Nurse Needlestick at Pediatrician -- WWYD

[Zukini]

We are leaving the pediatrician's office today when nurse C stops us and asks us to wait in the waiting room. She was on the phone with someone, I'm guessing now a supervisor or such. She steps out to find us and explains that apparently, nurse A or staff member B (whom I asked nurse A to get as back up because DS is not cooperative, he kicks and screams) who was in the room while administering an MMR vaccine to DS had a needle stick incident. I didn't hear nor see anyone get stuck, as I was laying halfway across DS upper half to keep him still. I was not aware until Nurse C, who was not in the room, told me.

Fast forward a few hours, and we are in a meeting with our attorney on something completely separate and Nurse C calls me. She wants us to come back into the office for them to test DS for several things, now and 6 months from now. Guessing hepatitis and HIV. He has been a patient of this practice from newborn, is fully vaccinated, comes from a low risk home / family and has never had anything more concerning than an ear infection. Mentioned it to the attorney who also takes his kid to same Pediatrician, and he pointed out what's good for the goose is good for the gander. I take that to mean I should be looking for blood draws from the nurse as well - since I didn't observe what happened, how do I know what order the needle poking happened...

So I'm calling back tomorrow to understand what the incident report said, what their standard operating procedure is, maybe speak to a practice or nurse manager or his pediatrician?, ask for access to blood testing results for not only my son but also the affected staff member... how do I word this? Is there anything else I should be asking for, even documentation wise? How might this affect his medical record?

[Zukini]

Backstory - DS is 3yo, and entering the local public school system for early education services. He has autism spectrum disorder and sensory processing disorder. He is working on his verbal skills, but is at nana-dada-hi-bye-ball-car level of expressive speech. He cannot indicate where or how many times he may have been stuck. We had to practice several times for today's office visit with his play doctor kit -- a simulation of being poked by the needle and running through what would happen. Still, today's visit upset him greatly. I'm dreading one or two more visits so close...

We recently had another extra needle stick, two actually as his veins kept rolling and they couldn't draw enough blood. This was to draw blood for the MMR titer - result was that he didn't have enough immunity for measles hence today's visit. We are actually current on all vaccinations and this may never have been discovered except for a paperwork "technicality" that we and his ped were aware of but didn't expect to deal with till closer to kindergarten. His first MMR vaccine was at 11 months due to extended travel, and school system required 12 months. Hence the titer, hence the shot today. I'm exhausted - we've been doubling up on therapy sessions cause we are about to leave for 8 days before school starts in two weeks. Dealing with this is not what I had planned but we want to do the right thing.

[calebsmama03]

I would be seriously annoyed by the situation but I would comply with the request. Even though they are sure to know the risk is low, it will put the nurse at ease to know for certain. And it may actually have serious consequences for her health insurance wise? I don't know the HIPAA regs around separation of injury and accident reports vs personal health care records. Overall it's a minor inconvenience for me and my child so I would do it. I don't think it is unreasonable for you to ask for documentation from her (him?) if they cannot prove the needle was sterile when used on your child and that the stick happened after. I wouldn't expect it to affect his record at all since it will just be a negative test result.

ETA I just read your update re his being on the spectrum. That definitely makes it more than a minor inconvenience but I would still do it. I'm sorry you're having to deal with this. What a pain!

[infocrazy]

Probably a long shot but what happened to the blood from the blood draw? Is it possible that they still have it and could test that?

[lalasmama]

Coming at this as a previous pediatric medical assistant for somewhere in the neighborhood of 12+ years....

We are leaving the pediatrician's office today when nurse C stops us and asks us to wait in the waiting room. She was on the phone with someone, I'm guessing now a supervisor or such. She steps out to find us and explains that apparently, nurse A or staff member B (whom I asked nurse A to get as back up because DS is not cooperative, he kicks and screams) who was in the room while administering an MMR vaccine to DS had a needle stick incident. I didn't hear nor see anyone get stuck, as I was laying halfway across DS upper half to keep him still. I was not aware until Nurse C, who was not in the room, told me.

