Better care at urban hospitals?

Sloppy syringe practices in High Prairie may highlight lax rural standards: doctor

By Cigdem Iltan And Darcy Henton, Edmonton JournalJuly 22, 2009



A northern Alberta hospital's former practice of recycling syringes may be an indication rural hospitals don't provide the same level of care as hospitals in urban settings, says the chief of the Health Quality Council of Alberta.
"This is one of our underlying concerns. If you are willing to do procedures that require constant updating, then you've got to be prepared to assume that additional responsibility," Dr. John Cowell said Tuesday.
Isolation and the "culture of conformity" in the operating room were the main reasons why nurses and physicians at the High Prairie Health Complex reused single-use syringes for patient IV lines in the hospital's endoscopy unit, said a report from the Health Quality Council of Alberta released Tuesday. Last fall, health officials began the process of testing 2,700 former patients for HIV and hepatitis after a senior nurse made the discovery.
"The physicians and the nurses were operating in a semi-isolated fashion. They were marching to the beat of their own drum if you will, as opposed to participating in the general practices of the facility," Cowell said.
The hospital had used single-use syringes to give multiple doses of medication to different people since 1990 in the recovery room and since about April 2004 in the endoscopy suite, despite being told to stop the practice, he said.
"They received a directive saying change your way and they just carried on doing what they've always done," Cowell said.
The physicians' and nurses' practice of sticking to old habits is not limited to High Prairie, and exists at other hospitals, too, especially rural hospitals, he said.
"An endoscopy should not be done in a rural setting if they can't do it at the same level and quality of safety as in an urban setting," Cowell said.
The report recommends closer monitoring of rural health-care centres and annual education reviews at minimum for health professionals.
Rural hospitals are just as capable of delivering adequate health-care services as urban hospitals, said Friends of Medicare executive director David Eggen.
"Certainly there is a narrower scope of procedures that can be done in a smaller place, but ...a rural hospital can be a decided advantage for someone who lives closer to it than in the city," Eggen said. "People shouldn't be steering around rural hospitals just because this story came up."
So far, there is no evidence that reusing syringes at High Prairie caused the spread of HIV and hepatitis in the northern Alberta community, Health Minister Ron Liepert said.
The medical advice his department has received suggests the level of those diseases in that community are not out of line with the norm, he said.
"The real good news is pretty much all of the testing has been completed in High Prairie and although there are instances of individuals that have tested positive for HIV and hepatitis, there has been no ability to link any of those diseases with the issue around the reuse of syringes," he said.
"It's one of those things that you can't ever be 100-per-cent certain, but I am confident that due diligence was done."
Liepert refused to blame doctors or nurses for not following the protocols, but said the lesson learned is there should be better monitoring to ensure that when new standards and policies are prescribed by his department, they are followed.
"Obviously, the review the Health Quality Council has completed found that was not the case and going forward we're going to do a better job of ensuring that the monitoring takes place and that new standards are followed," he said.