Tuesday, July 8, 2014

A Freak Diaper Change Accident With Unforeseen Consequences

Stax Splint from Urgent Care
          No, it didn't happen while I was changing my own diaper, but this freak thing happened in the business of caregiving. In the annals of medicine, I challenge you to find anything close to what happened to me while changing a diaper (or continence care product, as my company wants it to be called). Sure, you can jam your finger at anytime or anywhere, but on a diaper or on bedsheets? Probably only I can experience that even though I don't consider myself accident prone. This happened at 3:00 a.m. While pushing a diaper under a residents' body to remove it and replace it with a clean and dry one, I heard a pop and thought it was just a sound made when you crack your knuckles. So I didn't think too much about it and continued to give care to the resident. It was only several minutes later when I finally took my gloves off that I noticed the topmost knuckle of my left middle finger was bent at a right angle. My first thought was that I broke my finger! I tried to straighten it back in place but it just returned to the bent position. So I went to my lead care manager, showed the finger to her and told her what happened. She went to find a tongue blade and some tape and fashioned a splint out of them (she is a nursing graduate from the Philippines).
Tongue blade splint
          I then filled out an employee incident report and asked her what I had to do next, like how to obtain a authorization for treatment form so I can be examined at the urgent care clinic that our facility uses. She didn't know and neither did the lead care manager a floor below, nor the maintenance/security person. The consensus was for me to go to the wellness office at 6:00 a.m. when the nurse arrives. In the meantime, I managed to finish my shift, being careful not to poke the residents with the stiff middle finger with the tongue blade splint, nor injure the finger any further. Fifteen minutes before the end of the shift, I called the acting coordinator for the unit or neighborhood I work in and left a voicemail message asking how I should proceed, since I'm not yet familiar about how they do things, having just started working there the month before. When I went to the wellness office, nobody there knew about obtaining the treatment authorization form and I was to call back at 8 or 9 a.m. to find out. So I clocked out and went home to get a few winks in. A couple of hours later, I got a call from the wellness nurse giving me a toll free number to the Nurse Hotline of Sedgwick, the company that handles workman's compensation claims. I was directed to go to an urgent care clinic closer to home. I had to wait for them to email me the authorization form (which was initially sent to the wrong email address) before proceeding to the clinic. The urgent care clinic was surprisingly empty and the doctor was trying to fix the TV antenna to get a better reception to the World Cup. Meanwhile the medical assistants were debating whether I actually got proper authorization since the place I work wasn't on their list, and they couldn't input my data on the computer. The doctor told them to just do it on paper and clear it up on Monday. Then he asked me to take off the makeshift splint and the moment he saw my finger, he said "Oh, that's a mallet finger". I spelled out m-a-l-l-e-t for him and asked, that kind of mallet? He said yes. I guess it's because the finger is shaped like a mallet (darn, I should have taken a picture of that!). Here is a pretty simple explanation of what it is: http://www.patient.co.uk/health/mallet-finger . X-rays were taken of my hand and there was no evident fracture other than the ruptured tendon. It appears like this is quite a common injury since there are prefabricated finger-shaped splints of different sizes in the urgent care clinic already, but I doubt that it's common in nursing or caregiving circles. So the doctor found one to fit my middle finger, attached the new brace, and recommended that I be on modified duty. Unfortunately, I found out later, he failed to specify what I'm allowed and not allowed to do on the release form.
          Meanwhile, I'm in trouble with my supervisor. In 34 years of working, I'm charged for the first time ever with a no call/no show at my job because the supervisor was not properly notified that I would not be at work on Sunday night. I never got a definitive answer whether they covered my shift or not after the injury. Apparently I called the wrong people, the incorrect number and left a message with the incorrect voicemail. My supervisor said I should have persistently called her cell phone until she answered. I didn't do that because I didn't want to pester her after thinking that one voicemail at her office phone was enough. Not wanting to be labeled as pushy or a pest, I didn't make repeated calls and just waited for a response that never came. I even called the unit a few hours before my scheduled time to check if the supervisor left any word about covering my shift. There was none. Now I know better. Because I didn't show up for work, I left my co-workers inconvenienced because they were short one person for the shift with more than 30 residents to look after in addition to their housekeeping, dining room, and laundry duties. In retrospect, I should have just shown up, did the work as best as I could, or gone home if someone was there to cover me. Let's just charge the miscommunication a result of the long 4th of July weekend.
          In any normal industry, when an occupational injury happens, the point person or department is Human Resources who coordinates with the supervisor, but in this job, things are different as I'm painfully learning now.
          I'm supposed to wear the finger splint for two months which is the amount of time needed for the tendon to reattach and heal. An initial follow up with the doctor is scheduled for July 14th. I'll be returning to work on the p.m. shift on July 10th and we will have to see what I'm be able to do without being too useless to my co-workers.

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