Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United

[lostinblue 1,989]

Statement by RN’s at Texas Health Presbyterian Hospital as provided to National Nurses United

he RNs who have spoken to us from Texas Health Presbyterian are listening in on this call and this is their report based on their experiences and what other nurses are sharing with them. When we have finished with our statement, we will have time for several questions. The nurses will have the opportunity to respond to your questions via email that they will send to us, that we will read to you.

We are not identifying the nurses for their protection, but they work at Texas Health Presbyterian and have knowledge of what occurred at the hospital.

They feel a duty to speak out about the concerns that they say are shared by many in the hospital who are concerned about the protocols that were followed and what they view were confusion and frequently changing policies and protocols that are of concern to them, and to our organization as well.

When Thomas Eric Duncan first came into the hospital, he arrived with an elevated temperature, but was sent home.

On his return visit to the hospital, he was brought in by ambulance under the suspicion from him and family members that he may have Ebola.

Mr. Duncan was left for several hours, not in isolation, in an area where other patients were present.

No one knew what the protocols were or were able to verify what kind of personal protective equipment should be worn and there was no training.

Subsequently a nurse supervisor arrived and demanded that he be moved to an isolation unit– yet faced resistance from other hospital authorities.

Lab specimens from Mr. Duncan were sent through the hospital tube system without being specially sealed and hand delivered. The result is that the entire tube system by which all lab specimens are sent was potentially contaminated.

There was no advance preparedness on what to do with the patient, there was no protocol, there was no system. The nurses were asked to call the Infectious Disease Department. The Infectious Disease Department did not have clear policies to provide either.

Initial nurses who interacted with Mr. Duncan nurses wore a non-impermeable gown front and back, three pairs of gloves, with no taping around wrists, surgical masks, with the option of N-95s, and face shields. Some supervisors said that even the N-95 masks were not necessary.

The suits they were given still exposed their necks, the part closest to their face and mouth. They had suits with booties and hoods, three pairs of gloves, no tape.

For their necks, nurses had to use medical tape, that is not impermeable and has permeable seams, to wrap around their necks in order to protect themselves, and had to put on the tape and take it off on their own.

Nurses had to interact with Mr. Duncan with whatever protective equipment was available, at a time when he had copious amounts of diarrhea and vomiting which produces a lot of contagious fluids.

Hospital officials allowed nurses who had interacted with Mr. Duncan to then continue normal patient care duties, taking care of other patients, even though they had not had the proper personal protective equipment while caring for Mr. Duncan.

Patients who may have been exposed were one day kept in strict isolation units. On the next day were ordered to be transferred out of strict isolation into areas where there were other patients, even those with low-grade fevers who could potentially be contagious.

Were protocols breached? The nurses say there were no protocols.

Some hospital personnel were coming in and out of those isolation areas in the Emergency Department without having worn the proper protective equipment.

CDC officials who are in the hospital and Infectious Disease personnel have not kept hallways clean; they were going back and forth between the Isolation Pod and back into the hallways that were not properly cleaned, even after CDC, infectious control personnel, and doctors who exited into those hallways after being in the isolation pods.

Advance preparation

Advance preparation that had been done by the hospital primarily consisted of emailing us about one optional lecture/seminar on Ebola. There was no mandate for nurses to attend trainings, or what nurses had to do in the event of the arrival of a patient with Ebola-like symptoms.

This is a very large hospital. To be effective, any classes would have to offered repeatedly, covering all times when nurses work; instead this was treated like the hundreds of other seminars that are routinely offered to staff.

There was no advance hands-on training on the use of personal protective equipment for Ebola. No training on what symptoms to look for. No training on what questions to ask.

Even when some trainings did occur, after Mr. Duncan had tested positive for Ebola, they were limited, and they did not include having every nurse in the training practicing the proper way to don and doff, put on and take off, the appropriate personal protective equipment to assure that they would not be infected or spread an infection to anyone else.

Guidelines have now been changed, but it is not clear what version Nina Pham had available.

The hospital later said that their guidelines had changed and that the nurses needed to adhere to them. What has caused confusion is that the guidelines were constantly changing. It was later asked which guidelines should we follow? The message to the nurses was it’s up to you.

It is not up to the nurses to be setting the policy, nurses say, in the face of such a virulent disease. They needed to be trained optimally and correctly in how to deal with Ebola and the proper PPE doffing, as well as how to dispose of the waste.

