Paramedic & Medic Students...Practicing IV/IM/SQ/ID

[texmat3]

We were told that we couldn't stick each other, which I was okay with, but that meant that the first pt I stuck would be my first stick ever. I told her that I was an old hat at it....then I friggin missed. But I haven't had much problems after I got that first one out of the way.

 

[MedicMonty]

"What if?"

I was taught this way, too. While I understand the value of practice on a "real" patient, from a risk management perspective, it's nearly impossible to justify. At least in a clinical setting, you can balance the risk of complications against the benefit to the patient. When performing procedures on a student, there is no benefit to balance the risk against.

What would happen if his vein were to become permanently sclerosed, or infected and required a hospitalization or IV antibiotics, etc? Is your educational facility prepared to pay that bill? Is the student who performed the procedure responsible? The preceptor whose presence "should have prevented the infection" (we all know that infections happen anyway, but that's what the lawyers will say...) Too many questions such as these. We all know that lawyers live in the "What if", but sometimes, they have a good point. I think this is one of those times.

Whenever this question comes up, I strongly encourage my fellow educators to talk to their insurance carriers and legal counsel before allowing any procedures on students. Our students only perform invasive procedures on actual patients, in approved clinical settings, during scheduled clinical hours, in direct view and supervision of a licensed preceptor, and are required to obtain informed consent from the patient INCLUDING making sure the patient understands they are a student. They are also required to wear uniforms and name badges that identify them as such. This is the only way we see to mitigate that risk and liability, to avoid exactly the scenario the original poster described.

Nick Montelauro
Terre Haute, IN

 

[Hastings]

I was taught this way, too. While I understand the value of practice on a "real" patient, from a risk management perspective, it's nearly impossible to justify. At least in a clinical setting, you can balance the risk of complications against the benefit to the patient. When performing procedures on a student, there is no benefit to balance the risk against.

Multiple benefits discussed previously.

What would happen if his vein were to become permanently sclerosed, or infected and required a hospitalization or IV antibiotics, etc? Is your educational facility prepared to pay that bill? Is the student who performed the procedure responsible? The preceptor whose presence "should have prevented the infection" (we all know that infections happen anyway, but that's what the lawyers will say...) Too many questions such as these. We all know that lawyers live in the "What if", but sometimes, they have a good point. I think this is one of those times.

Six programs in the area over 40 years with no complications. And the skills of the graduating medics are top of the line. I suppose you could chalk it up to luck. But then again, the military has done it for ages with minimal oversight without any issues I know of. I believe it would be VERY easy to justify the use of IVs on live people.

Whenever this question comes up, I strongly encourage my fellow educators to talk to their insurance carriers and legal counsel before allowing any procedures on students. Our students only perform invasive procedures on actual patients, in approved clinical settings, during scheduled clinical hours, in direct view and supervision of a licensed preceptor, and are required to obtain informed consent from the patient INCLUDING making sure the patient understands they are a student. They are also required to wear uniforms and name badges that identify them as such. This is the only way we see to mitigate that risk and liability, to avoid exactly the scenario the original poster described.

What's the difference? In my experience, you're getting even more supervision doing them on other students than in the hospital on patients, every student knows the risks and has accepted them, and every student is cleared to a level of competency before doing it on others.

 

[emtsteve87]

In my medic class, we practice on dummies, but to get signed off to do the skills in the field or during our clinical rotations, we have to have a successful IV in a live human. That doesn't mean that everyone gets it the first try, so you end up practicing on a live human for a while. But I think it has more to do with your Med Director than regional.

 

[MedicMonty]

Multiple benefits discussed previously.



Six programs in the area over 40 years with no complications. And the skills of the graduating medics are top of the line. I suppose you could chalk it up to luck. But then again, the military has done it for ages with minimal oversight without any issues I know of. I believe it would be VERY easy to justify the use of IVs on live people.



What's the difference? In my experience, you're getting even more supervision doing them on other students than in the hospital on patients, every student knows the risks and has accepted them, and every student is cleared to a level of competency before doing it on others.

I'm glad to hear that those programs have been just that - lucky. Look at the complication rate for any procedure in any hospital or setting - eventually, there will be a complication. Nothing is 100%.

In terms of risk management (and I hate that RM sometimes makes decisions for us, but let's face it - it is what it is), the question is always, "Once we've done everything we can to mitigate the risk, is that risk worth the benefit?" I agree that sticking other students is one path to building excellent skills. However, I also believe that it's not the ONLY path, and furthermore, I don't believe it's any more likely to build a proficiency than sticking a dummy and clinical patients. In fact, I agree with several other replies here that the only way to build true skill is to practice that skill repeatedly.

So while you may decide that each student receiving a small number of sticks is an "acceptable risk," you should also ask yourself, "How many times do our students have to stick each other to meet the goal (skill proficiency)?" and "Why is this risk necessary when there are other avenues?"

Lastly, when a student signs up for a class, I doubt there is a section in any release they sign holding your facility (and instructors, by the way) harmless for all the potential complications of an invasive procedure. And if they signed it the first day of class, I find it even more difficult to believe that a jury would find that it was an informed consent. I'd be even more interested in whether or not your insurance company will stand behind you.

