Help me cope with sharps

[Kaisu]

I have hit a stupid snag in my paramedic career. I am brand new in the field and I have had 3 incidents in the last month where I have improperly disposed of my sharps. There are many reasons for this but obviously it is something I need to fix RIGHT NOW. I am looking for any tips, suggestions,etc that will help me remember to ALWAYS properly dispose of the sharp. Anything you can contribute will be much appreciated.

[JakeEMTP]

Kaisu, All I can say is dispose of them immediately after using them. Have a sharps container handy to you. In the Wheeled Coach ambulances we use, there is a sharps container at the front of the bench seat close to the side door. I dispose of them immediately after I have used a sharp. Also, there is a small sharps container in the bag we carry on calls. The same principal applies. As soon I use a sharp, it is immediately disposed of.

You just need to teach yourself this is part of the job. Use it, dispose of it. You'll get the hang of it, I have faith in you. :wink:

[Dustdevil]

Find the root cause. Was this a shortcoming in your education? After all, this is something that is established early in a quality education. Did you learn it, but are forgetting it in the heat of the moment? Or are you forgetting on routine runs too? Are you actually forgetting, or is there simply no convenient way to dispose of them immediately, then you're forgetting later on?

First, if your service does not provide a sharps container easily accessible in their ALS bags, your service sucks.

The first step is to make getting the sharps container out and ready part of your IV set-up routine. It should be laid out at the same time you are tearing tape and getting your alcohol preps out. Sit down with a pen and paper and start writing out, step by step, your IV procedure in a numbered list. Do it over and over for the next hour. Do it again when you get to work. If you forget again, sit down for two hours and write it over and over, just like the teachers in grade school made you do for talking during class. Punish yourself before someone else does it for you.

If the containers are there, and you're just forgetting, then this is really a simple fix for any intelligent adult. If you have to take a big piece of white 2 inch tape and mark the compartment of the bag that has the sharps container in it, do it. If you need to put a piece of tape on the back of your hand to remind you, that works too. If you need to be written up, well I'm sure that will be coming soon.

I don't see how anyone can forget. I mean, you have this thing in your hand, and your first thought is always going to be, "I need to get rid of this". Use that moment to answer your own question, and get rid of it properly. Don't leave it to come back to later, because I suspect that is where your system is breaking down. Finish EVERY step before moving on to the next one.

[vs-eh?]

Define "improperly disposed of my sharps".

Closely followed by "There are many reasons for this but..."

80-90% of the IV's that I start are on scene or in a stationary vehicle.

Honestly the 10-20% of IV's that I start that don't fit into the above are "optional" or "difficult".

That being said the IV's I use are safety sharps and relatively difficult to poke yourself with.

[Kaisu]

Root cause - in the area and system where I was trained, EVERYONE used retractable needles. After threading the catheter, there was a button that you pressed and the needle retracted and it was impossible to stick anyone with it. In class, the instructor retracted one and had us press it against each other - no way to get a stick. Disposal of sharps was part of the curriculum for national registries, but in those practicals, the damn container was right under your nose. You had to be stupid to not drop it in. So for root cause - that is it. My error occurred after 14 calls in 24 hours with less than 3 hours of sleep. That's when training kicks in cause the conscious brain is struggling. Good suggestions from you both. That is exactly what I will do. The people I am running with are convinced that the fact that I did not run as a basic is what gives me this trouble. They don't understand that there are different ways of doing things. I am going to go with the writing things out a million times, putting a piece of tape on the back of my hand and thinking of the sharp as a loaded gun. I do need to beat this thing and fast and I am very grateful for your responses.

[Dustdevil]

I forgot all about the retractable needle thing. I've not worked anywhere that they were the standard. Some ended up in my bag in Iraq, and first time I pulled one out to use it, I was like, "WTF is this??"

So you're saying this employer does not use the retractable needles? I thought that was pretty much the standard everywhere on civilian streets these days.

[Kaisu]

The employer does NOT use the retractables... This is Arizona Dust - I have no 12 lead, no CPAP, the only med for pain is morphine (if my patient is allergic then he/she is sool) - no drugs for N and V, the cheapest possible catheters, and supervisors think they are being generous because they will allow me to use a portable sharps shuttle to help lick this sharps problem. I am the only one that uses a NS lock, both paramedics and EMTs are convinced that because I did not run a year as a basic that I cannot possibly be ready for the field... the list goes on and on... Its a tough gig and a big adjustment for me.

[Kaisu]

Define "improperly disposed of my sharps".

Closely followed by "There are many reasons for this but...".

12th call on a 24 hour shift - 3 hours of sleep - call came in 20 minutes before shift change. Transfer nursing home patient with dementia and an extremely painful perianal abscess. 3 minute transport time. Got vitals, got an IV established with a lock for meds. Put the sharp down by the disposal container intending to get BGL off of it. and realized we were at the hospital. Patched, disconnected the patient, moved her to the hospital. Completely forgot about the sharp. My EMT partner found it and told me he was going to have to write me up. I told him that I understood, that I had f----d up and he had to do what he had to do. What he did was go into the supervisors office and rant - didn't trust me and was not going to run with me. If scheduled with me he would go home. Pretty harsh - supervisors told me they would help me with my problem but if I didnt get it under control I was gonna be canned....

Not the best day for me. I am going to do everything I can to get it under control. As mentioned in another response, I trained with the retractable ones. When I try to explain this to the supervisors, they tell me that it is all excuses and they are not buying it. I keep reiterating that I am not trying to evade responsibility but I have 0 credibility in this place - I am not from here, I am a female and I did not do it the way they did (Basic for a year). As I said, tough gig. Good thing I am a tough broad. :wink:

[reaper]

You will get it with time. You partner should know to look out for them when cleaning up! That is common sense.

Tell you sup. that this is 2008 in EMS, dump the jelco's and get saftey needles. I know smaller services are exempt from the mandate, but they should be looking out for saftey first! :roll:

[Eydawn]

When you go to draw bloods (aka the vacutainer bundle) take a moment before you attach the vacutainer tool and get a BGL strip on that nice venous access you just obtained. Stick strip in glucometer, then do vacutainer bloods.

That way, you can trash the needle immediately and get the BGL right away instead of waiting to use the needle as your blood source since they're not safe needles.

What my service uses is needles that pop a safety set of wings (for lack of a better term) over the poky end of the needle as soon as the cath comes off it. It's different, I also trained with the push button needles, but it seems to be working so far for me.

Wendy

CO EMT-B