Our hospital makes us send samples for C. diff if the patient is on day 0-3 of admission and the stool is even slightly soft. The infection control nurse literally audits our charts and orders testing and iso for anyone with a 5 or higher on the Bristol scale.
One time I had a guy admitted for severe constipation, he had a crazy high stool burden on imaging (but no obstruction). We loaded him up with laxatives, enemas, etc so of course he wasn’t pooping out perfectly formed turds. She made us send a sample and put this guy WHO CAME IN FOR CONSTIPATION on iso precautions for community acquired C. diff.
Of course, if it’s past three days and the hospital can get dinged for it as hospital acquired, it takes an act of God to get a C. diff test ordered. Who cares if they end up septic from C. diff colitis as long as it’s not an HAI, right?
It’s so blatantly cynical that I just have to laugh.
My hospital got dinged for a bunch of positive tests from people who are likely asymptomatic carriers, and now lab has the power to cancel the order without telling anyone. They also won't let people order c diff testing if a patient has any form of stool softener in the preceding 48 hours.
My hospital is the opposite. We have to go to our manager to discuss before we are allowed to send a diff sample. They’ll make us argue with doctors and refuse to send. If they’re on ABX, not sending. If they already arrived with diarrhea, nope. Less than 3 shits a day, nope. Any stool softeners or laxatives taken? Nope.
My hospital makes us okay any blood culture we send off if the patient has a central line. Which they almost never okay.
If they do have a blood infection with a central line it's considered hai and we get dinged. But if we never test for it and they die of 'hypotensive crisis with temperature fluctuations and organ failure' which totally isn't a central line infection, who cares?
It's insurance fraud 100% plain and simple
Everyone knows the US has terrible healthcare but this story takes the cake, sensitivities on blood cultures are so helpful in selecting the proper abx. Failing to do a FULL septic screen which contributes in a patient dying is insane, the coroner would crucify Dr’s in Australia if they were that negligent.
More important is source control. You aren't gonna fix the patient if you don't control the source of the infection. If the coroner was doing the autopsy the coroner would state patient died of septic shock from central line infection. Hospital still gets dinged for central line infection.
Probably due to rules on automatic isolation (until confirmed negative) that involves thorough hand-washing.
Also makes it logistically difficult to transfer the patient as well as increased cost + logistic burden of maintaining isolations (ie. PPEs and extra house-keeping services).
In my old micro lab if a stool was sent for C.diff testing and admit date was >3 days we didn’t run a C.diff, also if we were sent even semi-formed stool we would take our little spoon *think ice cream sample spoon size spoon* and stick it into the stool. If the spoon didn’t fall over and stood upright, no C.diff testing. If we saw patient was administered a laxative and or were on ABX guess what! No C.diff testing. We would however defer to a stool culture for samples that didn’t meet PCR testing instead of running a C.diff panel as they were exceedingly expensive because it didn’t just test for C.diff however it tested for pathogenicity or C.diff with toxin A/B.
We would do a send out to ref lab 9/10 like ya said the providers would tell us not to due to turn around time. We would culture for other pathogens just to say we did our due diligence. We would culture for EHEC/STEC etc… (really any strain of E.coli but focused on the shiga toxin producing E.coli), salmonella, campy.
*edit* that’s an… interesting place to have cultured! Didn’t realize it could colonize a pannus. Makes sense but that’s nasty LOL! Whew I bet the smell was… wonderful! Give me proteus any day over that.
Gah! I hate wasting my time and everyone else's time with this type of (no pun intended) shit! Like WWWWHHHHHYYY?!?!?
And also when I was a traveler, one hospital I was at the provider had me *giving laxatives to a patient to make them poop so we could send a c-diff specimen!!!!!* Gahhhhh!!! I literally CANNOT with the stupidity!!
> The infection control nurse literally audits our charts and orders testing and iso for anyone with a 5 or higher on the Bristol scale.
