International Hospitals in Udon - Poor Clinical Competencies

I wasnt going to post this, rather just write to the 2 major Int Hospitals here in Udon to complain about poor clinical competencies that have occured to me in the past 2 days.

Its not a rant , and has already been reported to both of them in a professional manner.

Firstly, I was admitted for oral cavity dental care for an GA and overnight post op stay.

The nurse came in to start an IV line and was only wearing 1 glove for the cannulation , It is normal practice to wear 2 gloves to protect the patient and the clinical provider, needle stick injuries are high risk and can lead to massive complications. Very politely ask her to wear another glove for the procedure, which was then done without any further issues.

Post op, a nurse came to the bed side to administer some IV drugs thru the IV Line. She started to commence this, when i asked her to stop, and advise what she was doing, she said it was antibiotics, and I said how do u know, there are no labels / ampoules attached or with the syringe and u havent even checked my name, the IV line, or asked me for for any drug reactions etc, I told her it was just normal saline and ask her to see the packaging.

When giving any drug, all Nurses / Paramedics, have to ask the International 5 R's

Right Patient ( incidently my arm band and the IV label were not compatable )
Right Drug
Right Day
Right time
Right route of administration

Theese 5 R's are put in place to reduce the incidence of incorrect drugs being administered to patients, which is a major well published problem world wide. People die from this.

Same thing happened the next morning with a different nurse .

So its time for the discharge and the IV needs to be taken out, it still has some blood in the cannula when it removes so again another major bio medical contamination is possible.

This time the nurse isnt wearing any gloves at all and was told by me to get some gloves or i will take it out myself.

So after 4 near misses , I needed to also get a blood test done for my work visa.

Thought i would see a friend at another International hospital and choose to go there instead, after the poor show over the last 2 days.

Checked into the general medicine counter and was told, to follow the Pathology nurse , who had my patient notes in her hands.

Walked to the specimen lab and sat down as she opened my folder and she stuck 1 glove on, no prewashing of hands and then prepared to swab my arm with an alcohol swab, with 1 glove on, she then attempted to start the cannulation process by swabbing the arm and then pressing on the vein with her incovered hand and contaminating the swabbed area again. She was asked by me to stop reswab and wear 2 gloves, some small language issues arose, but soon sorted.

She took the blood and then placed the 10 ml syringe with an uncovered needle with a blood drop still on the end of it, onto the normal desk and allowed the needle and blood to come in contact with the desk surface while she removed the torniquet and put a cotton bud and tale over the access site , then she injected the sample blood into tube to be given to the lab. The needle was left touching the desk for approx 5-6 seconds.

I stopped her and tried to say, its now contaminated and cant be used. That table has probably had 50 odd patients on it that day already and all subject to her poor aseptic technique. Was somebody elses blood directly on the same site my used needle was ?

International desk got ask to come and assist and the Pathology Nurse didnt understand my issue.

Translation back to me was the desk was cleaned with alcohol that morning, and my reply was 5 hours later is covered in bugs from other patients and my blood has been contaminated.

Bottom line was, it was taken again.

Many of you may ask whats the problem, well these procedures are so shoddy they deserve to be identified professionally which they will be.If any of my students started to commence any of the above practices, they would have failed immediately , as aseptic techniques are critical in any invasive care.

I have checked with my Ajarn friends at Nursing Colleges and its not acceptable practice by any means.

To every one of you that needs to have blood tests, or an IV line started make sure the Nurse / Clinical provider is wearing gloves on both hands, Infection is a 2 way street and I assure you needle stick injuries are common, and probably not that well reported in Thailand. It even applies to glucometers.

Dont be afraid to ask basic questions about your treatment, as i did and I found gaping holes.

Now i know why Bumrungrad is more expensive, they use gloves on both hands, have far better blood collection techniques using vaccum tubes and 1 retractable needle that cant stick into you or the nurse.

Thanks for the heads up Wazza.

Bumrungrad is a PITA to get to but the procedures you highlight someway vindicates my decision to go there earlier this year.

Excellent write up Mr. Wazza. I must ask in your opinion is the issue monetary or just laziness? Maybe a combination of the 2? I think you already have hit on training not being an issue or maybe?

