Hospital negligence re pain management day of and after

teltech · December 2018

Hi, Just wanted to get opinions from group, I had a mastectomy with a LD flap for reconstruction on Nov 14th approx. 230 pm. Coming out of surgery – approx. 630 pm ish -I was in extreme pain and asked for something. They gave me an IV shot of fentanyl (pain med) around 715 pm. Then 400 mg Motrin (?!) at 921 pm. I again said I was in pain at maybe midnight and at 256 am I received an IV shot of dilaudid. Needless to say, none of these took away the pain but made it manageable. Somewhere between 4-5 am a phlebotomist came for a blood draw. Let me preface by saying, I have small veins. I always tell anyone who needs to know so they are aware they may need the smallest equipment. My IV had been put into the vein on my hand by my little finger by Attila the Hun. She was not very gentle when I was admitted , but it was working properly up to that point. He took his blood sample from near my thumb, then looked at the IV loop and said "I don't like the way that loop looks". He proceeds to "adjust" the loop on my hand causing me pain, - I said 'ow, ow". When the RN came at 6 am to give me an antibiotic and another shot of dilaudid, she could not push the fluid. She tried, then called another who also tried. I told them what the phlebotomist did. They pulled out the IV and it looked like the letter "Z" - that's how kinked it was!

Now for the best part. Over the next 5-6 hours, 8-9 people came to replace the IV. The 3rd and 4th persons did not poke me when they could not raise a vein, all others did try multiple times. VERY painful. I was courteous to each new person and allowed then to try as I knew this was necessary for me to get the pain relief. I was now hurting really badly AND they also were causing me a LOT of pain with each new poke, wiggle, wiggle, poke. Around 11 am the doctor (my physician sent her associate as she was unavailable) ordered a pill, discontinuing the IV order. While waiting for the pills, an anesthesiologist came in, put a line into my hand near my pointer finger ("ow, ow") and left. Then, we had to wait for the doc to re order the IV med because he had ordered the pill just before the anesthesiologist came. The RN finally comes and tries to push the dilaudid (117 pm) - no good, the line had infiltrated my vein (ow!) so I did not get the medication or the antibiotic. I was released later that day. Fast forward - my drain #4 became infected, I saw my plastic surgeon who prescribed an antibiotic (11/20). By 11/25 I was still in so much pain at that site, thinking something may be wrong with the placement as the other 3 did not hurt that way, I went to a different hospital ER. The nurse tried to put in an IV. Now my hand – the initial place where all previous people have been able to put one was "scarred" and could not be used. She tried 4 times and quit then called the doctor. Now comes the miraculous part. He came in with an ultrasound machine. ONE poke and he was in!!! Not much pain either! The ER doc said this was a known procedure due to many people having collapsed veins. To say I was shocked is an understatement. 8 (my sister who stayed with me says 9) people over 5-6 hours and no one thought to try this procedure? I asked numerous times if there was something else, someplace else they could put the IV.

My question is. Should the hospital offer amends of some sort? I had just had major surgery, was in extreme pain from 3 am to 3 pm ish because they finally gave me a pill at around 223pm and it took 20-30 min to kick in.
I think it borders on malpractice, certainly negligence. What are your opinions?

Veeder14 · December 2018

Teltech,

What a horrible experience, If it were me, I would write a letter to hospital administration explaining what occurred in detail and how you were harmed and suffered. Then I would contact your State Licensing and request an investigation. the hospital likely violated licensing standards as well as hospital policy. Obviously the doctor should have been called way sooner after the failed attempt to get the iv in properly instead of repeated attempts and ordering pills after major surgery. Ugh! In my experience the hospital owes you a formal apology. Not sure what other amends would be given but they need to not have this happen again to anyone.

DebAL · December 2018

teltech, wow. I'm so sorry you had that experience. Going through the mastectomy/ flap is stressful enough. Agree with Vedder in writing the letter. To be honest, I would also call and speak with someone in administration. Do this while the experience is still fresh in your mind. ( although hard to forget) Most larger hospitals have an IV team for patients that need ultrasound. (Also, We use lidocaine prior to starting IVs in our department so it's always worth asking. Our patients love it) I could not see from your signature if you need chemo. If so, I would definitely think you need a port. Again, I'm so sorry you went through this. Write your letter and make your voice heard by calling or going in. I hope you feel better each day and heal quickly.

dtad · December 2018

teltech...so sorry you had to go through this. It does say a lot about choosing the right facility and how care differs so much in every facility. I agree with the above posters about contacting the administration. I would also make sure you never go to that hospital again!

Wised · December 2018

All hospitals have a patient advocate that you can contact. Call and say you want to speak to the ombudsman. They will put you right through. I've had to do this before.. your state should also have an ombudsman if you are not satisfied with the hospital s response.

pingpong1953 · December 2018

Like DebAL said, some hospitals prenumb with lidocaine, and it works beautifully. You may want to suggest that in your letter.