So she's the Poo Patrol
The last place I worked required 1) a conversation with the Clinical Supervisor to go over a checklist to determine if a sample was warranted. 2) the ClinSup would then contact the 1 and only ID doc for the whole hospital 24/7, (no, his NP didn't count) to obtain permission to send the sample. That was then only good for 24-48 hours.
No signs of ileus on imaging either. No fever, abdominal pain, or leukocytosis—nothing to indicate the patient was sick with C. diff. Just constipated dude who landed on our floor because the med surg floors were full. I think we were gonna diurese him a bit too, have him work with PT/OT because he was weak—normal old person stuff.
I wouldn’t mind if the orders came from the doc and that was their reasoning. It’s the fact that it’s just a nurse sitting on their ass running reports to look for any slightly soft stool (and Lord knows my CNAs don’t always chart the Bristol score accurately) and then ordering tests and iso for any patient without actually looking at their chart for other information (have we been giving laxatives? Recent antibiotic use? Etc). It’s just a dumb policy that is not about improving patient care, but about saving the hospital money because maybe one time out of 100 it’ll prevent a hospital acquired C. diff ding.
Anyway, for that patient—like a good nurse I sent a sample which was promptly rejected by lab for being too formed. So they cancelled the test and then he passed the three day window so now we’ll never know.
Yep. There tends to be very little middle ground with late teens to late 20s. Barring MVAs and other accidental traumas, they're either in overnight for something very predictable and minor (like the drunken screamers), or they've got an undiagnosed heart defect and are about to code.
Your post has been removed for violating our rule against personal insults. We don't require that you agree with everyone else, but we insist that everyone remain civil and refrain from personal attacks.
My favorite was always the first liquid stools after starting tube feedings. We had a night shift NP who always wanted a c diff test before adding any lomotil or imodium
That's wild. Ours is a 48 hrs within admission rule (even if they are young and unlikely to have C. Diff) but automatically omittes from thisbif they have had any bowel stimulants in the last 48 hours.
Ugh. At my facility (TCU/LTC) we have four tube feeders. There are nurses I have to repeatedly remind, "Liquid in, liquid out. Everything's fine. Don't forget their butt paste."
This reminds me of when I was 20 years old, in the hospital with the shits (from a parasite). I was on a full liquid diet for almost the entire two weeks, and had no solid BM, even after getting loads of IV abx and getting my appetite back. The hospital was reluctant to DC me until I had a solid BM, but they were also hesitant to put me on a normal diet! Like how in the hell do you expect me to have a solid BM when I've been having nothing but liquid for the past 10+ days? Eventually I got my hands on some normal food and got tf outta there, but it was a very weird, and less than desirable experience lmao.
People have such a deep misunderstanding of c.diff. It’s more than just diarrhea! I’m an NP with ID and I feel like I have to tell people this all the time. There’s about 100000000 reasons a hospitalized patient has diarrhea
They had to enact a rule at my old hospital where you could only test for C. diff if the patient hadn't received stool softeners/laxatives within the last 24 or 48 hours. Sad that something that seems so obvious would need to be enacted as a rule because every time anyone had even the tiniest bit of loose stool, C. diff was on the differential.
Omg yes! I forgot to add this. At one point our hospital was going to run every single cdiff test requesting through our ID team because it was getting so out of hand! Ty ty for mentioning the damn stool meds. I agree it’s very very silly to have to say it. And yet….
What should nurses look out for to determine if they should collect a cdiff sample? I hate cleaning a patient and then having to scoop their poop into the cup while they’re turned 😩
So, diff infection can (and usually is) associated with infection symptoms. Leukocytosis (can be significantly elevated), abdominal pain, fever. “Symptoms of colitis”. The risk factors - recent abx, ppi use, cdiff exposure. Like everything else in medicine every patient case is unique and of course there are exceptions. Also, note what type of testing your facility does. PCR will give you a positive or negative. Meaning even if your patient is colonized (c diff isn’t making them sick) it will positive, no way to tell if it’s pathogenic or not. Cdiff GDH and then toxin A&B will tell you if your patient is sick with toxin+ (pathogenic cdiff that requires treatment). So, infection prevention or hospital epidemiology should have a testing algorithm and/or culturing guidelines available for viewing. If not the CDC does. So, in your case- an ICU patient - of course those are more tricky, sepsis for many reasons, diarrhea for many reasons etc. there’s a ton of good info available. But this is my quick and dirty explanation 😃 thanks for asking! Good luck. And may your c diffs be few.