First, thank you for letting them know upfront that he needed extra help! Parents tell us all the time, "Oh, he'll stay still!" when it's obvious they won't, but they don't want to scare him. It's going to suck and be scary with or without extra help in the room, but I honestly appreciate when a parent tells me to get help! As far as not seeing/hearing a needle stick, I've had a few in pediatrics specifically, and the parents have never been aware until we stopped them on the way out. There's 3 common ways this happens--trying to engage the "safety" latch on the syringe after use, an unexpected movement from someone causing the syringe to be bumped in an unanticipated way (most commonly a wayward kick from a mad kid when I thought I had cleared the "hit zone"), or an over-full sharps container. I've had needle sticks each of the above ways.

Fast forward a few hours, and we are in a meeting with our attorney on something completely separate and Nurse C calls me. She wants us to come back into the office for them to test DS for several things, now and 6 months from now. Guessing hepatitis and HIV. He has been a patient of this practice from newborn, is fully vaccinated, comes from a low risk home / family and has never had anything more concerning than an ear infection. Mentioned it to the attorney who also takes his kid to same Pediatrician, and he pointed out what's good for the goose is good for the gander. I take that to mean I should be looking for blood draws from the nurse as well - since I didn't observe what happened, how do I know what order the needle poking happened...

The testing is standard procedure in a needle stick. You are correct about what they will order--a Hep panel, and an HIV panel. It is 100% your choice whether to get this done. We are instructed to ask, so that we know up front if there was some exposure (say, for instance, HIV, so the anti-viral could be given immediately). The nurse will get the same blood work, along with a few others (typically, a urine drug screen, and maybe liver function testing). While you know he's 100% healthy and doesn't have anything, and while it sounds kind of silly, they aren't allowed to look in his chart to see that he's been 100% healthy. They aren't even supposed to use their personal knowledge of you/patient/family to distinguish possible risk. On a side note, kind of offended by your lawyer. Sounds like he/she suggested that the nurse poked herself with the needle and then poked him? No nurse in their right mind would do that. If it happens before we poke a kid (it's happened to me--I thought the other assistant had kid's hand, and she thought mom had it, and kid swiped at me and hit an uncapped and ready-to-go needle straight into my hand), then we all stop and go redraw. And, in that case, they wouldn't be asking you for a sample from your child, because that wouldn't be a "dirty" needle stick. I really don't like professions that call into doubt the scrupulousness of other professions :-/ Just not cool in my opinion.

So I'm calling back tomorrow to understand what the incident report said, what their standard operating procedure is, maybe speak to a practice or nurse manager or his pediatrician?, ask for access to blood testing results for not only my son but also the affected staff member... how do I word this? Is there anything else I should be asking for, even documentation wise? How might this affect his medical record?

This will vary a little bit depending on how your state does it. In my state, the source blood (patient) testing does not go in the patient's medical record as needle stick testing, however, the results may end up in the medical chart. We don't even put it in their chart that they were a part of a needle stick. Personally, I would refuse to let my test results, as the "victim" of the stick, to be handed out to the patient/parent, and would be fully ready to defend my position in court. First, it's not standard operating procedure. Second, that has private information about me, and enough to start potentially stealing my identity. Would you like that nurse to take home your child's medical test record (name, birthdate, home address, other identifiers)? No? But you want a copy of her's? As your lawyer said, "Turn about is fair play," right? Third, if you think she would be willing to poke your child with a dirty needle, then you really need to be finding a new pediatrician's office.

Backstory - DS is 3yo, and entering the local public school system for early education services. He has autism spectrum disorder and sensory processing disorder. He is working on his verbal skills, but is at nana-dada-hi-bye-ball-car level of expressive speech. He cannot indicate where or how many times he may have been stuck. We had to practice several times for today's office visit with his play doctor kit -- a simulation of being poked by the needle and running through what would happen. Still, today's visit upset him greatly. I'm dreading one or two more visits so close...

This makes my heart hurt. I know plenty of children (teens, even some adults!) just don't have the ability (maturity, really!) to see that we are more than just the needles I went into this profession because I love kids, and love getting to help keep them safe and healthy. Again, as I said above though, I think it's over-reaching to jump straight to the conclusion that he was poked, she was poked, and then he got poked again. For that to logically happen, someone would have ended up with scratches, and it would have been evident immediately to everyone involved.

