Do I complain or not?

[kitkatz]

Last Friday I had a problem holding onto one of my sites after the tech pulled needles.  They did not have any sure seals available.  My arterial went crazy on me and would not settle down under the pressure I had on it.  The tech said: Put pressure eon it.  Well, no
shit Sherlock, I was putting pressure on it.  I have been doing this for eight years so far! And the tech left me sitting in my own blood and i had to ask twice for her to clean it up.  My questions are:
    Do I complain about the unit not having any sure seals?
    Do I complain because the tech left me sitting in a pool of blood on the chuck underneath me for fifteen minutes and did not change it until I had asked her twice and my sister walked in and saw it? Would she like to be left sitting in blood for a while?
     Also it is so damned cold in the unit I am freezing all of the time, even my sister, who is never cold, says it is cold in the unit, do I complain?  I already have a thick blanket.    
     Am I just being picky?  Will it help to tell the upper echelon in the unit how I feel about it?
     After eight years at this same unit, I feel I may be listened to more than other patients due to me surviving all of the changes we have been through in companies and in staff.   I just want the care I pay for and deserve.
   

[livecam]

Difficult question.  If you complain then you become known as a whiner and somebody is going to be offended.  On the other hand you have some very valid complaints.  Being made to sit in a pool of blood is not cool.  Is the temperature in the unit being set for the comfort of the patients or for the staff?  The unit might have run out of sure seals but it is really their responsibility to keep on top of supply needs.  I usually let things stew for a while and if I think the problem merits a complaint then to hell with what other people think, I'll let them know just how I feel.

[Joe Paul]

I would speak up and tell them whats on your mind. As far as it being cold, ask the Doctor if they can bump the machine up .5, it helps me lots. 

[NY2FL]

I agree, you need to pick your battles, but lack of supplies and neglect are not minor issues.
You have to ask all the questions, and allow your staff to reply. Nothing whiney about wanting
answers. You should never be concerned about repercussions or being labelled a "troublemaker."
If this is an issue for you, there SHOULD be a grievance procedure available and a way to
state a written complaint anonymously, though I believe that open complaints to the proper
people is always the way to go. Let's face it, some people make an issue of everything, but
you know when a complaint is ligit if you've been around as long as you have, kitkatz.
Just state your situation, and ask for answers. If your negligent tech was handling a crashing
patient, and the shipment of sureseals was delayed, just chalk it up to a rough day.  However,
 you are absolutely entitled to an explanation for what happened to you .

As far as the cold issue, have you inquired about setting the MACHINE temperature
higher? I had that problem at my last unit, and tried everything and could not get warm.
When I had exhausted my options and was consistently miserable throughout treatment,
I asked about the machine temperature. My unit physician initially refused, saying that increasing
the temp would contribute to dropping blood pressures.  Knowing that this actually WAS an
option, offered to me at a unit once before, I persisted.  I discussed this option with other
patients, and they began requesting it as well. Obviously, there is just so much that they can
increase the machine temp, but I found a big difference in my comfort level when they raised
it only 1 to 2 degrees.

I agree with livecam. Think about the issue and you will know if it is a valid complaint. 
Always assume that your staff WANTS to address patient issues.
If patients have complaints, and fail to raise the issue, how can staff respond?

Good Luck
Carol

[angieskidney]

Being made to sit in your own blood to me sounds like neglect and reminds me of hospitals when a patient is made to sit in their own urine because no nurse would come bring this lady her bed pan (she couldn't walk).

I know nurses are busy but sometimes it feels like they are punishing us. Like "you didn't hold it tight enough so now you have to sit in it" type of mentality. Sorry if I am being synical but that is the mood I am in since yesterday.

I would complain but here in my city I can go to the renal social worker and she brings it to the right people. That way names can be left out and you don't get labled as a whiner.

I don't think the temp would be adjusted however. I have learned at least in my unit that it is set for staff comfort.

When I have went to staff to complain about certain things that really upset me (I hardly complain) I found they protect each other and don't take the patients seriously at all and basically just shrug it off or get defensive or protective.