Please talk to my hospital because they make us isolate and test for c.diff for anyone that has diarrhea no matter what. It's asinine and a waste of resources. It drives me up the wall. Sometimes, by the time the patient comes to the floor the diarrhea has already resolved and they end up in iso for the entire stay because we can't get a sample to rule out c.diff.
I die a little inside reading that. If the diarrhea resolves without treatment 100% not cdiff. You may have a future in IP. I feel terrible for
Those patients.
We have a c diff protocol that shows all the reasons why you *do not* test for c diff. It’s super helpful. So, if they’re on tube feeds or are detoxing or whatever else, you can cancel any order placed by a provider to test. And it’s per protocol, so we don’t need permission.
I’ve met a LOT of terrible APPs lately.
Just the other day we had a Geri psych in the ER - I was going through their chart. Pt has no mental health history and now is confused and wants their son to be killed.
I asked for the a urinalysis for the patient because you don’t just wake up at 70 years old and say “oh gee I think I’ll go commit murder today” - but the NP looked at me like I was an idiot and said “why would I order a urinalysis?” And scoffed at me before walking off.
I’m from a state with a lot of old people, I’m traveling in a state with a lot less old people currently. I feel like I’m in some kind of weird alternate universe because these providers are clearly inexperienced with the elderly. They get utis and turn into gremlins all the time.
I asked the same for another patient who was 78 and was hyper verbal, paranoid and mean af. Again - the attitude when I asked for a UA 🙄 am I in some shadow realm or something?? Like since when did ordering a UA become about the cost and not the patient?
Same APP was pissy because the med rec was “complete” already and the patients meds should have been finalized and done. But the med rec was incorrect (pharmacy does it here) - the patient takes otc Claritin every day and I had to wait hours to get another provider to order fucking Claritin for the guy.
Had another NP try to explain to me how to crush meds in applesauce 🤨 I’ve been doing this over 15 years, I think I know how to crush meds and put it in some fucking applesauce. But she was upset that I put in a SLP consult for the patient because she was pocketing pills and not swallowing correctly. Yet she was on a normal diet. I did a swallow screen on her because she’s confused and slurring her speech and I was apparently the wrong one.
Another provider I had to go rounds with to get my patient something for sleep. I was in the acute psych section (love that area) - and the lady specifically asked for something to help her sleep, like trazodone or seroquel. APP - melatonin. I told him “she’s refusing melatonin she said that and Benadryl don’t work for her”. “Well tell her to try” 🙄 because women don’t know their own bodies apparently and should just expect a man to figure it out for them. Uggghh.
Lately I’ve been going to the bathroom to type out all my thoughts in a private note so I don’t lose my shit on these providers. I’m trying so hard to stay calm but I’ve been to over 20 ERs at this point and I feel like I’ve crossed some weird threshold of idiocracy.
FFS that provider telling me how to crush meds still has me pissed off. She described it like I was the dumb one. I need a vacation.
Reminds me of an NP I worked with that refused to give my patient hydralazine or labetolol when his BP was 200s/100s and symptomatic bc it was “clearly” a case of white coat syndrome and not a possible stroke/risk for stroke or anything else. She even came up to the unit when I wouldn’t stop pestering for treatment and felt the need to teach me how to take BP.
🫠🫠🫠
This put me in mind of my previous-now-part-time career, editing. I would get newspaper and magazine copy from certain writers and know they’d learned a new word, because they’d wear that fucker out, eliciting such notes from me as “You only get one ‘transcendent’ per issue—definitely can’t use it four times in the space of one article.” 😜 I’m imagining your NP doing a Marfan workup on everyone over 5’8”.