In summary, the nurses state there have been no policies in cleaning or bleaching the premises without housekeeping services. There was no one to pick up hazardous waste as it piled to the ceiling. They did not have access to proper supplies and observed the Infectious Disease Department and CDC themselves violate basic principles of infection control, including cross contaminating between patients. In the end, the nurses strongly feel unsupported, unprepared, lied to, and deserted to handle the situation on their own.

We want our facility to be recognized as a leader in responding to this crisis. We also want to recognize the other nurses as heroes who put their lives on the line for their patients every day when they walk in the door.

http://www.nationalnursesunited.org/blog/entry/statement-by-registered-nurses-at-texas-health-presbyterian-hospital-in-dal/

No need to worry folks everything is under control.

[DavenRoxy 1,073]

Lucky for me I live where it's so rural ebola would be skeert to even try and infect us. If ebola took a bite out of a local, it would get so sick from thinking about things outside the county line that it couldn't infect another soul!!

[Mr. Big Dog 10,747]

All anonymous. "Reports are emerging". The usual. Did you get to this blog post via facebook?

[Pooky 3,343]

All anonymous. "Reports are emerging". The usual. Did you get to this blog post via facebook?

Did you even bother to look at the website? Apparently not.

NNU was founded in 2009 unifying three of the most active, progressive organizations in the U.S.and the major voices of unionized nursesin the California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association.

Not the kind of people I would contemptuously dismiss as writing just another blogpost about a subject they know far more about than either you or I.

[JohnR! 5,495]

I think the question in everyone's minds is whether the hospitals are wising up and beefing up their protocol. By watching footage from Africa and from the arrival of the first two patients at Emory, I'd bet that everyone thought hospitals would require nurses to wear full body suits when treating infected patients.

Having said that, hindsight is 20/20, but with hunting won't help. We need to start closing the gaps on existing protocols. This is one of those situations where common sense goes a long way, in addition to the recommendations set forth by the CDC.

[Pooky 3,343]

I think the question in everyone's minds is whether the hospitals are wising up and beefing up their protocol. By watching footage from Africa and from the arrival of the first two patients at Emory, I'd bet that everyone thought hospitals would require nurses to wear full body suits when treating infected patients.

We were told by the head of the CDC and the White House that our hospitals were fully prepared to deal with patients infected with Ebola.

Having said that, hindsight is 20/20, but with hunting won't help. We need to start closing the gaps on existing protocols. This is one of those situations where common sense goes a long way, in addition to the recommendations set forth by the CDC.

So, are you now saying that the CDC and the White House were not being truthful with the American public?

[JohnR! 5,495]

They might be speaking of Emory and likes, which apparently followed the recommended Ebola protocol and saved the lives of a few people. Incidentally that is where the nurses from Texas were sent, for treatment.

We were told by the head of the CDC and the White House that our hospitals were fully prepared to deal with patients infected with Ebola.

[Pooky 3,343]

They might be speaking of Emory and likes, which apparently followed the recommended Ebola protocol and saved the lives of a few people. Incidentally that is where the nurses from Texas were sent, for treatment.

You and I are both smart enough to realise that's not what they meant.

[Curmudgeon 227]

Does no one understand risk assessment? I am sure US hospitals were not spending a lot of time or money on a extremely low risk eventuality, an eventuality that is still extremely unlikely to develop into a significant issue. Complain about health insurance premiums and simultaneously complain that the private health care services are not wasting enough $'s developing plans for something that isn't likely to happen? That makes sense. Stop worrying, go out and enjoy the day and if you want to do something, send some money to those who are risking their lives to help those who are genuinely in danger in West Africa.

[Pooky 3,343]

Does no one understand risk assessment? I am sure US hospitals were not spending a lot of time or money on a extremely low risk eventuality, an eventuality that is still extremely unlikely to develop into a significant issue. Complain about health insurance premiums and simultaneously complain that the private health care services are not wasting enough $'s developing plans for something that isn't likely to happen? That makes sense. Stop worrying, go out and enjoy the day and if you want to do something, send some money to those who are risking their lives to help those who are genuinely in danger in West Africa.

I believe the problem with risk assessment is when the risk that was assessed, and deemed Insufficiently risky to warrant additional protective measures, happens to you, as it did these medical professionals. Then it stops being a risk to them and becomes an actual danger.

