WhiteCoat

Guaiac issues

JCAHO apparently requires that the doctors show nurses results of all hemoccult testing. I can’t find the actual requirement anywhere, but then again, JCAHO hides its patient safety requirements and makes anyone who wants to learn about patient safety purchase their books.
In addition, whomever interprets the test must take a certifying exam every year to show that they are able to properly interpret the color change on the hemoccult card. Kind of like taking a certifying exam each year to prove that you can determine when a traffic light turns from green to red, I suppose.

Apparently physicians are competent enough to manage a multi-trauma patient, intubate, insert chest tubes, and calculate the doses for vasoactive medications, but, on that same multi-trauma patient we lack the fundamental knowledge to determine whether a piece of paper impregnated with resin from the Guaiacum species of plant on a hemoccult card turns from white to blue. Did you also know that one of the other uses for the guaiacum species (pictured at right) is to create guaifenesin for cough syrup?
Don’t tell JCAHO that. Otherwise we’ll have to keep the cards under lock and key in case someone with a cough decides they want to chew on the cards instead of taking cough medicine. Patient safety, you know.

Oh, and then for patient safety reasons we have to log each and every test result not only on the patient’s chart, but also in a log book. No one ever says what the log book is for, and no one has ever used the log book other than to log results from the hemoccult testing that the doctors are unable to interpret — and to show JCAHO investigators that we are actually keeping the log book — but woe be to the nurse who took care of the patient where a hemoccult was done, but a result (including lot number of the card, a lot number on the bottle of developer, and respective expiration dates) was not logged. Major nursing demerits on you!

That was an interesting mind melt that had nothing to do with the actual post. Getting back on track …

During one recent shift, we had a run on abdominal pain patients — as in I was managing 7 patients all with some varied form of abdominal pain. Because I do a rectal exam on most patients with abdominal pain, we were going through a lot of stool guaiac cards. One nurse started giving me a hard time for doing too many rectal exams.

Then she did it.

She called me a “turd tickler.”

Them’s fighting words. So I hatched a plan.

I went into the break room, found some A1 Steak Sauce, and put a little on the edge of my gloved hand. Then I put some on the back of a hemoccult card. I walked into a room, asked the patient how she was doing, then came out of the room and handed card to nurse, telling her to make sure that she logged the results in our JCAHO-approved stool sample logging book . When she grabbed the card, she immediately felt the moisture, looked at her hand, gasped, dropped the card, and ran to the sink.

She watched me as I looked at my gloved hand, made a face, and rubbed my hand on my scrub bottoms. Then I took the glove off, grabbed the next chart, and walked into the room. I heard the nurse say “eeeeeewww” as I was walking away.

She was pale and had this disgusted look on her face when I walked out of the room several minutes later.
“Was that last sample heme positive or heme negative?”
“Uuuuuuggh. That’s disgusting. Why would you do that?”
“Do what?” I asked innocently.
You know what.”
“Oh this?” I asked, rubbing my fingers on my scrubs and raising them to my nose. “Hmmmmm. Smells like … like … steak sauce.”
Then I smiled, did a little circle in the air with my index finger, and went to see the next patient.

Ahhhh, the fun you can have with condiments.

15 Responses to “Guaiac issues”

  1. Connie says:

    love it!

  2. DocV says:

    At least you didn’t lick your finger.

  3. JJ says:

    Is there any doubt we could save millions (?billions) by eliminating JCAHO, or at least limiting their scope? Their raison d’etre is no longer patient care, but seems to be how they can come up with a rule more idiotic than the previous rule. The money wasted in compliance with something like the above log book is not that much. However, if you multiply that stupidity, by the other millions of stupid rules, by the time wasted in compliance by the health care providers you could pay for somethings in health care we really need.

  4. Nuclear Fire says:

    It was the senior residents job to keep a stack of cards and a bottle of developer hidden so that we could do guaics without dealing with the hassle.

