky wheel. Demand (or insist if you feel that is less Karen-like, LOL) that the agency never, ever send that newbie nurse to infuse your DD. She obviously needs more training.
I would also let her doctor know about the quick infusion to make sure that it won't cause any issues with her health.
Hope your daughter can rest and feel better after this stressful day. Know the Peas have your back and will hold your earrings if necessary.
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basketdiva
Pearl Clutcher
Posts: 3,619
Jun 26, 2014 11:45:09 GMT
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Post by basketdiva on May 11, 2021 16:47:38 GMT
I’m sorry that is happening to your daughter. Makes me glad I go to a rheumatology clinic with an infusion clinic for my drug. They are so efficient and professional as well as safety conscious.
I hope you get this taken care of quickly.
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Post by jenjie on May 11, 2021 16:57:44 GMT
What craftedbys said. That should never have happened.
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Post by Skellinton on May 11, 2021 17:04:13 GMT
I am sorry, what a horrible situation. I would follow up your phone calls with written letters. Be factual, be specific, and keep opinions and personal feelings out of it,
How scary that she thought she was giving different medications then she was actually supposed to be administering and didn’t want to follow the protocol of temperature check prior to administering.
I am not a nurse, but my family members are and I believe there is a nursing board that might need to be contacted as well, but I would hope nursing peas will chime in.
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Post by flanz on May 11, 2021 17:14:28 GMT
I am sorry, what a horrible situation. I would follow up your phone calls with written letters. Be factual, be specific, and keep opinions and personal feelings out of it, How scary that she thought she was giving different medications then she was actually supposed to be administering and didn’t want to follow the protocol of temperature check prior to administering. I am not a nurse, but my family members are and I believe there is a nursing board that might need to be contacted as well, but I would hope nursing peas will chime in. Excellent advice! I'm wondering if the person they sent over is an actual nurse too
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Post by littlemama on May 11, 2021 17:40:52 GMT
Yikes. My insurance will not allow me to get my infusions at the hospital's rapid treatment center anymore. They made me switch to home health, but were no help in finding one and neither was my doctor's office.
The one I found is only a mile or so from my house. The one thing I dont like is how much trouble my nurse seems to have getting the IV started - one memorable time it took 7 tries (at least some of this is due to my veins, but damn)
In your case I would have stopped the nurse and demanded someine who knew what they were doing. If the med is to be infused over 30 minutes, then that is how it should be done. Definitely not in 10 minutes.
Now that the ship has sailed, I would make a bunch of phone calls that would result in that nurse being banned from my home and someone competent being sent.
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Post by birukitty on May 12, 2021 17:10:56 GMT
I'm not a nurse nor have I ever worked in the medical field but my sister gets weekly infusion therapy at her home. I am so very sorry this happened to your daughter. It never should have happened!
So many things went wrong. If I were you I'd take the time to write out every single detail of what happened while it is fresh in your mind along with your daughter. List every single thing that the nurse did incorrectly. Then I'd write letters (a paper trail is better than a phone call) to everyone you can think of-the office that sent her, the district office and national office if there is one. Anyone and everyone involved. Your insurance company too. List each thing that was done incorrectly. Don't mention a thing about your daughter not advocating for herself-this isn't on her shoulders at all! The nurse not washing her hands these days during the pandemic-inexcusable! Same with not using the alcohol wipes! Who knows what damage was done with the 10 minute rate vs. 30 minute rate. Really sock it to 'em in the letter but stick to the facts-know what I mean?
I wish you the best of luck and mostly I wish your daughter continued health and no harm from this experience.
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Post by oliquig on May 12, 2021 17:13:47 GMT
Your local or state health department should have an area for issues with a nurse/doctor.
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peaname
Pearl Clutcher
Posts: 3,389
Aug 16, 2014 23:15:53 GMT
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Post by peaname on May 13, 2021 0:45:53 GMT
Not every vial and tube needs to cleaned with alcohol. If the vial is single use and has a sterile cap it can be punctured with a sterile needle or needless connector without cleaning. IV tubing comes in a sterile package and should not need wiping.
No excuse for the nurse not being familiar with the medication and requirements though. I’m sorry you experienced this. I hope you get an apology from the infusion company.
