Pureflow Pak don't fit

[Speedy1wrc]

Please call it in. Unless they hear from patients, nothing will change because everything is fine.

[Maggie and Jeff]

I totality agree they need to hear from patients. 

When they called they told me if they could they would stop the shipment of these 3 paks I just got because I made the ones I already have usable.

I'll call them in just to see what they say....

I have 16 months worth of paks they expire in 15 months I don't need any more.

[Speedy1wrc]

I spoke to them today on another matter. I had a bag leak on the warmer and, well hopefully the cycler dries out. But apparently an internal email informed the techs that new PAK's are supposed to be shipping. They will be or have sent me one that is supposed to be good.

I did find out something else today too.if you are with DaVita there is a contact who deals with NxStage issues. My nurse called NxStage and tried to escalate this is got the same story we all have. She was annoyed so she called her management team and found out there was someone at DaVita she could have handle NxStage issues. So let your nurses know for any issues so it can go up the ladder and they can get a handle on what kinds of troubles patients are having. Let them get frustrated with NxStage.

[Maggie and Jeff]

Let us know if you really get one that fits.

Have you tried to fix one yet?

[obsidianom]

I just did one. I actually just opened up one end to expose the foam when it stood up and then pulled it straight up an out . I didnt have to expose the wiring at the end that way. I will try it out for use on Monday or possibly tomorrow  eve. to see if it works. Thanks for the visual as it made figuring it out easier.

[Simon Dog]

I asked phone support about this when I was calling on another issue.  The tech support person (Dan) told me that the foam insert is additional protection for the PAK in shipping, and that a supplier made it a bit too big.  He told me the foam is still in new PAKs, but that the dimensional problem has been corrected.

[Speedy1wrc]

That's pretty much the story. Depending on the particular tech you talk to will yield a similar story. I heard weeks ago that the problem was identified and no chubby PAK's were shipping. Meanwhile 10 bad PAK's later.I lost count how many Jeff had.

[obsidianom]

I am now using the Pak I took out the foam on . It seems to be working ok. It was pretty easy to slip out the foam . Then it fit well.

[Simon Dog]

you got to remember most of them live up north so they are a bit odd

Us Yankees think people from down south at a bit odd.

[Simon Dog]

you got to remember most of them live up north so they are a bit odd

Us Yankees think people from down south at a bit odd.

Coverups are common as are lies and lack of information.

A RN explained to me that medication errors are not recorded in your chart in the hospital - only the MDs orders of what you were supposed to get.  So, if you are given a dangerous drug by mistake - there is no record of it in the paperwork, and no legal requirement that the patient be told they were given a non-ordered medication, or incorrect dose, by mistake - basically a system of "automatic cover up" to keep plaintiff's counsel at bay.

[Hemodoc]

you got to remember most of them live up north so they are a bit odd

Us Yankees think people from down south at a bit odd.

Coverups are common as are lies and lack of information.

A RN explained to me that medication errors are not recorded in your chart in the hospital - only the MDs orders of what you were supposed to get.  So, if you are given a dangerous drug by mistake - there is no record of it in the paperwork, and no legal requirement that the patient be told they were given a non-ordered medication, or incorrect dose, by mistake - basically a system of "automatic cover up" to keep plaintiff's counsel at bay.

Well, with over 20 years in the medical field before I retired, you are supposed to record all adverse drug reactions including mistakes. That is the law. If it is not recorded, that is an actionable event and people can and have lost jobs and more.

That being said, I am under the belief that my father suffered an adverse drug reaction that was not recorded in his chart while being treated in the ER. He ended up in the ICU on a ventilator. I arrived 2 about 36 hours later from the other side of the country and when I reviewed the chart, I asked the nurse why he had dropped his blood pressure so dramatically in the ER. The nurse gave me an honest answer that when she took report from the ER, the nurse there stated they gave him an IV BP med. However, when my dad arrived on the floor at the ICU, she didn't find that drug recorded. I wasn't able to take it any further, but that is exactly what the nurse reported to my question.  Funny, I didn't see her again in the week I was there. My dad survived but never really recovered and died a year later at the age of 82.

All actions whether favorable or unfavorable are legally mandated items for the medical record. It is much easier to get fired and lose a medical license for fabricating medical records than for a patient dying. In fact, Paul Newman had a movie based on just that event. When he proved that the nurse changed the record at the doctors direction, they won the case. I hope American medicine is not slipping to the point where this type of fabrication is widespread, but that may just be wishful thinking.

[Simon Dog]

Well, with over 20 years in the medical field before I retired, you are supposed to record all adverse drug reactions including mistakes. That is the law. If it is not recorded, that is an actionable event and people can and have lost jobs and more

I live in Massachusetts.   A very experienced RN (who has worked in several of the big name Boston hospitals) I know tells me that if a nurse makes a med error, it is reported internally and may be recorded on a safety report (which by MA law is excluded from civil discovery) but is not entered into the patient's chart, and there is no requirement that the patient be notified.    She also told me that if an another drug is ordered to counteract the erroneously administered drug, that drug will be in the chart as it was an "ordered administration".

