# EMT Recommended Pen?



## JesterEMS (Aug 10, 2016)

Hello,

I was wondering what pens you would recommend for clinical rotations.
I plan on writing simple OPQRST and SAMPLE history on the posterior portion of my palm.
Since there are germs that I will be exposed to, I was thinking my pen would collect some of it.
What kinds of pens do you suggest I get that are antibacterial or antimicrobial coated.

One thing I've noticed about pens it that ball pens work best when writing on latex gloves.

Cheers!


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## Tigger (Aug 10, 2016)

What is the posterior palm?

Also, cavicide wipes. And don't write a history on your gloves.


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## JesterEMS (Aug 10, 2016)

the top of the hand, I guess. 
Studying some anatomy so please correct me if I am wrong..

If SAMPLE doesn't contain any names or any identifying information we still shouldn't write it?


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## Tigger (Aug 10, 2016)

JesterEMS said:


> the top of the hand, I guess.
> Studying some anatomy so please correct me if I am wrong..
> 
> If SAMPLE doesn't contain any names or any identifying information we still shouldn't write it?



The palm would be the anterior surface of than hand in normal anatomical position.

Nothing to do with privacy, it's just kind of an icky habit. And what happens when the glove becomes contaminated?


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## JesterEMS (Aug 10, 2016)

Thank you, Tigger for clarifying 

Well when writing a PCR, we can transfer the history to the report. 
Just for quick note taking, I was thinking if this was a good thing. 

Of course, gloves will become contaminated but we dispose of them after the report has been written.
I was thinking to use this idea because if I were to use a notepad, wouldn't the notepad collect germs over time?
What would be the best way to effectively take quick notes?


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## Akulahawk (Aug 10, 2016)

I go through gloves like they're free.  I also don't write anything on my gloves because most of the time, they'll be in a trash container within a few minutes and therefore anything that I wrote on them will be gone. What do _I_ do to take notes? In each of the rooms in my ER, there's a white board. I use that. If I don't have that available, I get a paper towel from the dispenser and write on that. If that's not available and I have it immediately available, I'll put a 2" strip of tape on my thigh and go with that. Most of the time that's not available so I just depend upon a good memory to catch the highlights. 

When I'm taking notes during a call, I often just write a time and a single word to remind me what I was doing at that time. Then later I reconstruct the call from memory and my simple notes. I'm not saying you should do this, I'm just saying what _I_ do but then again I have a kind of mental scaffold from which to hang all the details from.


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## Summit (Aug 10, 2016)

I was always a 2" waterproof tape on my rectus femorus at the patellar insertion type of guy.


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## Akulahawk (Aug 10, 2016)

Oh, and as far as pens go, I pretty much used the cheapest BIC click pen I could buy... if my company didn't provide them for me. Of course we bought something like 5,000 of them at a time so...


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## gotbeerz001 (Aug 10, 2016)

Pens: Whatever I pick up for free at insurance offices, U-Haul or one of my favorite Breweries. 

Notes: Try typing your PCR with your gloves on and see how well that goes over. Gloves go in the trash... I use a strip of monitor printer paper if the hx is too complex to remember. I also write notes on the back of my 12L. In clinicals, I had a cheap pocket notebook. 


Sent from my iPhone using Tapatalk


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## JesterEMS (Aug 10, 2016)

Mmmm,
So it seems like 2" tape is what is used for note taking.
If I broke this strategy out in my basic class for simulation would this be appropriate?

What other note taking skills are out there now???
As far as pens @Akulahawk, you would use them 1 time use?


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## JesterEMS (Aug 10, 2016)

gotshirtz001 said:


> Pens: Whatever I pick up for free at insurance offices, U-Haul or one of my favorite Breweries.
> 
> Notes: Try typing your PCR with your gloves on and see how well that goes over. Gloves go in the trash... I use a strip of monitor printer paper if the hx is too complex to remember. In clinicals, I had a cheap pocket notebook.
> 
> ...


I am barely starting EMT-B this late August. I don't think I will have any computer access so I'm assuming everything is manually written somewhere.


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## Summit (Aug 10, 2016)

There is no pen except the Pilot G2 Gel Ballpoint Retractable.

All other pens are heresy.

0.35 or 0.5 for charts
0.7 or 1.0 if you are writing on tape on your leg or the IV pump
Black Ink

Death to the nonbeliever!