[JerseyGirl]

I would at least talk to the head nurse.  There is no reason a tech couldn't have come over and changed the bloody chux.  That is a given.  You've been at that center 8 years now, and this is a valid complaint.  It could have been a new tech that isn't aware of what should have been done.  If you don't tell management and they are not made aware of the situation, they can't do anything about it.  Again, I feel this is a valid complaint.  As an ex-clinic manager I'd like to have taken this on.  It is merely good practice and this should be brought up generically in staff meeting.

[DeLana]

Yes, I think you have legitimate complaints.  The tech should have replaced the chux or at least added another one (or more) so all the blood was covered, for various reasons but especially patient comfort.

Sure Seal bandages - they may no longer stock them.  The clinic I worked in used to always have them and we didn't appreciate how great they were until they took them away.  Why?  To save a few pennies (no more than 10-15 cents per bandage).  And for that you got:  unhappy patients (more bleeding, longer wait times), unhappy staff, and more usage of chux and other materials.  Some savings!  However, I think if enough patients complain they might well consider bringing them back.  And your clinic may have just run out... which management might not be aware of.

Unit temperature - oh, what a common complaint.  And no, it's not kept like a freezer for staff comfort - many of us were just as miserable as the patients.  It's for certain staff comfort - usually those who are closest to the thermostat... again, complaints can be very effective.

As pp has mentioned, it is often most effective to involve the social worker to either bring this up with the FA for you or with you as they act as a patient liaison; however, it is certainly not necessary.  You have a lot of credibility based on your seniority there and I'm sure others look to you as a leader.  No doubt, these are also complaints that many others would like to make!

Good luck!

DeLana 

[JerseyGirl]

Regarding Sure-Seals, aren't they the stops that had to be removed two hours after application?  In all fairness I remember they were still on the accesses two days later when the patients came back in and that caused a wave of access infections not to mention if you didn't take them off within the recommended two hour time frame they sort of "grew" into the clot and could cause maximum bleeding when you took them off.  Sometimes it is not all cost, but patient safety.  Believe me, I am NOT towing the corporate line but from my experience it was a safety/infection control issue, as well as cost.

[DeLana]

Regarding Sure-Seals, aren't they the stops that had to be removed two hours after application?  In all fairness I remember they were still on the accesses two days later when the patients came back in and that caused a wave of access infections not to mention if you didn't take them off within the recommended two hour time frame they sort of "grew" into the clot and could cause maximum bleeding when you took them off.  Sometimes it is not all cost, but patient safety.  Believe me, I am NOT towing the corporate line but from my experience it was a safety/infection control issue, as well as cost.

That sounds like Tip-Stops, which have a thick white gel-like substance in the middle that works like a dream for the heaviest bleeding; we rarely used them and (probably for that reason) never had a problem with them; need I add they also stopped buying them?

Sure Seals are like a regular bandage with a thin layer of absorbent material; they work for all but the heaviest bleeding (and are better than a regular bandage anytime) and can be removed whenever the patients chooses to; even if they left them in place (a common problem with nursing homes), it never caused a problem for us.

When I asked the FA specifically about this I was told that it was a $$ issue - they couldn't justify spending 15 cents or so on a bandage - and it was a corporate decision, out of her hands.

DeLana 

[Hawkeye]

When I asked the FA specifically about this I was told that it was a $$ issue - they couldn't justify spending 15 cents or so on a bandage - and it was a corporate decision, out of her hands.

DeLana 

The reasons for not having them in the clinic is due to overall cost.  If I was able to reach my monthly supply budget, or get below it I would be allowed to order them.  Save a Penny Spend a Penny, it all comes down to that almighty dollar.  You can however purchase your own and use them.

Fixed Quote - Rerun - Moderator

[kitkatz]

Now why in the hell should I buy my own bandages!!!  I go every time to every treatment. I try to treat the staff with respect.  I am the patient. I am hardly in control of supplies for the dialysis center.  I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!

[JerseyGirl]

Tip-stops - yes they were the ones.  Thanks DeLana.

[DeLana]

Now why in the hell should I buy my own bandages!!!  I go every time to every treatment. I try to treat the staff with respect.  I am the patient. I am hardly in control of supplies for the dialysis center.  I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!

Amen. But I rest my case, I wasn't able to get through to my manager (I think she would have bought them if she could have - but total supply cost probably made that impossible, probably because they ended up spending so much more on other supplies:  gauze, gel foam, chux- which are much more expensive than Sure Seals  ).