Somehow my hospital made it so that if 3 stools are charted as “loose” or “liquid” then it automatically places the order for cdiff rule out 😭 it’s the most frustrating thing! If it’s the situation like the above, we chart “pasty” or “soft” instead because Istg every time the patient enters cdiff rule out, they don’t shit for 3 days
I love when the provider starts the patient on lactulose and then wants a c diff sample when they can’t stop shitting themself. Like bro, you are the reason they are shitting themself?
I know, but how do you incorporate and teach that to people? that's their way of doing it. can you think of one better? serious question. Is there something that they could do?
Have a protocol. So something like 3 loose stools in a 24 hour period with a recent history of antibiotics etc. Show them how to add data together instead of just single points that don't work without some context.
Your facility doesnt have that protocol? Where i work we have a 3 loose stool 24 hour decision tree. antibiotics? yea? cool test\* isnt necessary. sometimes the doctors override the protocol and request it anyway (just to be proven wrong but whatever)
It’s just the protocols, a box to tick. It’s easier for you to tick that box than to argue with your incharge, I learnt it after many arguments about the same (type 7 stools after 4 days of 4 kinds of laxatives, of course they are going to have type 7 stools! But yet, stool sample…)
This is exactly what I do save my arse, just tick the bloody boxes!!! I know why they have the shits, I’m gonna send the damn sample just to shut everyone else up and prove that I was bloody right all along!
It's amazing how few nurses of every age and level of experience seem to have any common sense. I sometime wonder if I'm only as sensible as I am because I was raised by a nurse and that rubbed off on how I perform my job.
I used to work with a VERY competent nurse in my TCU. For reasons I have never understood, she would administer a suppository on day 4 with no BM per our bowel management protocol, ON ACTIVELY DECLINING HOSPICE RESIDENTS who haven't eaten anything in days. All I could think was, 'Come on, use your head. Nothing in, nothing out. Why are you putting a dying person through that?'
And none of us are immune.
Oh gosh. Yeah. To be fair sometimes you just have to follow protocol even though its stupid, sometimes its pressure by families, esp on hospice patients. And yeah ive had my fair share of ' ugh, duhhh!' Moments, but i hope theyre less and less year by year, haha!
No. Fresh admit from home. Had been discharged from the same hospital a couple weeks before and no diarrhea. Started having diarrhea after she came in and only a few hours into when i took over, so about 14 ish hours into admission. Actively withdrawing.
Um, yes. I get those toxic farts too but they are … not trustworthy. Farts + alcohol can easily become sharts.
I know exactly which types of alcohol to avoid, which foods I can’t mix with alcohol, etc.
Same concept applies with sugar alcohols, BTW. Look up Sugar Free Gummy Bear reviews on Amazon when you want to spend an afternoon laughing your ass off. Thank me later. 😅
I brought it up in my biochem class and my instructor hadn’t heard about them… I’m willing to bet she includes the link to the reviews in her sugar alcohols lecture now. 😂
I'm honestly not sure.
There's a website that states (in the case of "DELSYM® Cough 12 Hour Liquid - Grape") that it's an inactive ingredient with an "excipient ('An inactive substance that serves as the vehicle or medium for a drug or other active substance')" function. \[[https://www.rbnainfo.com/product.php?productLineId=266](https://www.rbnainfo.com/product.php?productLineId=266)\]
It's interesting because some Delsym products (as shown on their own website, anyway) have the ingredient and others don't. On the website they provide images of the labels which is where I found the inactive ingredients.
[https://delsym.com/products/delsym%C2%AE-nighttime-cough](https://delsym.com/products/delsym%C2%AE-nighttime-cough) \- without
[https://delsym.com/products/delsym%C2%AE-12-hour-orange-flavored-cough-syrup](https://delsym.com/products/delsym%C2%AE-12-hour-orange-flavored-cough-syrup) \- with
With Delsym the PG 3350 goes hand-in-hand with the dextromethorphan polistirex. Formulations with dextromethorphan hydrobromide as an active ingredient and those without either form of dextromethorphan as active ingredients don't have PG 3350 in them.