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## Akulahawk (Aug 10, 2016)

My own _personal_ pens are stainless steel Zebra G-301 pens, preferably Gel, black ink. I have used the Pilot G2 pens referenced above and they are awesome. I very much concur about the point size for stated purposes.


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## JesterEMS (Aug 10, 2016)

@Akulahawk @Summit 

To be honest, I love G2 blue ink gel pens.
I've been using them for a while.
They are my go to.
The only thing is that they are expensive and I wouldn't recommend them as disposable.


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## Jim37F (Aug 10, 2016)

I've been trying to break myself of the habit of writing on my gloves, for several reasons. Although initially it seems easier to just pull out your pen and jot down on your hand, (which is the same reason I got into that habit as a rookie), I've since found a simple pocket notebook is vastly superior. 

Firstly although Large gloves fit me best, they aren't a quite perfect fit, there's just enough extra slack in the material that the tip of the pen catches on and pulls at the glove itself often enough to demand I have to take extra care to produce a legible letter (notice that's each individual letter) vs a piece of paper I can just write on like normal. If larges aren't available for whichever reason, I find XL's the next most useful size for me to actually work and perform patient care tasks in, but those produce enough extra material that catches the pen that writing on them is virtually impossible. I can squeeze into a pair of mediums of no L/XL's are available, and while those are easiest to write on, they're so tight on my hands that I feel constrained and break them far more easy. So it's easier just to put on the proper sized gloves to do effective patient care and pull out the paper to write on.

If my gloves break, get blood, or other icky on them, I can pull them off and replace without worrying about losing all my notes.

Even for relatively clean patients, there's a definitive "ickyness" to holding onto the gloves used. Whether you keep the same pair of gloves on throughout the entire call or carefully pull off your notes and keep them with you until you transfer the info onto the PCR, they're still left bunched up on the bench seat of in your pocket or on the counter at the hospital....if you keep doing that with "clean" gloves you'll find yourself doing that with the "nasty" gloves and no one else that sees them knows which one they are and wont appreciate you repeatedly placing dirty gloves on their counter everytime you drop off a patient at their ER....

Plus by using simple paper notebooks, you completely avoid the original question of which pen works best on nitrile, or is anti-microbial etc, pretty much every pen will work fine with standard pocket sized notepads.


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## NomadicMedic (Aug 10, 2016)

Get a notepad.


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## StCEMT (Aug 10, 2016)

The best pen is a free pen. Or the one you haven't lost yet. You will be exposed to germs regardless, so no, don't throw them away after one use.


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## JesterEMS (Aug 10, 2016)

StCEMT said:


> The best pen is a free pen. Or the one you haven't lost yet. You will be exposed to germs regardless, so no, don't throw them away after one use.


So after use of a pen, clean it with a CaviWipe?


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## StCEMT (Aug 10, 2016)

JesterEMS said:


> So after use of a pen, clean it with a CaviWipe?


I don't. I just use an alcohol prep if/when I do. Handwashing is what I am picky about.


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## Summit (Aug 10, 2016)

StCEMT said:


> I don't. I just use an alcohol prep if/when I do. Handwashing is what I am picky about.


Why would you be picky about handwashing and not about proper disinfectant procedures for equipment?

Alcohol is not sporocidal, doesn't penetrate protein rich material, and it evaporates quickly making it a poor choice for equipment, especially if just using a prep pad as opposed to a drenched cloth or immersion.

How many of us do disinfect our pens... how about our stethoscopes... how about our smart phones?


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## JesterEMS (Aug 10, 2016)

Summit said:


> Why would you be picky about handwashing and not about proper disinfectant procedures for equipment?
> 
> Alcohol is not sporocidal, doesn't penetrate protein rich material, and it evaporates quickly making it a poor choice for equipment, especially if just using a prep pad as opposed to a drenched cloth or immersion.
> 
> How many of us do disinfect our pens... how about our stethoscopes... how about our smart phones?


Isn't one thing we definitely should disinfect is our stethescope??


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## MonkeyArrow (Aug 10, 2016)

How many of us disinfect our uniforms? Or ourselves at the end of a shift before getting in your car? If you're going to be worried about getting sick from your pen, well, never mind. The "germs" that w encounter in the back of the rig are no more bad than what's floating around for the common patient to catch (unless dealing with a truly extraordinary situation like ebola).