Are you saying that this is incorrect?

If I am in the hospital and given 120mg of a drug when the order is written for 12mg, will I be formally notified?   Will it be entered into my medical chart?  Will it be on any written record I can obtain from the hospital?   I have been told by those "in the trenches" executing, rather than writing, the orders that the answer is "no", although depending on the situation, the patient is sometimes told.

the nurse there stated they gave him an IV BP med. However, when my dad arrived on the floor at the ICU, she didn't find that drug recorded.

In the hospitals I am familiar with, that drug would be in the chart if it was ordered by an MD, even if the MD was mistaken in his/her choice of that drug, or ordered it for the wrong patient.  It would not be in the chart if administered as the result of a nursing error.  (record of "what is ordered" vs. "what is given")

[obsidianom]

I ALWAYS stay in the room when my wife has been hospitalized. I will not allow her to be left at the mercy of the system EVER. We always get a private room with an extra bed for me and I bunk in for the whole time (they even feed me). I do some of the nursing care myself to pay them back. WE have had aroound 6 hospitalizations in the past 10 years.  I have seen all kinds of potential MISTAKES that thankfully I caught before they injured or killed her. Its scary to see what I caught.
Examples: wrong medication doses, overflooding with fluids causing pulmanary edema to the point that if I werent sleeping in the room she would have died from choking on her own fluids (that was a very long night) ,  stopping a nurse by grabbing her hand when she tried to give a medication IV that was ordered IM and can severly injure or worse when given IV,  stopping a doctor who ordered a medicine that was contrindicated strongly with the meds my wife is on whe the idiot doctor never bothered to stop and look first at what she was taking (and said "well we would have taken care of any adverse reaction anyway"), constantly had to check every medication order as the doctors would leave out crucial meds or the nurses didnt check for the correct meds, and on and on it goes.
It shocked the hell out of me. I wont ever let her alone in the hospital.  I feel bad for patients who dont have someone there to watch out for them. Hospitals are VERY dangerous places.

[Hemodoc]

Well, with over 20 years in the medical field before I retired, you are supposed to record all adverse drug reactions including mistakes. That is the law. If it is not recorded, that is an actionable event and people can and have lost jobs and more

I live in Massachusetts.   A very experienced RN (who has worked in several of the big name Boston hospitals) I know tells me that if a nurse makes a med error, it is reported internally and may be recorded on a safety report (which by MA law is excluded from civil discovery) but is not entered into the patient's chart, and there is no requirement that the patient be notified.    She also told me that if an another drug is ordered to counteract the erroneously administered drug, that drug will be in the chart as it was an "ordered administration".

Are you saying that this is incorrect?

If I am in the hospital and given 120mg of a drug when the order is written for 12mg, will I be formally notified?   Will it be entered into my medical chart?  Will it be on any written record I can obtain from the hospital?   I have been told by those "in the trenches" executing, rather than writing, the orders that the answer is "no", although depending on the situation, the patient is sometimes told.

the nurse there stated they gave him an IV BP med. However, when my dad arrived on the floor at the ICU, she didn't find that drug recorded.

In the hospitals I am familiar with, that drug would be in the chart if it was ordered by an MD, even if the MD was mistaken in his/her choice of that drug, or ordered it for the wrong patient.  It would not be in the chart if administered as the result of a nursing error.  (record of "what is ordered" vs. "what is given")

I retired from practice in 2007. During my entire time in the medical field which started when I was 19 years old working as an orderly in the same hospital that my mother worked as an RN, I have never heard or seen anything as you are describing. If the hospital tries to hide something from discovery, it is first of all very unlikely it won't come out somewhere which compounds the degree of guilt not only of the providers but also of the entire system.

The medical record is a legal document where every single medication, procedure and observation MUST be recorded.

What is not subject to discovery is QA inquiries into adverse events. That is not documented in the chart, but the event itself is. In fact, medical errors are much more common than we would like and it is often not the adverse event itself that is at issue, but how the event was addressed. If you do enough procedures complications will occur. If you give enough medications, adverse events will occur. Providers that try to hide these events are subject to robust sanctions above and beyond litigation.  That is the easiest way to lose your medical license. So, QA proceedings are not discoverable but the adverse event is to be documented not only for good medical care to correct any complications, but yes, for the legal documentation that is open to discovery not only to the patients representatives, but to state and county and federal officials.

What you are describing I would hope is absolutely not true since that would end any semblance of oversight and transparency that medical records are supposed to represent. In fact, the nurses document when you come to the patient's room, any orders you give and, when they carried out those orders and how the patient reacts. That is why a single hospitalization can generate hundreds of pages of documentation. I have seen and documented medical errors, adverse events and the steps taken to correct these actions. That is the nature of practicing medicine literally in a fishbowl where all of our actions are open to 20-20 review which can be quite brutal for sure.

[Speedy1wrc]

I am curious what is entered into record. I was the victim of a screw up that could have been averted. I was trying to advocate for myself but was ignored. When the surgeon came in he knew exactly what was wrong and I was rushed into surgery. If it had been left to the ICU Dr and substitute nurse I would have died. Not my own exageratin, but that of the anesthisiologist who visited me a couple days later once I woke up. It was a nurse who did not follow written orders.