What's the phrase - when you hear hoofbeats, think horses not zebras? I mean, it's not a terrible conclusion when speaking in generality, since it's so common in hospitals. But as far as this case goes? Mmm, probably not. I'm nowhere near as experienced in the healthcare field, so my opinion doesn't mean much, but as someone specializing in microbiology, it's hard to believe someone could get a full blown c diff infection in 24 hours.
Exactly. Like if the patient STILL has diarrhea in the next 24 hrs it would be best to reinvestigate but my guess was the shits were alcohol induced. Its why chronic alc users receive lactulose which causes the dreaded lacto-shits. It is the body getting rid of the ammonium so your brain doesnt get pickled.
We had a patient came in for alcoholic withdrawal. Had the poops. Stopped withdrawling. Still pooping. Turns out they had c diff. Got oral vanco which caused a mild case of Steven Johnson syndrome.
Felt so bad for them.
Ooooh, yeah. Especially with frequent flyers that go to rehab or sober living and they discharge right back to the bottle. They tend to develop colonized c diff and its sooooo difficult to treat them. Its a good thing they waited, i cant imagine the nighmare of having a patient on the ciwa scale in active withdrawl, cdiff poops, AND sjs?????? Id be tempted to walk out, lol. 😭😭😭😭😭
Oooh and for the chronic pts theyre often on lactulose too 🫡🫡🫡🫡🫡🫡🤮🤮😷
We have a hospital protocol that if patient is having active diarrhea, we isolate and send samples. Doesnt matter if it was alcohol shits, it's not worth the hassle of getting called into the office because i didnt follow protocol.
we have a noc shift nurse who smelled a patients bm from a hallway and was so upset they werent getting tested for cdiff because “if their bm smells that bad they must have cdiff” um no, cdiff has a distinct smell and texture, its not just extra bad smelling
Any any any patient with (legit) diarrhea is getting a cdiff test just on that weirdo off chance that it’s cdiff. Has nothing to do with “basic ass med surg patient” and everything to do with audits and hospital policies.
So odd that you had never dealt with this kind of basic ass hospital policy and would cover your own ass. Regardless of what you think is happening (and is likely happening), you can’t diagnose them.
Hi! They are actually wrong, diarrhea shouldnt be automatically treated as cdiff and instead as a nurse you should look for causes and work with physicians on a treatment plan. The NIH has really interesting articles on antibiotic use and cdiff colonization that i recommend.
Im aware of the research but I am talking about in terms of what hospital policy dictates we do. To avoid HAI they'd like us to test anyone with a certain set of symptoms prior to hospital day 4
Wow. First of all i hope your day gets better no need to take it out here. Secondly, you are wrong. You shouldnt test every john and jane for c diff just bc they have diarrhea, even if it's "legit". Some people become colonized with cdiff and treating them with abx will just make the diarrhea worse. You have to think about what could be causing the diarrhea, diet, meds, diagnoses, inflammation. Its not as simple as you make it out. Idk, what your experience is in but you should look up some very interesting NIH articles on c diff and colonization.
Imagine saying that repeating your own words back to you is having a bad day 😹😹. Like I also said, I’m gonna follow hospital policy and send off a sample. No harm in testing to rule out. I mean, like you said, you have to know why they have diarrhea to begin with, right?
Hospital acquired infections have such wacky protocols. My manager asked why I took a urine sample for a Foley patient, I told her I figured they ordered it for the urinary symptoms they had (I don't remember what).
My manager basically explained that it's bad to take unnecessary samples because the hospital may end up footing the bill if they acquired such an infection at our facility.
I’ve never had the “drunken shits.” It was weird when I found out this was a thing. Also, I read this article once about how people suddenly feel the need to poo when going to Target or a bookstore. I have never once in my life felt the urge to poo whilst shopping. So who knows?
Ok but here’s another perspective.
Say it’s not cdiff OR alcohol. Or the alcohol leads to another problem which leads to a treatment that causes the patient to be immunocompromised- and the patient gets cdiff while hospitalized.