DeLana

[Hawkeye]

Now why in the hell should I buy my own bandages!!!  I go every time to every treatment. I try to treat the staff with respect.  I am the patient. I am hardly in control of supplies for the dialysis center.  I feel the dialysis center should provide what the patient needs in order to have a treatment that is proper and complete, down the the tiniest bandage and the biggest dialysis machine!

I agree with you completely.  Unfortunately that's not how it works.  In my case both the staff and the patients are to blame for our out of control supply costs.  More so the staff, but myself and several other staff have caught patients walking up to the supply carts and grabbing entire boxes of supplies and putting them in their bags as they leave after their treatment.  I'm sure the staff probably take things with them too on top of what they just throw away.  We are going back to the pack system (supplies packaged for each treatment) to reign in the problems with theft and waste.  Then all that will be on the carts are the packs that they need for that shift, and a few extra gauze and what not in case of an emergency or a bad bleeder.

[kitkatz]

See the I hate dialysis thread to see the letter and and response I got at the unit under general discussion.

[Panda_9]

Leaving you sitting in blood isnt very nice, but if theres no bandaids then just use gauze and tape. I dont see a need to complain about no bandaids, unless it is a continual problem. Nothing wrong with just using gauze and tape.

[RichardMEL]

Hmm not sure about sure seals... we use these circle things - tape around the outside and a bit of gause or something in the "dot" to cover the access pointand seal it. They then tape a wad of gaude over it with instructions to take them off the next morning before a shower or so. These work pretty well and only once have I had bleeding and they had to pull it off go again. Think we were just a bit too eager to get me off in time. Now I know how long i take to stop bleeding and time it

[kitkatz]

I am sitting longer and longer to stop the bleeding.  I also am starting to bleed through on the sure seals.  The needles go in awkward places on the graft and it is hard to get to it to hold it.  They have solved the Sure Seal problem.  I just have to ask the supervisor to get me a supply and she will.  She said there was no reason they should have been out of sure seals for two weeks.  They just could not get in to her office to get them.  Seems it was her fault.  Oh well. 

My letter worked wonders.  The nurses are telling me what they have for me before they give me meds.  The place is slowly warming up after turn over time.  The chairs are uncomfortable, but oh well.

[nkviking75]

In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.  Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems.  Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary.  For me, bleeding is generally not a problem.

[angieskidney]

In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.  Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems.  Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary.  For me, bleeding is generally not a problem.

Heparin.

[nkviking75]

In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.  Maybe they need to use less blood thinning medication (the name of which is escaping me right now) if you're having bleeding problems.  Our unit will also apply something called Caltostat to the wound to stop bleeding if necessary.  For me, bleeding is generally not a problem.

Heparin.

That's it.  Thanks.  Don't know why I couldn't remember it.

[Hawkeye]

In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.

When I first started at my clinic we had these clamps.  Our Medical Director told us to stop using them because he was afraid the pressure created by them was damaging the patient's sites.

[angieskidney]

In our unit, they place plastic clamps on our arms and use tape to make sure the clamp stays on the wounds.

When I first started at my clinic we had these clamps.  Our Medical Director told us to stop using them because he was afraid the pressure created by them was damaging the patient's sites.

Ya ours is going to get rid of them too. But you want to know my opinion? Well for me the clamps aren't very tight since my arms are so small. The real culprit are the nurses! They wrap tape around the arm so tight that I KNOW that must NOT be good for the fistula.

So I got these black velcro bands that another patient made and that way I can loosen it when out of the nurses sight.

If I just relied on the clamps I bleed all over. I know this is different with anyone with bigger arms but for me I know that the tape is much tighter than the clamps .. so wouldn't that be more of a worry for any dialysis unit for the longetivity of the fistula??

[kitkatz]

My vascular surgeon said NO CLAMPS, NO TAPE all the way around the arm ever.  I have had good results following his directives.

[Panda_9]

My surgeon also said nothing tight around the fistula EVER, and as most know, no BP on that arm, no blood tests no nothing. He doesnt even like the idea of fitted tops that you roll/push up for dialysis. He told me to get a loose shirt, cut up the sleeve and sew some buttons in the sleeve so you can just undo it for dialysis. Pfft theres no way Im doing that to all my tops. I just wear tops that if rolled up arent tight.