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Post by kandie on May 13, 2021 1:11:36 GMT
Not every vial and tube needs to cleaned with alcohol. If the vial is single use and has a sterile cap it can be punctured with a sterile needle or needless connector without cleaning. IV tubing comes in a sterile package and should not need wiping. No excuse for the nurse not being familiar with the medication and requirements though. I’m sorry you experienced this. I hope you get an apology from the infusion company. Actually, the evidence shows that nurses need to scrub the top of the vial with alcohol wipe even with sterile cap. Also need to scrub all needle hubs on the IV. This nurse sounds unqualified, very sorry this happened
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 1:21:49 GMT
As a home infusion mom too I am LIVID for you and your dd.
Did home health ever teach you to go through the supplies when they are delivered to make sure everything is in order?
I would ask that extras be sent just in case. Dd gets 2 extra tubing (needle set and flo rate tubing) and lots of extra IV3000, PrimaPore, Gauze, Box of gloves, etc.
I suggest contacting your state's depth of managed health to file a complaint.
You could also see about asking the state to force insurance/supplier/dr office to cover previous home health company with an out of network contract.
That is how we got dd's home health pharmacy. I have also had to do this for DD when TPN dependent and for medical formula.
Let me know if you need any help.
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Post by Zee on May 13, 2021 1:22:30 GMT
So obviously, this nurse was new to this type of infusion and probably took the job thinking she'd just be giving antibiotics all day.
The agency maybe didn't vet her knowledge very thoroughly, but I have never worked agency or home health so idk what's the norm.
What she SHOULD have done was call whoever is her supervisor and their pharmacy for instruction.
Just last night we had to give an IVIG infusion and while it's not hard, it's a lot more complicated than just hooking up an antibiotic. None of us had ever done it before (we're a cardiac floor, this patient was an overflow). So, we consulted with the Dr, the pharmacy, and looked it up online. We had a rate infusion table to follow.
Here's what I would do going forward: print off infusion information from the manufacturer website (most have a separate page for healthcare providers), run it by the doctor to make sure it matches what they've ordered, and keep it for all future RNs who come to your home. Make sure to instruct the nurses to use alcohol and gloves and follow handwashing, and to take vital signs as per your usual routine. Type it up step by step. Not everyone is automatically familiar with every medication just because they're a nurse--and you don't know what your don't know until you encounter it. So while they SHOULD know, it's best to have instructions prepared.
What she did wrong (besides being unhygienic) was to not acknowledge that this was new to her and that she needed help, and while she tried to follow the package, she should have gotten direction from someone experienced and from the manufacturer site. I hope she tells her agency that they need better training to cover all types of infusions they will be giving. I'm sure you will! They need to know what they're giving and why.
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 1:24:41 GMT
Not every vial and tube needs to cleaned with alcohol. If the vial is single use and has a sterile cap it can be punctured with a sterile needle or needless connector without cleaning. IV tubing comes in a sterile package and should not need wiping. No excuse for the nurse not being familiar with the medication and requirements though. I’m sorry you experienced this. I hope you get an apology from the infusion company. Dd's subcutaneous infusion tubing (26 Guage Hig-H-Flow 2 needles and flow rate tubing do not need to be cleaned (claves/male/female connections). Just the vile of IgG medication. Now ds' TPN lines had to be sterilized (claves/male/female connections).
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 1:28:02 GMT
So obviously, this nurse was new to this type of infusion and probably took the job thinking she'd just be giving antibiotics all day. The agency maybe didn't vet her knowledge very thoroughly, but I have never worked agency or home health so idk what's the norm. What she SHOULD have done was call whoever is her supervisor and their pharmacy for instruction. Just last night we had to give an IVIG infusion and while it's not hard, it's a lot more complicated than just hooking up an antibiotic. None of us had ever done it before (we're a cardiac floor, this patient was an overflow). So, we consulted with the Dr, the pharmacy, and looked it up online. We had a rate infusion table to follow. Here's what I would do going forward: print off infusion information from the manufacturer website (most have a separate page for healthcare providers), run it by the doctor to make sure it matches what they've ordered, and keep it for all future RNs who come to your home. Make sure to instruct the nurses to use alcohol and gloves and follow... And with that, make sure you have the packing slip, cross check everything is there in quantity stated, and then cross check with doctors/home health pharmacy orders and number of each item.