However when I spoke of the incident months and even years later, the staff looked at me like I was crazy and in a dismissive way. If I had to guess,I bet there is no record of the mistake. I wonder how the emergency surgery is written up.

[Zach]

That's pretty much the story. Depending on the particular tech you talk to will yield a similar story. I heard weeks ago that the problem was identified and no chubby PAK's were shipping. Meanwhile 10 bad PAK's later.I lost count how many Jeff had.

Have you mentioned these issues on the Home Dialyzors United (NxStage Users) FB page?
https://www.facebook.com/groups/nxstageusers/

[Maggie and Jeff]

That's pretty much the story. Depending on the particular tech you talk to will yield a similar story. I heard weeks ago that the problem was identified and no chubby PAK's were shipping. Meanwhile 10 bad PAK's later.I lost count how many Jeff had.

Have you mentioned these issues on the Home Dialyzors United (NxStage Users) FB page?
https://www.facebook.com/groups/nxstageusers/

I have not.

[obsidianom]

According to my contact way up in company , the PAK problem is over and all new shipments should be ok now.

[Speedy1wrc]

No they are not.

I was supposed to get on of the new PAK's last Monday. By Friday I hadn't received anything so I called. I think I caught them by surprise and after a little backpedalling they said they would send me two of the new good lot's to arrive today. Fail. I did get two PAK's but they are a very old lot number which were still the chubby PAK's. Lot# 40379004. I had received weeks ago PAK's with lot number 403791xx so these were certainly not new production units. I measured them to be sure and indeed they were too wide.

I called NxStage and was told that indeed new ones were shipping and the good lot's were from 40379136 and up. I looked and saw I had one of those in my stack, so I pulled it out and it is a chubby PAK. Internally they think 40379136 and up are good but they apparently aren't. I was told this would get escalated to a supervisor and I have two more PAK's coming on Monday.

[obsidianom]

No they are not.

I was supposed to get on of the new PAK's last Monday. By Friday I hadn't received anything so I called. I think I caught them by surprise and after a little backpedalling they said they would send me two of the new good lot's to arrive today. Fail. I did get two PAK's but they are a very old lot number which were still the chubby PAK's. Lot# 40379004. I had received weeks ago PAK's with lot number 403791xx so these were certainly not new production units. I measured them to be sure and indeed they were too wide.

I called NxStage and was told that indeed new ones were shipping and the good lot's were from 40379136 and up. I looked and saw I had one of those in my stack, so I pulled it out and it is a chubby PAK. Internally they think 40379136 and up are good but they apparently aren't. I was told this would get escalated to a supervisor and I have two more PAK's coming on Monday.

I think they have a picture of you at Nxstage and use it for dart practice. (this is a joke so dont get too excited) . You do seem to have more bad luck then most. Maybe its where you live? Arent you in Buffalo , former home of OJ Simpson? 
I just figured  it out, if you are in Buffalo.  NxStage is in Massachusets and of course this is the home of the Patriots. The Buffalo Bills are a long term foe of the Patriots   .  Maybe Tom brady is behind this . Or Bill Belichick.  "SPYGATE"
Sorry for the humor but I do like to laugh at things.

[Maggie and Jeff]

I expect it will be months before the paks being shipped fit in the pureflow.  That is what my experience tells me.

 

I'm cool with that. 

 

[Speedy1wrc]

Twenty years ago I would have defended what were MY Bills. Now they are someone else's Bills. I had season tickets for a long time but just couldn't justify spending that kind of or any money for that matter on such a bad team. I got tired of decades of rebuilding. I no longer hold my breath. As far as OJ goes, we aren't missing him. We are also very proud of our last place Sabres too. Cuz they're...rebuilding.

I'm sure they dread when I call, but that's OK. I'm keeping them honest. I'm not vulgar or mean when I call, but please one of these days get it right. And if you promise to and me a PAK on Monday, do it. If they were to simply say, you know what, we can't send you a good PAK till a particular day, so be it. But don't make a promise then break it. They've been promising me good PAK's for almost 4 weeks now.

[Maggie and Jeff]

I went to home depot to get the rubber part of a french door threshold.  All they had was 36" ones I asked about 72" one so I could put a solid piece in without a seam.  The guy called the supplier they said they would ship me one free .............. never came.....I wanted to buy it not get it free. 

[Speedy1wrc]

Apparently I set off something at NxStage. I've gotten several calls this morning about the supposed good PAK I got. They believe lot 34079136 is good but the one I got was the worst of the bunch. Almost 98 mm. They are issuing a call tag to get it. Oopsie!

[Speedy1wrc]

I got two more PAK's today. Without opening the boxes I know they will fit. Guess how I know? They are old PAK's, the lot numbers are from last year.

I had a clinic visit today and spoke with my nurse about this. All she could do is shake her head. She was getting the same responses I was. Gee, we're sorry, but we have identified the problem.... She was told however that the chubby PAK's will still work. Just shove them in the chassis and force them in. She laughed.