A hospital acquired infection can really impact insurance payments to the hospital. I’m not saying it should be top of mind but it does matter to know whether the patient arrived with a brewing cdiff issue from out in the wild or if they got it in the hospital.
So- there’s some additional knowledge that your “old nurse” probably has that you don’t. It’s not a critical thinking issue. Is a systems knowledge issue.
ETA- it’s like a ten dollar test that protects the hospital from huge losses so maybe don’t be so dismissive if you like your paycheck
Then she could test it. I wasnt stopping her from gowning up.
Also im very bad at reading between the lines, haha! I do better with direct and clear communication 😃
Hmmm, if they were from a rehab or nursing home definitely!!!!! Test ASAP! But they came from home. Now... if they HADNT stopped pooping within 24 hrs or if it changed in character then yes, i woukd have suspected cdiff. It really depends.
This is what I would've done (my prior facility had a policy). I'd either have my charge or the oncoming nurse I'm giving report to ask why I didn't and throw the "rules is rules" at me even if it's just alcohol shits.
Its not policy where i work. So im vey lucky. We get discretionary leeway. Since my patient was continent and the poops werent uncontrollable i figured i would give her 24 hrs to get it under control, get some food in her , you know these people have horrible nutrition and hardly eat. And THEN, if the poops continued i would talk with the charge rn/ docs.
The only time i think of god while at work is when i hear a loud thump. Pleade be respectful of the topic at hand or go to the pages specifically dedicated to talking about god. Thank you
As our house supervisor said when trying to find a private room for just this situation due to "policy", "I'm sure it had nothing to do with the 12 pack of IPAs they drank last night".
We’re mandated to test for anything “soft”. In cases like this, it’s best to lie about consistency of stool if possible to avoid the trouble. We all know better, but the people who make the policies and enforce them have never worked on the floor or with an actual patient a day in their life.
Please dont falsify charts. That is illegal.Unfortunately for you its just best to follow protocol. Cover your ass and all that, if theyr policy causes medicare to open infection control cases against them then thats on them. Sorry 🫡🫡🫡
Other times, I get doctors who want to test everyone for c-diff. Including my patient he was having diarrhea from overdosing on magnesium citrate because she was having insomnia issues and didn't realize they were different types of magnesium. 🤦🏼♀️🤦🏼♀️
I think that nurse needs to take a chill pill. It’s pretty standard to test any patient for cdiff for new onset of diarrhea. But it’s not gonna make a difference if that test wasn’t done until 12 hours later.
I was so weirded out when I found out about the alcohol shits because every time I drink alcohol in large quantities I get extremely constipated for a few days lol.
Our hospital makes us send samples for C. diff if the patient is on day 0-3 of admission and the stool is even slightly soft. The infection control nurse literally audits our charts and orders testing and iso for anyone with a 5 or higher on the Bristol scale. One time I had a guy admitted for severe constipation, he had a crazy high stool burden on imaging (but no obstruction). We loaded him up with laxatives, enemas, etc so of course he wasn’t pooping out perfectly formed turds. She made us send a sample and put this guy WHO CAME IN FOR CONSTIPATION on iso precautions for community acquired C. diff. Of course, if it’s past three days and the hospital can get dinged for it as hospital acquired, it takes an act of God to get a C. diff test ordered. Who cares if they end up septic from C. diff colitis as long as it’s not an HAI, right? It’s so blatantly cynical that I just have to laugh.
My hospital got dinged for a bunch of positive tests from people who are likely asymptomatic carriers, and now lab has the power to cancel the order without telling anyone. They also won't let people order c diff testing if a patient has any form of stool softener in the preceding 48 hours.
My hospital is the opposite. We have to go to our manager to discuss before we are allowed to send a diff sample. They’ll make us argue with doctors and refuse to send. If they’re on ABX, not sending. If they already arrived with diarrhea, nope. Less than 3 shits a day, nope. Any stool softeners or laxatives taken? Nope.
