Whilst on the orthopaedic inpatient ward during my last clinic an incident occurred following a miscommunication between the physio and I. The treatment plan was to assist the patient, a 72 year old male 10 days post-THR with pain complicating things due to metastatic prostate cancer, to stand and walk with a pulpit frame. His attachments were an IV line, IDC and O2 (which he did not need when we treated him.) Whilst transferring from sitting to standing his IV line came out. As he was also taking warfarin this was particularly messy; there was blood on his gown, the frame and the floor.
My immediate reaction was concern for the pain I expected it to cause the patient, however he was only slightly bothered by the incident, and seemingly more for the mess than the discomfort. We had the patient apply pressure to the bleeding hand with his other hand and elevate the arm until I had gloves on and a dressing to apply the pressure for him. While I did this the physio found a nurse to dress it properly and organised for him to have the IV line reinserted a little later on. I was annoyed at myself for letting it happen and felt that the reason was a miscommunication between the physio and I.
Initially I saw the patient alone and had checked the patient’s chart, pulled back the sheets and positioned the IVC, which was on the side of the bed we were going to be standing on. The physio then came in and put the bed down from the opposite side of the bed and removed the oxygen. At this point she said to finish getting him ready and sit him up then she’d be back to assist us with standing. I assumed she said finish getting him ready because she was unaware of what I had already done before she came and did not notice the IV line had no extra length where it was wrapped around the gown. Failure on my part to check everything on the other side or to ask the physio rather than assuming she had checked was the cause of the incident.
Through this incident I have become more aware of the potential for misunderstanding when working with colleagues in terms of the extra communication required when you are not performing all aspects of the task yourself. There is usually a benefit of having an extra set of hands, however it is important to be mindful that the other staff member is not a mind reader and you both need to be clear who is doing what. I believe it is also important to have a leader and an assistant in these cases. As I am a student and the other physio is a senior there was some ambiguity as to who was in charge. It was my patient and therefore I should have been in charge of the session. During the rest of the placement and in the future I will check things for myself when it is “my patient” or will specifically ask if the other physio has checked particular things to avoid a similar incident. Although it was an extremely unpleasant incident it gave me a useful wake-up call and learning experience!
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Although this was a pretty awful situation to be in, it should be viewed as a valuable learning experience. Once something like that happens to you with a patient, I believe that it heightens your awareness and you become a lot more diligent next time you are faced with the same situation. It is easy for things to be looked over, but once you look over something once, its guaranteed that next time you will double check!!!
Its also important to note that when working in a pair with another physio or another student it is easy to assume that the other party will notice or take care of things. I feel that it is important before you see a patient to discuss your roles and who will do what to ensure that there are no grey areas in terms of who is in charge or running the session.
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