DebAL · December 2018

I agree with all of you too. Pingpong, the reason we started using lidocaine stemmed from responses on patient satisfaction surveys. It doesnt happen over night but positive change can take place.

Teltech, let us know what you decided to do. I hope very much that your pain is minimal and that you are on the road to recovery and feeling better.

WC3 · December 2018

I have small veins that are notoriously hard to get. I can get them to come up if they let me run my hand under hot water but you would not believe how much pushback I get to this.

Good to know about the doppler US though.

teltech · December 2018

Thank you for responding. I did go to the hospital and spoke with the Patient Service Center. I explained what happened and asked what the usual procedure would be, other that saying "Im sorry that happened to you...". The woman said she would contact me. Still waiting.... Guess it depends on how much energy I can muster for that "fight" .

I appreciate all the sympathy/comments.....helps to know someone else also thinks it was a bit outrageous. I shall ask about topical lidocaine though the ultrasound is the way I shall insist on in future if the 1st person cannot get the job done.

Beatmon · December 2018

The hospital has to have a policy and accompanying procedure for hard sticks and nonexistent veins. I am wondering if your infection was due in part for not receiving postop antibiotic as ordered. You can ask what changes and/or education will be given to the staff that this won’t happen to the next person with small veins.

And I can promise you The Joint Commission would not approvenof such slow responses to your requests for pain management. Sorry you had such a bad experience

teltech · December 2018

Again, thank everyone for responses. Seems if I do not listen to my first/good brain, I shall reap the consequences. I went for PE scan with contrast on Wed 12/ 12. First nurse tried - 4 pokes none good insert. Then tech came to try SAME places nurse tried - OWW!. He caused an infiltration and lump. He tried to hide it from me but I saw and it did leave the back of my hand swollen. He then tried my elbow, twice- OWW! I said no more. Went for medi port implant on 12/17. Doc indicated he would put one tube in my chest and one in my neck (?). As my previous port (1999) did not go into my neck, I was...curious..as to why this one would. He said "it was easier for the ultrasound machine to find that vein". As I say, I am not a medical professional, I said ok - medical progress ??. Prior to starting, IV needed to be placed and I had requested US machine person (doc) the day before and that day. A nurse comes up, chats me up, starts wrapping me in blankets then a doc with the US machine comes. The nurse pulls out my right arm and starts checking for veins. I notice I am swaddled like a baby and cannot sit up or remove my other arm from blankets.. Little panic and I insist they remove swaddle. Nurse tells me she is the 'teaching' nurse and doc remains quiet/hesitant. Nurse insists she can do procedure with one prick. After a minute back and forth, I agree. She chooses a different vein -inner arm between wrist and elbow - ok - good - and gets it in- yay!. Well, that was short lived. They go away and I try to pull the blanket up as it is cold and feel something...snap? I notice swelling and call all to say, I think something broke. 4 people check my arm and all say - 'nah...everything is ok, no swelling..'. Well anesthesiologist comes to push meds and OOOOWWWWW! - port did infiltrate, arm swells. Doc comes to use ultrasound as I first requested. IV goes in. Surgery gets done, extreme neck swelling, and maybe 45 degree movement of neck with PAIN!. New nurse calls 4 more people to look. All say, 'yes,, extreme swelling". XRay says port placement ok. Finally get pain med. Thanks!. Next, they take blood pressure from that arm and - wait for it - break IV! Is this candid camera?! So, they want me to stay overnight- no way! By this time I think if I stay, they will just find a new way to hurt me so I insist on going home. The next day I go to Oncologist for teaching chemo class, and doc assistant sends me for ultrasound stat as neck is still unusually swollen and she wants to check for blood clots. I go directly to hospital, wait get ultrasound, Small clot in elbow - neck and port ok. Prior to ultrasound, around noon I send a pic of my neck to my breast surgeon (her associate did the surgery as she was unavailable). I get home that evening and I see a red...bruise? on my neck. I take another pic. I wake up net morning, see bruise is now much larger and doesn't look good at all. I arrive for chemo and tell nurse. She speaks with Oncologist and they ask if I want to postpone. I say yes please. Good for me! As chemo is not a healing drug, I figure maybe my guardian angel is doing for me what I have not been able to do for myself - sending a BIG signal to wait. So I do. One week later -neck heals some. Looks much better. I go in yesterday for treatment and pre meds go in ok. They start taxol and within 2-3 minutes - wow! not a flush but a high fire starts in my upper body - engulfing head and chest. Then I cannot sit up, cannot breathe and think I may throw up. Blood pressure goes up to 202/151. They react quickly - stop drip, benadryl, oxygen, whatever else I am not sure,and within 10 minutes I am better. I have not had one procedure go well or without incident. My next appointment is next Thursday. I need to work on bringing my pressure down and we will see. It has been running high as of late - wonder why - maybe because I've been in pain for the last month (haha)? I am to see my primary doc (hbp meds) and Oncologist prior to chemo. Wish me luck. I appreciate this forum.

Hospital negligence re pain management day of and after

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