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## JesterEMS (Aug 10, 2016)

@MonkeyArrow 
So we shouldn't wash our uniforms????


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## StCEMT (Aug 10, 2016)

Summit said:


> Why would you be picky about handwashing and not about proper disinfectant procedures for equipment?
> 
> Alcohol is not sporocidal, doesn't penetrate protein rich material, and it evaporates quickly making it a poor choice for equipment, especially if just using a prep pad as opposed to a drenched cloth or immersion.
> 
> How many of us do disinfect our pens... how about our stethoscopes... how about our smart phones?


I'm lucky if I don't lose a pen before I even am worried about going that far. My pen isn't really any worse off than some other things in the back if the truck. I don't disinfect the stretcher after every single call and we grab those all the time. Unless it's a really nasty person, I am just not worried about the general things I could potentially get sick from. If mawmaw Betty tripped and fell, I probably wouldn't go crazy with thr wipes on my pen, stretcher, etc. Stethoscope I will go over with cavicide from time to time though.


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## Summit (Aug 10, 2016)

@JesterEMS Absolutely! Stethoscope are as contaminated as hands and gloves.

See here: http://www.sciencedirect.com/science/article/pii/S0025619613010847

Cell phones can also be a hangout for the bacteria that cause nosocomial infections: http://jidc.org/index.php/journal/article/viewFile/19801807/291



MonkeyArrow said:


> How many of us disinfect our uniforms? Or ourselves at the end of a shift before getting in your car? If you're going to be worried about getting sick from your pen, well, never mind. The "germs" that w encounter in the back of the rig are no more bad than what's floating around for the common patient to catch (unless dealing with a truly extraordinary situation like ebola).


I am talking about all of these things because it is your job to make sure you aren't spreading bacteria that can cause infection to your patient.

It is about you too. And you colleagues.


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## StCEMT (Aug 10, 2016)

JesterEMS said:


> @MonkeyArrow
> So we shouldn't wash our uniforms????


Nowhere in his post did he say that.


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## Summit (Aug 10, 2016)

StCEMT said:


> I don't disinfect the stretcher after every single call and we grab those all the time.


You should...



> Stethoscope I will go over with cavicide from time to time though.



What about your patients? They deserve a disinfected stethoscope. Every time!


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## OnceAnEMT (Aug 10, 2016)

Second, third, and fourth the recommendation of Pilot G2. More specifically, the 0.5mm Extra Fine in black. You'll never look back. Buy in bulk (packs of 12 to 20) to save big money.

In ER our notes are on the back of patient label paper, sticky notes, or paper towels. Some of the doctors have spiral notebooks, some have notepads, some drag their computer around. 

In SAR we use tape on the patient and personal notepads. Can't say I've ever seen anyone tape their own legs to be a notepad. Maybe forearm, but not legs...


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## ViolynEMT (Aug 11, 2016)

A cheap pen that you don't care about losing. You should probably have three or four. Things are going to get "icky". It's pretty tough to avoid that.


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## DesertMedic66 (Aug 11, 2016)

To everyone who is not using a Pilot G2 0.7mm in black, you are all wrong and need serious help.

0.5mm? I'm not trying to poke holes in the paper or my hand. 1mm? Might as well be finger painting. 

Only in black. My black tactical pen needs to color match my black tactical uniform so I can use a stealth approach on those diabetic patients


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## StCEMT (Aug 11, 2016)

Summit said:


> You should...
> 
> 
> 
> What about your patients? They deserve a disinfected stethoscope. Every time!


 But not every patient requires the use of my Stethoscope....


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## NomadicMedic (Aug 11, 2016)

How about the pen that your waitress gives you to sign the check with?
How about the PIN pad on the checkout at the grocery store?
How about the door handle on the way into Starbucks?

Also, there's big differences between icky and Infectious. Sticking my finger into a cup of urine may well be icky, but if I have intact skin, it's most likely not infectious. Don't sweat the small stuff, just wash your hands frequently. Good hand hygiene is the most importnat thing in preventing casual transmission.