We recently had another extra needle stick, two actually as his veins kept rolling and they couldn't draw enough blood. This was to draw blood for the MMR titer - result was that he didn't have enough immunity for measles hence today's visit. We are actually current on all vaccinations and this may never have been discovered except for a paperwork "technicality" that we and his ped were aware of but didn't expect to deal with till closer to kindergarten. His first MMR vaccine was at 11 months due to extended travel, and school system required 12 months. Hence the titer, hence the shot today. I'm exhausted - we've been doubling up on therapy sessions cause we are about to leave for 8 days before school starts in two weeks. Dealing with this is not what I had planned but we want to do the right thing.

If you decide to let him be tested (and again, you don't have to consent, and they can't do anything), then I would make an effort to have him seriously hydrated, and go to a children's hospital for the draw if at all possible. Hydration can help calm down rolly veins, and having someone who does tiny little veins, and sick little veins, and newborn little veins, and special-needs little veins can be immensely helpful and less traumatic.

Were you as concerned/cynical about the chance that your son was poked with a dirty needle before talking with your lawyer? Just a general question to think about, because, like I said before, I kind of think that calls into question the comfort you may or may not have with your pediatrician's office.

Again, not trying to sound harsh, and I'm truly sorry if it comes off that way! Needle sticks are just such a common thing to deal with, and I just hate to see my former profession's ethics called into question.

[Zukini]

Thank you all so, so much for your insights. I will ask about the blood drawn from the recent titer, but I doubt the lab keeps samples much past a few days and it's been a couple weeks. We will, in good faith, go in and comply with the request for the blood testing - and yes, I will ask about having the draw done at the children's hospital. We are definitely fans of this practice, and while nurse A and B weren't on my usual doctors team, Nurce C is familiar. I didn't mean to come across, and I apologize for it seeming so, that we are super focused on the needles part of it. The nursing and admin staff at this place are pretty awesome. We are really hands on with explaining processes to DS and even pausing the staff to introduce everyone - which we did today. I stooped down to his level and we all introduced ourselves despite the tears.

I was surprised at the attorney's comment too, as I never for a moment thought about it in that way until he said it. But really, no rational health professional would do something like that. It made me pause as the actual vaccination happened so fast once we got him on the table, that I was really scratching my head for when the needle stick occurred. And I certainly didnt visualize that it could have happened while trying to recap the needle etc. thank you for that perspective.

[mommy111]

1) your poor baby! I am sorry
2) your lawyer is an ass
3) if you're seriously concerned that the needle stick may have happened before your child got the shot (as Lalasmom pointed out above, extremely unlikely), you can totally ask for the nurses test results and they will give them to you. Not her name etc but just the results. If it gives you peace of mind, ask for them!
4) if it helps to know, risk of any infection transmission with a vaccine shot is very very very low

[HannaAddict]

I don't think for a second that the lawyer meant that nurse stuck the child as retaliation or at all - no idea how that was derived. The comment good for the goose, good for the gander, I took to mean if the child was being tested then the nurse who was stuck needed to be tested as well. Lawyers protect people's rights and all he meant was that the nurse should also be tested which it sounds like is common practice.


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[mommy111]

I don't think for a second that the lawyer meant that nurse stuck the child as retaliation or at all - no idea how that was derived. The comment good for the goose, good for the gander, I took to mean if the child was being tested then the nurse who was stuck needed to be tested as well. Lawyers protect people's rights and all he meant was that the nurse should also be tested which it sounds like is common practice.


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I don't think anyone said the lawyer suggested retaliation.....at least I didn't mean to say that. He implied the nurse lied and that she was stuck first followed by OPs DS.

[JBaxter]

I don't think so either. I think his/her "law brain" kicked in to make sure the nurse was stuck AFTER the injection was given and she did not continue with the immunization after she had stuck herself. We would all like to think our health care professionals are that ... professional but its not always the case. Sometimes in the heat of the moment things happen. I would ask for an account of the incident before agreeing to the blood draw. I would also like to see the nurses blood work and you may ask for and email or letter stating that before agreeing to your childs blood draw. Is all that over kill probably but its your child and that blood draw is going to traumatize the hell out of the child. This might sound horrible and I have a family of nurses & health care professionals but I would have to really consider it before agreeing to it.