My first day

TODAY was the first day back on the wards. The ward is as I was told a diabetic unit (the infectious disease bit seems more sidelined at the moment due to low patient numbers of this nature). The ward seems really nice, and the staff lovely. The work was divided between a 6 bedded bay and a small two bay unit further up the ward. There was plenty of work to do, and today was the day where I was also in carge of the dispensing of medications including tablets, nebulisers, IV antibiotics (both infusion and bolus administration). I stumbled upon an infection control issue today as well, mostly due to the normal situation I find myself in when I try to do something for the first time without direct supervision and find equipment missing. The one for today was thus: I was required to give Tazocine 4.5mg to a patient as an IV infusion of tazocine 4.5mg reconstituted in 20ml sodium chloride. The solution is then added to a 100ml infusion bag of saline. Now, the first problem was the before lunch the drug was not in the pharmacy cupboard (there was one Tazocine 2.25mg and that was it). So, I went to lunch (this was one hour before the prescribed time), and on returning to the ward found the pharmacy delivery had arrived. The Tazocine was available in the correct dose. Then I found that there was no 100ml saline bags in the boxes. There was a choice of either 50ml or 250ml that was relevant. I had to choose the 250ml. Now here comes the interesting part. To remove the excess, I had to snap off the white port and withdrew 130ml to waste, leaving 120ml in the bag using a 50ml syringe (the first cock up there was when I opened the first 50ml syringe to hand only to find it to be a bladder syringe AFTER opening it) then withdrawing 20ml from the bag to reconstitute the Tazocine with. Now, the drug was mixed, and the whole thing injected into the bag. The yellow labels were affixed and filled in with all appropriate information. Then, this was taken to the patient and the blue end removed for insertion of the IVI giving set. What I said to the infection control link nurse who was standing next to me at the time was what had happened and why I did what I did. I swabbed between the different withdrawals, and as the blue end was running to the patient did not want to withdraw from that end as if anything nasty got left behind (bit of Staff. Aureous etc) it would cause a bit of trouble, but in the situation I was in, is there any other risk involved in doing such a thing by using different needles to go between the ports.

The unfortunate part of the day was when I met an SHO who was working on the ICU the same time I was there last year. It turns out he did not survive the Mass Medical Cull and has had his career "Modernised" and is now out of a job though was at a conerance at the hospital. Not very nice thing to see happen as he was a good doctor and a great person to work with. The human face of the MMC farce.