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 1:29:33 GMT
Also for both ds' TPN and dd's IgG subcutaneous infusions, we have to clean with Chlorahex. Ds's TPN also required sterile field and sterile gloves. I somewhat do a sterile field for dd but no sterile gloves. Just medical non latex.
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 1:36:45 GMT
iluvpink this is my set up for dd's subcutaneous IgG infusions. In the bottom under the sterilite containers is the packing slip. I keep it for that week and make notes of what was used and what extra I have and then what I need extra of for next delivery (gloves, Guage, prima pore, topical numbing med come in larger quantities).
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Deleted
Posts: 0
May 18, 2024 21:31:46 GMT
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Post by Deleted on May 13, 2021 9:27:05 GMT
That is a very worrying situation.
When nurses were doing home visits for husband’ s health problem some nurses were very good and we had faith in them ,others shocked me, it was as if they had no training at all and made some serious mistakes.
You need to keep a close eye on this and make sure someone else is in the room as well to witness the next one and future ones , especially if you get different nurses each time.
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Post by mikklynn on May 13, 2021 11:15:25 GMT
That is awful. We had wonderful home nurses for DH. I hope you have better luck going forward.
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uksue
Pearl Clutcher
Posts: 2,500
Location: London
Jun 25, 2014 22:33:20 GMT
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Post by uksue on May 13, 2021 14:30:36 GMT
My daughter has just started infusions for MS. There has been a dreadful catalogue of errors so far with her diagnosis and treatment and I hated the fact I couldn’t go with her last week (due to covid)for her first infusion and check everything was done correctly ( I’m a retired registered nurse). The problem is once you lose confidence in their competency it’s almost impossible to get it back .
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The Birdhouse Lady
Drama Llama
Moose. It's what's for dinner.
Posts: 7,175
Location: Alaska -The Last Frontier
Jun 30, 2014 17:15:19 GMT
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Post by The Birdhouse Lady on May 13, 2021 18:36:59 GMT
I'm wondering if the person they sent over is an actual nurse too I was wondering that exact thing myself. FWIW I would totally be pissed too. I *may* have not even let her do the infusion if I felt she was that imcompetent.
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pridemom
Pearl Clutcher
Posts: 2,843
Jul 12, 2014 21:58:10 GMT
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Post by pridemom on May 13, 2021 19:19:50 GMT
I am angry for your daughter. As a Juvenile Arthritis family you are not alone in being forced to use home health for infusions. Call your insurance, the rheumatologist, the home health agency, and your state bureau of insurance to complain. You can also see if the manufacturer of the drug has an advocacy office. The Arthritis Foundation advocacy might have some information to help, too. 1-800-283-7800
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Post by Legacy Girl on May 13, 2021 21:33:00 GMT
Hindsight is 20/20, but if this type of situation arises again, I would tell the incompetent nurse that we would not be needing her services and dismiss her before the infusion takes place. Anyone who is that incapable and induces that kind of anxiety for your daughter needs to be gone and the agency needs to send someone competent in her place ASAP. I'm sorry for your experiences.
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Post by tkdmom on May 13, 2021 22:02:35 GMT
I am sorry you had to experience this. This is what I would do (and have done for my patients and family members) 1. Contact the agency, ask to speak to the director of Nursing. In the conversation state everything that happened: a. Nurse did not know anything about the medication she was being given b. Phone call to agency by you and their response and lack of response c. Second phone call. Nurse said she understood d. Not following protocol to do vitals prior until you insisted. Failure to scrub the hub for thirty seconds e. Running the infusion over ten minutes instead of 30 minutes. Ask that this nurse never be sent again as you have lost faith in her ability. Ask that an RN's experienced in giving this medication be sent. Inform them if this happens again you will make a complaint to CMS and the State Department of Public Health regarding their agency. Follow this up with a written complaint referencing the phone call. You may want to send it with a return receipt so they can not deny they have received this. Send a copy of the letter to your insurance company, physician, the pharmacy.
You can also contact the State's insurance omsbuden for assistance.
