I need advice re making a complaint against a member of A&E staff

[KidneySchmidney]

So I got admitted to hospital for the second time in a week with MRSA that has come categorically from a cannula in my arm placed in A&E.

It's been swabbed and found to grow it so it's definitely that.

The cannula was inserted by a medical student who reinserted it 4 times, 3 x in my left arm and 1 in my right. It was placed on a table and fell off onto the floor, whilst they reapplied the tourniquet on my right arm and then reinserted.

I don't want them to lose their job or get into trouble but that's really bad technique and they need more training.

Please can someone advise me what to do?

Reinserting cannulas: totally wrong. Picking a dropped cannula up off the floor and using it: also totally wrong. Should go without saying. Suggest you approach PALS or the medical school direct if you know which one it is.

Infections from poor cannulation technique can be deadly. This student needs to appreciate that this is very poor practice and puts patients at risk.

(I'm a doctor. I'd go absolutely nuts if I saw one of our students doing what you describe).

Oops, just seen your other post. You're still in hospital :(

PALS is the most appropriate response if you are looking to identify the root cause with aim of learning to be identified and training implemented.
If you are not satisfied with their response you can escalate to Ombudsmen so you will still have recourse.
FWIW - I had Jr Doc have at least 8 agonising attempts through scar tissue at a lumbar puncture before getting consult anaesthetist in who did it on attempt 2 with no pain. My back was agony and looked like a pin cushion...and they lost the 4 samples they took... but they handled my informal complaint fabulously!

I am so sorry this happened. When you feel really ill you are not always going to know what is happening but if you have evidence the infection came from the canula I would certainly complain. Sorry, no idea what the procedure is, but the hospital may be able to help you do it.

Where I work cannulas can and are reinserted more than once while attempting to insert same.
As others have said MRSA is present on healthy skin.It only becomes a problem if it enters the skin.
When found there is always an investigation.
You can certainly complain about poor practice and lack of supervision.
However you cannot say with certainty it came from the cannula.

Send a letter to PALS detailing as much as possible. It does not matter if they were a student or not. It will be in your records. When making a complaint, they will look at the medical records and compare what you say to the notes. The more details you give the better. In my experience, our hospital has made changes following our letters and we have had meetings with staff to discuss more serious issues.

Don't be hard on yourself about not saying anything at the time. Due to my children's health complications, I have spent a lot of time in hospitals and know how things go, but still miss things. You were ill and you trusted your doctors. Just write a letter and hopefully, it will help someone else.

@callmybabybalonz would you like to see the cannula in my arm? The bruise it left behind? I can PM you the details of the hospital I'm at if you'd like you can ask for the medical student and check they exist?

Or I could pm you my name and you can call the hospital and check I'm
On the ward and in the bed I say I am?

I used to work for PALS/complaint dept until recently. They will look into this for you no problem. If you contact any other department they will direct it to PALS.

Im a senior clinician on a ward and i dont let medical students anywhere near me.

OP this sounds awful - you must complain - not through PALS but i would do it directly to the Trust.

Ah, ok OP. Then he'll be attached to a medical school nearby. As pp says there should be a clinical supervisor and educational supervisor he reports to - not necessarily attached to A&E. He definitely needs feedback and more discussion if he carried on without seeking assistance (or felt unable to) as it could be even more serious at FY1 when he may be left to look after a ward.

The PALS team should be able to either provide you with their details or arrange for your concerns to be passed to the right people. Ask to be kept updated and request feedback / a response.

@HappyGirl86 that is not true.

PALS do not always reroute complaints.

If i wanted a complaint to be dealt with thoroughly i would make a complaint through contacting the Trust directly .

Thank you. I will speak to the infection control nurse tomorrow as pp suggested they already might be looking into stuff anyway. I'm sorry if I've come to the wrong place for advice. I'm so bruised and sore and frustrated that I'm in a room with the door shut.

I'll be speaking to PALS when I'm
Out. Do I have to wait?

You can ask to speak to someone while you're still an in-patient.

@iklboo thank you I'll ask in the morning.