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## Summit (Aug 11, 2016)

DEmedic said:


> How about the pen that your waitress gives you to sign the check with?
> How about the PIN pad on the checkout at the grocery store?
> How about the door handle on the way into Starbucks?
> 
> Also, there's big differences between Icy and Infectious. Sticking my finger into a cup of urine may well be icky, but if I have intact skin, it's most likely not infectious. Don't sweat the small stuff, just wash your hands frequently. Good hand hygiene is the most importnat thing in preventing casual transmission.



Let me preface this response by saying I like you and respect you as a provider based on your past posts. I say that because it is going to sound harsh, but it is more of a generalized commentary.

ATMs and pens at a restaurant are examples that indicate you are only thinking in terms of protecting yourself, not the patient.

You have an ethical imperative to protect your patients from contact transmission from yourself and previous patients... patients with weakened immune systems, open wounds, and more. You cannot see human pathogens or potential drug resistance with your naked eye.

The pen the waitress gives you AFTER your meal was not handled by gloves that were touching who knows what patient in their house (or hands that touched a surface that was just touched by those gloves) or the potentially drug resistant colonized bodies of your patients coming from a nursing home or hospital.

This nonchalant attitude about infection prevention interventions the rest of healthcare has been focusing on reminds me of the old school EMS people who used to say that gloves were overkill. I've presented both scientific evidence and ethical reasoning. You have to come up with a better response than "no biggie."

Responses about infection prevention in this thread are a screaming reminder that the vast majority of EMS personnel do not taken College Biology much less Microbiology. You understand and see concepts that would make you think about your actions. 

It also is a reminder that EMS doesn't see the patients who get nosocomial infections and MDRO infections and what happens to them because EMS only sees their patients for a few minutes.

Even a good CNA program will use an invisible dye that fluoresces under UV as a lab exercise to demonstrate just how wild and wide contact transmission is along with the difficulty of proper equipment disinfection/hand hygiene. I've never seen an EMS program that does this...


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## NomadicMedic (Aug 11, 2016)

Summit, I also respect you and don't think that your post wasn't harsh in the least. It's obviously a point that you're passionate about.

However, after reading your interpetation of my statement, I should reprashe to be a bit more clear as to my point; The OP seemed worried about getting cooties from his/her pen. This was followed by much talk about things getting icky... and my statement was made to reiterate that there are many possible vectors of disease transmission that should be as forefront as the everr popular "EMS pen".

And how do you know that the pen that waitress just handed you wan't contaminated by a sick person? When was the last time that pen saw a cavicide wipe? How do you know that the waitress hereslf isn't colonized by a drug resistant bug? How do you know the Pin Pad at the ATM wasn't just operated by a person with Impetigo and those weeping sores? Do you wash your hands before and after each use of the ATM? Does anyone?

Does the waitress have a imperative to protect me from the pathogens that may be on the pen or the menu? Does the restaurant owner?

Yes,  I agree. I think EMS hand hygiene, and infection control as a whole, is atrocious. But, that's where it needs to start. Not by scaring EMS providers into throwing away pens because every patient that signs will give them MRSA. If EMS really wanted to be relevenat in the world of infection control, we would we wearing a uniform that was discarded after each patient contact, use fully disposable equipment and have a full on decon procedure for the vehicle and fixed assests after each patient encounter. I don't see ANYONE doing that. Or anything close.

Barring all that, I think a base education other than, "if its wet and sticky and not yours, don't touch it" and a solid hand hygiene program is a good start.

"...handwashing is the single most important public health practice to prevent the spread of disease from person-to-person in instances in which respiratory droplets are not the vehicle of transmission."

Y Nigam and J Cutter. _A preliminary investigation into bacterial contamination of Welsh emergency ambulances. _Emerg. Med. J., Sep 2003; 20: 479 - 482.


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## NomadicMedic (Aug 11, 2016)

DEmedic said:


> Summit, I also respect you and don't think that your post wasn't harsh in the least. It's obviously a point that you're passionate about.
> 
> However, after reading your interpetation of my statement, I should reprashe to be a bit more clear as to my point; The OP seemed worried about getting cooties from his/her pen. This was followed by much talk about things getting icky... and my statement was made to reiterate that there are many possible vectors of disease transmission that should be as forefront as the everr popular "EMS pen".
> 
> ...




And here's the Paramedic CE class on infection control that I took last year. http://www.ems-ceu.com/courses/485/index_ems.html


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