What these medical professionals wish to make public is the mis- and dis-information that has been spread about what has been going on. That they feel badly let down, given what has happened and what we have learned, is entirely understandable.

[Dakine10 5,452]

Several screw ups by the hospital. I think we knew that already.

Duncan should have been diagnosed in ER, not necessarily with Ebola, but they should have figured out something was wrong with him and isolated him based on his history.

If a hospital is not capable of the level of providing adequate equipment and facilities for isolation, the patient should have been moved immediately. Not every hospital is equipped to deal with Ebola or other pathogens of that nature.

This hospital should have been ready though. They got caught with their pants down. The mistakes made in this case are on the hospital.

Edited October 18, 2014 by Dakine10

[JohnR! 5,495]

True. Being a pathological cynic, my first reaction was of suspicion. However, when you take a step back, the first experience of treating patients in the US was a qualified success. Speaking from that experience, you can draw the conclusion there is an effective protocol - Emory has proven that several times. The CDC is practically a department inside Emory, both in the literal and figurative senses. It is not too far fetched to conclude that if Emory did it any other hospital in the US can do it too.

There are two differences however and those must be addressed by each individual facilty. First, all patients were brought into Emory under strict protocol - they didn't walk into the ER. In addition, it should be mentioned that the protocol itself is quite simple in that the components are very similar to those used by sanitation workers or those who deal with hazmat on a daily basis. The crux of the protocl is execution, and that appears to have been the issue in Texas. Danger of contagion is highest during removal of the gear, at a time when the nurses have just undergone the stressful part of treatment and may have let down their gard.

You and I are both smart enough to realise that's not what they meant.

[Dakine10 5,452]

True. Being a pathological cynic, my first reaction was of suspicion. However, when you take a step back, the first experience of treating patients in the US was a qualified success. Speaking from that experience, you can draw the conclusion there is an effective protocol - Emory has proven that several times. The CDC is practically a department inside Emory, both in the literal and figurative senses. It is not too far fetched to conclude that if Emory did it any other hospital in the US can do it too.

There are two differences however and those must be addressed by each individual facilty. First, all patients were brought into Emory under strict protocol - they didn't walk into the ER. In addition, it should be mentioned that the protocol itself is quite simple in that the components are very similar to those used by sanitation workers or those who deal with hazmat on a daily basis. The crux of the protocl is execution, and that appears to have been the issue in Texas. Danger of contagion is highest during removal of the gear, at a time when the nurses have just undergone the stressful part of treatment and may have let down their gard.

And not having the right protective equipment available, which also falls on the hospital. You can (and do) get patients who require isolation at any time. Happens behind the scenes every day. You can't wait until that happens to find out your inventory is depleted.

[JohnR! 5,495]

Indeed, the hospital should do some soul searching. Ebola is not the only pathology that requires isolation.

And not having the right protective equipment available, which also falls on the hospital. You can (and do) get patients who require isolation at any time. Happens behind the scenes every day. You can't wait until that happens to find out your inventory is depleted.

[Curmudgeon 227]

I believe the problem with risk assessment is when the risk that was assessed, and deemed Insufficiently risky to warrant additional protective measures, happens to you, as it did these medical professionals. Then it stops being a risk to them and becomes an actual danger.

What these medical professionals wish to make public is the mis- and dis-information that has been spread about what has been going on. That they feel badly let down, given what has happened and what we have learned, is entirely understandable.

The risk prior to anyone entering the US carrying he disease of having to deal with the disease was precisely 0%. You are expecting a private institution to justify spending a lot of money on mitigating against a negligible risk prior to that event? I can see that going down well at the end of year board meeting. The actions of the hospital after the initial presentation of the patient and the subsequent diagnosis prove that the measures in place were adequate. No one outside of the highest risk group has contracted the disease. That two health care workers did contract the disease after the patient was properly diagnosed is clearly a concern, they need to deal with that concern but we do not yet know if it was a failure in protocols or a personal failure by the staff members. Either way, they are being cared for and are expected to recover. If that's not a reasonable outcome, I am not sure what is. Perhaps someone could enlighten me?

And not having the right protective equipment available, which also falls on the hospital. You can (and do) get patients who require isolation at any time. Happens behind the scenes every day. You can't wait until that happens to find out your inventory is depleted.

If it is something that should have been available regardless of the case of Ebola having to be dealt with, then indeed that's a failure at hospital level and is not relevant to any discussion about failures specific to having to deal with Ebola patients.