Safety of care
Keeping a sharp eye on sharps
An article for for physicians by physicians
Originally published March 2004 / Revised April 2008
The proper disposal of materials such as sharps is important.
Of interest to physicians doing procedures
As with any tool used in a physician's office, a sharps container is only as useful and safe as the user. The following case demonstrates the danger of improper procedures for disposing of sharps.
A physician prescribed intravenous therapy to patients, which was then administered by registered nurses in his office. The nurses were employed by the clinic that was owned by the physician.
On one occasion, the nurse inserted the IV catheter, withdrew the needle and maintained pressure over the catheter and venipuncture site. She dropped the needle in the sharps container, but didn't actually hear it land. Maintaining control of the venipuncture site, she carried on with securing the catheter and initiating the flow of the IV therapy. She then took a quick look around for the needle, but when she did not see it, she concluded that it was in the sharps container.
Once the procedure was finished, the patient retrieved his shoes from under the chair, put them on and went home. The next day, he called the clinic to complain that he had found a needle in his shoe and that it had poked him in the foot. On examination, there was evidence of a puncture wound, and he had the offending needle in a plastic bag. The patient started a legal action claiming damages for anxiety caused by the fact that he did not know the source of this needle.
Other physicians performing similar procedures in their offices were asked to provide opinions on this matter. None were able to support the procedures, nor were nursing personnel able to support the nurse's approach. Accordingly, the case was settled in favour of the patient, with payment made by the CMPA on behalf of the member physician.
The lessons to be learned from this cautionary tale:
- It is important to confirm that material to be disposed in a container has actually been properly inserted into the container. A cursory search for a missing item is likely to be considered inadequate.
- A physician does not have to carry out the procedure personally to be found liable for a bad outcome. The principle of "vicarious liability" assigns responsibility to the employer of the person who actually caused the harm. The employer is expected to have properly trained employees who carry out their duties with appropriate diligence.