Sorry for focusing on the MRSA I guess it was just a giant shock. I think it's mainly the incorrect technique I want to focus on.

I can't believe that even a student wouldn't know that you don't re-insert a cannula?

This was the last attempt on my arm before they managed to get it in. It bloody killed! I know cannulas are hard to do. But I feel like it was attempt after attempt after attempt. A HCA walked in as he was taking the syringes of blood as he didn't have the containers for it or the vacuet to get it out and shouted at him for all the blood. It literally was everywhere, I think I'll have to bin my jeans as it was all over the thigh, over my stomach, down my leg on the chair and on the floor.

Cannulas are not hard to do and nobody should be taking 5 attempts. It’s not fair on the patient.

A dropped cannula should be binned immediately. I don’t reuse them after missed attempts either but I know some people do if they have been kept sterile - I’m not sure how you can keep one sterile if it’s been in through the skin once however.

After 3 attempts the student should have requested assistance from someone more senior, or used an ultrasound to find where the veins were hiding. Blood all over the place is poor preparation but happens sometimes.

Cannulas are not hard to do and nobody should be taking 5 attempts

on a septic patient? that's a very sweeping statement given that you don't know the state of her veins. I've taken five attempts and successfully got a cannula in, as the third person who had tried and probably the last option before a central line I was pretty pleased with myself.

After 3 attempts the student should have requested assistance from someone more senior,

yes, in an ideal world. But if you read about the recent Dr. Bawa-Garba case, you'll see that senior cover often isn't available.

What kind of trust re-inserts a cannula? That’s awful practice. Fresh cannula for each attempt at insertion. However, cleaning the skin is not needed, I tend to as it brings the vein up though. Although, if he was using a vacutainer, I’m a bit confused how it was reused? Surely once you’ve pulled the needle out of the cannula to safety catch activated and covered the end of the needle?

BigBaboon my DD1 had meningitis when she was 3 (14 years ago now) and we had similar experiences with cannulas. She also cried every time they gave her the intravenous antibiotics because she said it stung her as it went up her arm (I thing she obviously didn't like the sensation of the difference in temperatures). She was also in hospital a few times in her early years with what turned out to be asthma, and there were similar experiences then with cannulas.

I think some people are just more skilled than others at inserting them (and doctors have to learn by direct experience) and it's horrible to see it done unsuccessfully to a child. Every experience of this that I had the person trying to insert it was changed after a couple of failed attempts, to someone more senior. A big part of this is also that some are more skilled at putting the child at ease than others. Once when they tried to change DD's cannula the two paed nurses and the doctor just couldn't do it. She was frightened and upset and jumped out of bed and tried to hide, and then became sweaty and tachycardic as the failed attempts and attempts to pin her down continued (sorry about the spelling there) and they said they'd have to anaesthatise her. But then a lovely Sister came in who knew exactly how to handle a 3 year old frightened child and she managed to calm her down change the cannula no problem.

She was left with a needle phobia and routine vaccinations were a real issue for a few years. But the GP was lovely and we'd be given Emla cream to numb the area. But anyway, after a few years she was well over it now and no lasting effects.

I didn't complain. I realise that people need to learn and the Sister had loads more experience than the two young nurses and the doctor.

Obviously this is a different issue to the one raised by the OP, which is infection.

I''m a med student (made an account so I could post!).

I'd contact PALS as they will be able to contact his supervisor.
Even as a final year I only have 2-3 attempts at a cannula. I usually draw the line at 1 (if they have rubbish veins) or 2 as they are not a pin cushion, they're a person! New cannula for every attempt. I've seen doctors re-insert cannulas but I think students in particular should follow rules to the letter as if you don't do it now when will you?

Cannulas can be very very tricky though if you are unwell or have rubbish veins. But his behaviour needs to be flagged up for his sake and patients.

@Steeley113 he did have a vacutainer or a vacuet. He got it in and then panicked, asked me hold it, ran off to get 3 20ml syringes took the blood with those (inc cultures and vbg) then realised he didn't have an octopus so used the one from Vbg.

As he finished a CSW came in and bollocked him for not getting someone else and for using a fabric tourniquet