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iluvpink
Pearl Clutcher
Posts: 4,291
Location: Michigan
Jul 13, 2014 12:40:31 GMT
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Post by iluvpink on May 14, 2021 14:48:42 GMT
Quick update (copied from my FB page).
Well I was unclear about something. They do still use HomeMed nurses, but all along they have also contracted out to other companies. And because of retirements and people quitting they are now extremely short on HomeMed nurses so are using the other ones more. HomeMed told me this is one of the better companies usually. 😱 But apparently this company called them even before I did to tell them what happened. HomeMed is probably going to send one of their nurses to train them better on infusion medication etc. And Lia will never have this particular nurse again. HomeMed said that in a couple of months they hope to be better staffed so we might be able to get one of their nurses again. They both apologized profusely. Unfortunately Lia did get a really bad headache after. She usually does somewhat but this was even worse. But she was able to work through it as it was a work night. She drank a lot of Gatorade and some Tylenol and got better as the evening went on.
Adding here, she's been having the infusions for about five years, the first year at the Univ of MI children's hospital and they were fabulous. When insurance said she had to get them at home, I was upset but it turned out great. HomeMed nurses are U of M nurses and they are wonderful. Very professional. DD has had two regulars and a few substitutes. We've never had any problems whatsoever. Very sanitary, never any issues not knowing what to do etc. In and out, friendly etc. So I've never paid much attention to the supplies and methods they use as they did exactly what the nurses did in the hopsital and clearly knew way more than I did about the process. Hopefully we can get them back soon but in the meantime I will be on everyone about making sure we do not get that nurse again and that anyone sent follows procedures.
She was an RN according to her name tag/id.
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huskergal
Pearl Clutcher
Posts: 3,002
Jun 25, 2014 20:22:13 GMT
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Post by huskergal on May 14, 2021 16:05:51 GMT
My daughter has just started infusions for MS. There has been a dreadful catalogue of errors so far with her diagnosis and treatment and I hated the fact I couldn’t go with her last week (due to covid)for her first infusion and check everything was done correctly ( I’m a retired registered nurse). The problem is once you lose confidence in their competency it’s almost impossible to get it back . What medication is she on? Where does she get it done? My daughter has been getting them for almost 6 years now. She goes to the Med Center where her doctor is located. She has had great nurses and awful nurses. Dh or I used to go with her. Now she goes alone since she has never had a reaction to the meds. It is frustrating to say the least.
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pridemom
Pearl Clutcher
Posts: 2,843
Jul 12, 2014 21:58:10 GMT
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Post by pridemom on May 14, 2021 16:36:16 GMT
Quick update (copied from my FB page). Well I was unclear about something. They do still use HomeMed nurses, but all along they have also contracted out to other companies. And because of retirements and people quitting they are now extremely short on HomeMed nurses so are using the other ones more. HomeMed told me this is one of the better companies usually. 😱 But apparently this company called them even before I did to tell them what happened. HomeMed is probably going to send one of their nurses to train them better on infusion medication etc. And Lia will never have this particular nurse again. HomeMed said that in a couple of months they hope to be better staffed so we might be able to get one of their nurses again. They both apologized profusely. Unfortunately Lia did get a really bad headache after. She usually does somewhat but this was even worse. But she was able to work through it as it was a work night. She drank a lot of Gatorade and some Tylenol and got better as the evening went on. Adding here, she's been having the infusions for about five years, the first year at the Univ of MI children's hospital and they were fabulous. When insurance said she had to get them at home, I was upset but it turned out great. HomeMed nurses are U of M nurses and they are wonderful. Very professional. DD has had two regulars and a few substitutes. We've never had any problems whatsoever. Very sanitary, never any issues not knowing what to do etc. In and out, friendly etc. So I've never paid much attention to the supplies and methods they use as they did exactly what the nurses did in the hopsital and clearly knew way more than I did about the process. Hopefully we can get them back soon but in the meantime I will be on everyone about making sure we do not get that nurse again and that anyone sent follows procedures. She was an RN according to her name tag/id. The rate of the infusion is very concerning because it increases the risk of anaphylactic reaction. My daughter’s Remicade infusion was to be done over four hours and an inexperienced nurse gave it over an hour. I about lost my 💩. Sure enough, her tongue started tingling after she got home and we had to take her in for steroids by IV.
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