Let me lastly say that I hope it doesn't sound like I'm judging your programs or any other. If it works for you, great. But I would hate to see any "excellent" program grind to a halt because of an unnecessary risk - and in a lot of places, it would only take one....

Respectfully,

NJM

 

[Shabo]

As for the liability for student practicing on student 1. they have to VOLUNTEER for the procedure, no one is forcing the student. 2. The student can't say that they weren't aware of the other students competency level, they are learning together. 3. The students are informed as to possible complications - because they just covered it in class. 4. In our program each student is enrolled in a personnal $2M liability and medical malpractice policy.

The risk for me would be with the clinical patients. If the students have practiced on each other it stands to reason that the likelyhood of complication for the first few patients would be greatly reduced. Perhaps there are better mannequin arms than what we used, but for me there is no comparison between it and a real person. Would it not be far easier for a clinical patient to claim that they were not properly informed as to the abilities and risk involved, unless each patient is signing a waiver. The reduced risk to the sick patient outweighs the risk to the healthy student in my book. JM2C

Shabo

 

[MedicPrincess]

We did not practice on each other. We used the arm a few times and did all of our live sticks in the clinical setting. We were required to have 10 first time attempt successful sticks in the hospital setting (ER or OR) prior to being allowed to start our EMS clinicals.

 

[Hastings]

As for the liability for student practicing on student 1. they have to VOLUNTEER for the procedure, no one is forcing the student. 2. The student can't say that they weren't aware of the other students competency level, they are learning together. 3. The students are informed as to possible complications - because they just covered it in class. 4. In our program each student is enrolled in a personnal $2M liability and medical malpractice policy.

The risk for me would be with the clinical patients. If the students have practiced on each other it stands to reason that the likelyhood of complication for the first few patients would be greatly reduced. Perhaps there are better mannequin arms than what we used, but for me there is no comparison between it and a real person. Would it not be far easier for a clinical patient to claim that they were not properly informed as to the abilities and risk involved, unless each patient is signing a waiver. The reduced risk to the sick patient outweighs the risk to the healthy student in my book. JM2C

Shabo

There we go.

Honestly, there was a reason we were sticking patients as well as the ER staff when clinicals came around. We had been doing live IV sticks on each other a hundred times prior to that. As a student, I wouldn't have wanted it any other way. There's truly no substitute for the real thing.

 

[jochi1543]

I know we'll be practicing on each other in the EMT-A class (I've dropped by their classroom to watch them do it one day), I don't know if we'll be starting with oranges or something else first, though.

The most painful finger poke I ever experienced was in my EMT-B class when we practiced blood sugar testing. I literally screamed and jumped in my chair. Not looking forward to IVs...:wacko:

 

[marineman]

I know we'll be practicing on each other in the EMT-A class (I've dropped by their classroom to watch them do it one day), I don't know if we'll be starting with oranges or something else first, though.

The most painful finger poke I ever experienced was in my EMT-B class when we practiced blood sugar testing. I literally screamed and jumped in my chair. Not looking forward to IVs...:wacko:

for SQ and IM's we practiced on oranges otherwise we had a little pad that simulated the delt that we would stick. As for the finger poke I don't know if you were taught this or not but going on the side of the finger makes it much less painful as that area is not callused like the tip of the finger.

In our class we did sign a hold harmless form regarding invasive procedures practiced in class but like was said earlier nobody is forcing us to get stuck, it's mostly a courtesy thing to allow people to stick you if you want to stick them at least in our class. The benefit to practicing on students is held within that hold harmless form and the knowledge that they are agreeing to the procedure. If you're trying your first time in the field and are obviously not proven proficient there is your added risk. Different schools have different views on it but I wouldn't want it any other way.

I see it much the same as the LEO's that have to be tased before their allowed to carry a taser.

 

[jrm818]

or shot before they get to use a gun.....

 

[MagicTyler]

or shot before they get to use a gun.....

I never agreed with LEOs that used that excuse... A gun is used as a last resort, intending to permenatly incapasitate the threat. When using a gun, its to prevent a loss of their own life.

I think its important to know what your patient is going through if you can. If you don't want to experiance somthing, what right do you have to convince your pt they should.

 

[BossyCow]

I have no issue with needles. I've always allowed students to practice on me. The hospital where I used to work would offer free cholesterol screenings to anyone who would let a new phlebotomist practice blood draws on them.

I'm currently in a class for IV cert and after two weeks of dummy sticks will start live people sticks next saturday. I must say I'm stunned by the chickenpoo attitude of those who cheerfully stuck me while they were learning! Including my dear husband and best friend!!!! I'm trying very hard not to take it personally!

 

[TransportJockey]

I have no issue with needles. I've always allowed students to practice on me. The hospital where I used to work would offer free cholesterol screenings to anyone who would let a new phlebotomist practice blood draws on them.

I'm currently in a class for IV cert and after two weeks of dummy sticks will start live people sticks next saturday. I must say I'm stunned by the chickenpoo attitude of those who cheerfully stuck me while they were learning! Including my dear husband and best friend!!!! I'm trying very hard not to take it personally!

I freely offer my veins in class, so it annoys me that when I try to get a stick, someone will try to get out of it...