Needlesticks

shandyside

Has anyone had a nurse that reported a needlestick but then refused treatment? If so, what did you do? Is it enough to simply do the blood screens for Hepatitis and HIV on the patient that she was treating when she received the needlestick and note that she refused any further treatment? Obviously, the small needlestick itself does not need any treatment, it's the possibility of an exposure that's at question. Any advice would be appreciated.

Rockie

Under OSHA guidelines, the employee has to submit to testing. However, they can refuse to take the treatment. Some treatments (AZT) have very bad side effects and sometimes the employee, if they feel fairly confident that there is no issue or the patient is tested negative, will elect not to have treatment.

However, patients can refuse to have their blood tested which would complicate the matter greatly.


OSHA and Workers Compensation are notified when there is a needle stick.

Hope this helps.

System

All needlesticks are OSHA reportable incidents. Report the incident to your workers comp carrier and the case manager will handle it. The employee has a right to privacy but the employer will be held liable for the medicals.

Very carefully document how the needlestick occurred. Note whether or not the employee laid the needle down on a tray and reached for it, or whether or not there was a combative patient. All of those details are important. Well, this is not what you asked for - just a bonus I guess.

dchr9203

I've required that the nurse sign an attestation that he/she is aware of the treatment recommendation and with full knowledge, voluntarily refuses the recommended treatment. Then promptly filed it in the work comp file. You cannot force anyone to accept any treatment, but you can CYA yourself/company.

shandyside

Thanks for your help. For some reason I thought the RN had to give consent to have her blood drawn, but I guess OSHA requires it so that's how we'll handle it. Again, thanks --

Don D

The RN can still refuse. You're not going to strap her down, are you?

shandyside

I don't know -- the Federal Register reads: "The exposed employee's blood shall be collected as soon as feasible and tested after consent is obtained". So, if they refuse to consent does that mean their job is in jeopardy or what?? Kind of interesting.

Rockie

In our OSHA training classes (mandatory) where we also go over bloodborne pathogens and other "nasties", it is made perfectly clear what the procedures are in the case of a needlestick. It is also clear what will happen if they refuse to cooperate.

It's pretty difficult to get a needle stick if proper procedures are followed (ex. using a needleless system, etc and proper disposal of used syringes). Human nature being what it is though, it does happen occasionally. We've never had an employee give us a hard time about submitting to a blood test. (And never had to strap one down yet!)

safety

Do you have a D & A testing policy? This would be considered an accident in my environment and testing would occur. It sounds like this RN may be worried about you finding something, just a thought.

Don D

If I'm not mistaken, drug/alcohol tests are not considered medical procedures; whereas further testing for things like AIDS is and that's where the difference comes in. You cannot require a medical procedure but can require a urinalysis for the presence of drugs. Even those businesses which REQUIRE testing for pricks (no comments from the peanut gallery) have a clause like "upon consent". I don't mean to imply that any nurse would refuse a test if needle-stuck; but, who knows.

dchr9203

I don't read that the nurse refused to submit to the blood withdrawal, but from further treatment for HIV/Hep exposure. Treatment can be painful and does have adverse side affects (nausea, migraines, etc.) Again, the nurse may refuse the treatment; just CYA your company by having her sign that she refused the treatment.

shandyside

Nope, the nurse actually refused to have her blood drawn for the initial testing, not follow up treatment. I believe she just didn't want to take the time and hassle since she felt the patient was a low risk and it was a minor stick. But I've never had it happen before.

dchr9203

never had one refuse to give blood before either. Don't think you can force her to do that either. I would still just have her sign a document that says she refused and move on. Needle sticks are common place and nurses are aware of the risks. If she wants to take the risk of non-test & non-treatment, that's her choice.