In article <003201c1569a$e02ecb80$65237ad5@afogarty>, Adrian Fogarty
<[log in to unmask]> writes
> Our occy health consultant has politely suggested that we should
> participate in the "needle stick hotline", i.e. offer advice and
> counselling to any trust staff members who sustain a needle stick
> injury, including advice on post-exposure prophylaxis and
> immunisation etc, 24 hours per day. She quoted that 80% of A&E
> departments already do this! She's way off the mark isn't she?
> Maybe 80% of departments keep the triple therapy packs in their
> drug cupboards, but I doubt 80% of A&E consultants offer this sort
> of service. We're not trained for this, are we? Does anyone out
> there have experience of this, or is she trying to dupe us into
> doing her work for her?
I've recently agreed a policy with occy health and the micro consultant:
Mon-Fri 9-5, staff go to occy health and they sort everything.
Outside of these hours, occy health are shut (lucky them), so staff come
to A&E after "wash and bleed".
Occy health / micro con have provided a simple check list for staff
victims of needle sticks and A&E staff (likely to be SHO or senior nurse
going through it with patient). This could easily fit on 1 side of A4
and is a simple tick-box affair with a 2-pronged decision pathway (high
risk or low risk). I can provide EMail address of occy health contact if
anyone would like to see their version.
A&E staff's input is purely to assist the member of staff with assessing
their risk (according to clear guidelines provided) and to dispense PEP
starter pack to victim if high risk. The risk assessment is such that
any nurse, PAM or doc should be able to self-complete it anyway.
There is a full patient advice leaflet in the PEP packs. Occy health and
con micro are happy this provides at least as good information as an A&E
SHO could reading from the BNF.
Victims are given full responsibility for approaching occy health
themselves the next working day to arrange formal counselling / blood
tests etc. as indicated and for prescription of the full PEP course if
risk confirmed.
It is fortunately not a common problem here, so hasn't been tested yet,
but I think is unlikely to be problematic to A&E: simple yes / no
questions, and perhaps 5 minutes of staff time.
We keep post-exposure prophylaxis starter packs in the dept.
HOWEVER...
The initial suggestions from occy health were:
A&E to be 1st port of call even in office hours
A&E to provide counselling
A&E to provide advice on drug side-effects etc.
A&E to arrange follow-up.
A&E to perform serology on victim and donor (i.e. on ward patient)
A&E to obtain informed consent for above.
Firm approach and "mutual" understanding fixed all that.
Many out there might consider this "not our job", but someone has to do
it and I can think of worse uses of our time than 5 minutes spent
assessing risk with a colleague and dispensing starter packs and written
information. The policy makes it very clear that responsibility lies
with the victim for instigating follow-up and makes it very clear that
occy health / microbiology are taking the lead in this. We are merely an
out-of-hours emergency risk assessment (guided by others' written
advice) and dispensing chemist. We are NOT required to get involved in
counselling, consent for serology or follow-up, and quite right too.
Should you choose to accept this mission, Adrian, certainly insist on
safeguards for yourself and your staff and make it absolutely clear what
your role is. Make sure you see all guidance sheets etc. before "going
live": I picked up several "innocent" mistakes on our documents from
occy health when I insisted on seeing drafts.
At the end of the day, you can always decline their kind invitation to
provide their out of hours service for them and suggest they make
themselves available on-call as much as you do.
Our micro con has been very supportive to the department in the past and
has regularly been bothered at night, whether on-call or not, for
questions regarding risk and PEP requirement. He therefore had a vested
interest in distilling his expertise into writing for the duty SHO to
use on his behalf and on his authority / responsibility. I think that's
probably OK on this basis.
Dr G Ray
A&E
Sussex
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