    JCAHO rebel since 2001.

  5. DreamingTree says:

    That dumb rule is probably why nurses at our hospital aren’t allowed to develop guaics. They probably don’t trust us to record the information. Fine with me.

  6. Steve says:

    I rotated at one hospital that banned hemoccult developer and required the cards to be sent to the lab to be developed…the given reason- so that they can bill for the “lab interpretation” of the cards.

    I would say just buy your own and forget about the hospital’s rules but they aren’t cheap (about 4 bucks a piece)… http://www.amazon.com/Hemoccult-Fecal-Occult-Blood-System/dp/B0017VXANA

  7. I want to work with you, bud! LOL WE hardly are ever stocked with drinking pitchers and glasses so I drink out out of a bedside urinal–apple juice, of course. Thanks for the laugh, bud.
    Jim

  8. Felix Kasza says:

    @Steve — if you search Amazon for “Hemoccult” slides you’ll find the singles for $68 per 100 (comes with developer, but if you need more, it’s $10 per 30 ml or so).

    The $4/test stuff is individually packaged, I believe, so the patient can take it home.

  9. There’s no law requiring hospitals to be accredited by JCAHO, right? Isn’t it just a merit thing that everyone wants to have b/c they are afraid to be one of the only hospitals that aren’t “JCAHO approved”? Why don’t all the hospitals just say screw JCAHO and put them out of business? If not, I’d at least take a JCAHO hit on the guiac card issue. Thats going too far.

    • igloodoc says:

      While innovation and competence are the soaring eagles of ideas, leave it to the jet engine of government to suck the eagles in and leave bird bits and feathers in its wake.

      I worked in a non-JCAHO approved hospital. It doesn’t matter it didn’t have the JCAHO seal of approval, because their nonsense filters to the state licensing bodies. So state inspections usually parrot the El Toro poo that JCAHO spews.

      So now we hoard Guaiac developer and cards, constantly looking for “the card dood” to score us some cards. Off the JCAHO log, of course. Right now I’m really jonesin’ for some high grad developer. I cut the cards in half, so I don’t go into full withdrawl and have a gloved-finger-siezure.

      Yep. I’m getting to retirement one guaiac card at a time. I have 768 to go. Maybe if I send them to the lab, I could get into the guaiac card hall of fame….

      • Aaron says:

        Its amazing the way that to help patients doctors can be compelled to act like drug seekers who act to the detriment of patients.

    • Soronel Haetir says:

      Because it’s the admins who make the decision and the docs who have to live with it?

  10. Dave says:

    I guess the problem with guaiac cards is everywhere. I actually went to our lab to get “certified”. The test material (a lab tech told me he thought it was it was bean curd mixed with blood) turned the card the strongest positive I’ve ever seen. Still have to sneak hemoccult cards out of the lab.

    Being on the infection control committee, I asked our IC nurse to get me a copy of JCAHO’s manual on monitoring handwashing compliance. I was expecting something abut 10 pages long. The printout was over 240 pages long. JCAHO is totally out of control, and there’s a whole layer of personnel that suck up health care dollars just to deal with them. But they sure do drive fear into the hearts of everyone who has to deal with them.

  11. ERP says:

    Now wait. You may be accused of harrassing the nurses who have “faecophobia” and creating an unpleasant work place.

  12. Rob says:

    Our hospital no longer allows anyone to read these cards. They all have to be sent to the lab as well. But your log book is an example of the bullshit we have to deal with in the lab every day. We have to keep all that information that you have in your log book for every single test we perform. The worst part of it, is that we have to keep these records indefinitely. Having these records in a computer isn’t good enough, they all have to be physical documentation records kept in some mysterious warehouse somewhere. My job has bascially become all about compliance with regulations and has nothing to do with patient care. There’s no reason for anyone with an education to work in a lab. Everything is so over regulated that there’s no room for common sense or professional judgment any longer.

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