JCAHO apparently requires that the doctors show nurses results of all hemoccult testing. I can’t find the actual requirement anywhere, but then again, JCAHO hides its patient safety requirements and makes anyone who wants to learn about patient safety purchase their books.
In addition, whomever interprets the test must take a certifying exam every year to show that they are able to properly interpret the color change on the hemoccult card. Kind of like taking a certifying exam each year to prove that you can determine when a traffic light turns from green to red, I suppose.
Apparently physicians are competent enough to manage a multi-trauma patient, intubate, insert chest tubes, and calculate the doses for vasoactive medications, but, on that same multi-trauma patient we lack the fundamental knowledge to determine whether a piece of paper impregnated with resin from the Guaiacum species of plant on a hemoccult card turns from white to blue. Did you also know that one of the other uses for the guaiacum species (pictured at right) is to create guaifenesin for cough syrup?
Don’t tell JCAHO that. Otherwise we’ll have to keep the cards under lock and key in case someone with a cough decides they want to chew on the cards instead of taking cough medicine. Patient safety, you know.
Oh, and then for patient safety reasons we have to log each and every test result not only on the patient’s chart, but also in a log book. No one ever says what the log book is for, and no one has ever used the log book other than to log results from the hemoccult testing that the doctors are unable to interpret — and to show JCAHO investigators that we are actually keeping the log book — but woe be to the nurse who took care of the patient where a hemoccult was done, but a result (including lot number of the card, a lot number on the bottle of developer, and respective expiration dates) was not logged. Major nursing demerits on you!
That was an interesting mind melt that had nothing to do with the actual post. Getting back on track …
During one recent shift, we had a run on abdominal pain patients — as in I was managing 7 patients all with some varied form of abdominal pain. Because I do a rectal exam on most patients with abdominal pain, we were going through a lot of stool guaiac cards. One nurse started giving me a hard time for doing too many rectal exams.
Then she did it.
She called me a “turd tickler.”
Them’s fighting words. So I hatched a plan.
I went into the break room, found some A1 Steak Sauce, and put a little on the edge of my gloved hand. Then I put some on the back of a hemoccult card. I walked into a room, asked the patient how she was doing, then came out of the room and handed card to nurse, telling her to make sure that she logged the results in our JCAHO-approved stool sample logging book . When she grabbed the card, she immediately felt the moisture, looked at her hand, gasped, dropped the card, and ran to the sink.
She watched me as I looked at my gloved hand, made a face, and rubbed my hand on my scrub bottoms. Then I took the glove off, grabbed the next chart, and walked into the room. I heard the nurse say “eeeeeewww” as I was walking away.
She was pale and had this disgusted look on her face when I walked out of the room several minutes later.
“Was that last sample heme positive or heme negative?”
“Uuuuuuggh. That’s disgusting. Why would you do that?”
“Do what?” I asked innocently.
“You know what.”
“Oh this?” I asked, rubbing my fingers on my scrubs and raising them to my nose. “Hmmmmm. Smells like … like … steak sauce.”
Then I smiled, did a little circle in the air with my index finger, and went to see the next patient.
Ahhhh, the fun you can have with condiments.