These are curiosity question only.

The cost of a latex glove is probably 2 baht ??? so maybe 1 box per day saved, yep thats the Thai thinking for me.


All these nurses were under 30, so i dont think its just complacency from years of doing it this way, therefore its the correct way.

I did have a form filled out by an International Coord, it was in Thai, so i still dont know what i really signed off on, thus my letter following it up.

Since I had some bad experiences concerning dental work, I avoid the two int. hospitals and now go to other places. Sometimes this means bringing a book and waiting for my turn. But it also means getting better quality and service for a lower price.

When I lived in Bangkok over 5 years ago,we used Bumrungrad for all our medical need.

If you go to the dental there,you need to tell them that you do not want a cleaning,unless you do!

Because the initial appt.,they will only clean and x-ray,the charge was 1500 baht at the time,then they would give another appt,say to extract a tooth,another 1500 baht.

I told the dentist at my first appt to ''just pull the tooth'',he said ''A different dentist does that''!

They didn't inform us that this was their procedure!

I felt scammed!

Dental care is expensive at the international hospitals and too be honest what I had done was excessive as I was sure that it was due to lack of due diligence on their part. I also choose a dentist privately and have experienced far superior service.
With regards to the competence of the staff, I have never felt that any staff who have treated me over the years, were anything but professional in their treatment and their own competence, coming fromm a medical family I am only too well aware of the standards and what I expect, they have never failed to impress me.
it may be a change of staff recently has caused a gap in proceedural competence and also in supervisory skills, but I am sure that will be addressed.
One could say that a person is being to picky but it certainly does raise eyebrows when a nurse ( or was it a nursing auxilary) was dispensing Saline instead of antibiotics, I must say.

KP

The Nurse didnt dispense Saline, I said, it could have been to her, as it wasnt labelled or checked prior to admin.

Basic drug checking wasnt done and thats how people die so easily when the Nurse preparing the drug, is distracted , called to another patient, picks up the wrong kidney dish and the rest is history.

Doesn't anybody remember the Irishman that was in the hospital at Paolo,he had someone else chemotherapy drugs hooked up to his IV?

He said they nearly killed him!

Bumrungrad dental clinic is the worst i've ever been to, a real horror story. i frankly don't care for the whole hospital, overpriced and full of themselves.

been to aek udon dental, just fair, and overpriced. panterv???/paolo, little bit better, but still overpriced. nobody seems to have a clue here, more salesperson than medical attendants, trying to push something i don't want or need. sadly, with no training, i find myself more knowledgeable than them, that's really sad. when getting service, also do the same as wazza, double check all their procedures and read everything before hand or allowing them to do anything. once had a iv, with 3 med administered via 4 way hub. she didn't attach the last one too good, as it was sucking air in, just what i need, so i pinched it off, and ree tracked her down, by the time she got back, the iv tube was half full of air. just gave her my 'how f'g stupid are you look', and she fixed it and walked away, trying not to show any feelings, though i know she sh*t herself when she saw my predicament. you really have to pay attention, or they will try to kill you.

Yes , and had they done the right checks,

Right Drug ! it wouldnt have happened,

Stan, it just proves that basics arent been done even after a major near miss like that a while ago.


Scratch the surface and its dangerous.

Geez LA , an air embolism isnt the nicest thing to get, at least ur in hospital to get treated for it !

a heads up penicillin based antibiotics, even though same base, not advisable to mix, especially cipro and very especially norafloxin, great care with this one. also if switching, need to go a couple days without any, as it bonds to your cells and not out of the body that fast, as i tried to kill myself one time, switching from cipro to norafloxin, with only one day in between. a fun day imobilized in bed, talk about distressful. though my only f'up in so many years of self medding.

very few docs have asked me here, if taking or allergic to med, before administering or prescribing

I wrote recently about my experience in Panyavejinter, basically the same shoddy handling of my baby... it was pure luck ONLY that he never became ill afterwards... On the 24th i have another appointment, i really hope they have sorted their procedures out by then, but fear sadly they will not have!!!! if i take him to AEK will he be handled in the same (dangerous) way???