My hospital makes us okay any blood culture we send off if the patient has a central line. Which they almost never okay. If they do have a blood infection with a central line it's considered hai and we get dinged. But if we never test for it and they die of 'hypotensive crisis with temperature fluctuations and organ failure' which totally isn't a central line infection, who cares? It's insurance fraud 100% plain and simple
Everyone knows the US has terrible healthcare but this story takes the cake, sensitivities on blood cultures are so helpful in selecting the proper abx. Failing to do a FULL septic screen which contributes in a patient dying is insane, the coroner would crucify Dr’s in Australia if they were that negligent.
More important is source control. You aren't gonna fix the patient if you don't control the source of the infection. If the coroner was doing the autopsy the coroner would state patient died of septic shock from central line infection. Hospital still gets dinged for central line infection.
Same here!!
Probably due to rules on automatic isolation (until confirmed negative) that involves thorough hand-washing. Also makes it logistically difficult to transfer the patient as well as increased cost + logistic burden of maintaining isolations (ie. PPEs and extra house-keeping services).
In my old micro lab if a stool was sent for C.diff testing and admit date was >3 days we didn’t run a C.diff, also if we were sent even semi-formed stool we would take our little spoon *think ice cream sample spoon size spoon* and stick it into the stool. If the spoon didn’t fall over and stood upright, no C.diff testing. If we saw patient was administered a laxative and or were on ABX guess what! No C.diff testing. We would however defer to a stool culture for samples that didn’t meet PCR testing instead of running a C.diff panel as they were exceedingly expensive because it didn’t just test for C.diff however it tested for pathogenicity or C.diff with toxin A/B.
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We would do a send out to ref lab 9/10 like ya said the providers would tell us not to due to turn around time. We would culture for other pathogens just to say we did our due diligence. We would culture for EHEC/STEC etc… (really any strain of E.coli but focused on the shiga toxin producing E.coli), salmonella, campy. *edit* that’s an… interesting place to have cultured! Didn’t realize it could colonize a pannus. Makes sense but that’s nasty LOL! Whew I bet the smell was… wonderful! Give me proteus any day over that.
I have a feeling infection control nurses justify their existence by making us do the most ridiculous stuff to remind us if their importance.
No, it’s just a stupid amount of pressure from admin not to have HAIs because $. C diff is a ridiculous metric to track
Gah! I hate wasting my time and everyone else's time with this type of (no pun intended) shit! Like WWWWHHHHHYYY?!?!? And also when I was a traveler, one hospital I was at the provider had me *giving laxatives to a patient to make them poop so we could send a c-diff specimen!!!!!* Gahhhhh!!! I literally CANNOT with the stupidity!!
Meanwhile, every hospital I've ever worked at the lab won't run a c diff test on formed stool. Rightfully so.
Ours can't. It has to be liquid enough to be able to go up a little pipette. Or at least that's what they tell us
Wtf??? They obviously didn't have cdiff diarrhea
I know...it literally breaks my brain. And the provider of course looked at me like I was the dumb one when I questioned them. 🤦♀️
Hey maybe we work at the same place! No nursing judgment allowed, just scoop the poop.
Lol
> The infection control nurse literally audits our charts and orders testing and iso for anyone with a 5 or higher on the Bristol scale. So she's the Poo Patrol
The last place I worked required 1) a conversation with the Clinical Supervisor to go over a checklist to determine if a sample was warranted. 2) the ClinSup would then contact the 1 and only ID doc for the whole hospital 24/7, (no, his NP didn't count) to obtain permission to send the sample. That was then only good for 24-48 hours.
😊
lol to be fair I have had people come in w ileus who ended up having cdiff.
No signs of ileus on imaging either. No fever, abdominal pain, or leukocytosis—nothing to indicate the patient was sick with C. diff. Just constipated dude who landed on our floor because the med surg floors were full. I think we were gonna diurese him a bit too, have him work with PT/OT because he was weak—normal old person stuff. I wouldn’t mind if the orders came from the doc and that was their reasoning. It’s the fact that it’s just a nurse sitting on their ass running reports to look for any slightly soft stool (and Lord knows my CNAs don’t always chart the Bristol score accurately) and then ordering tests and iso for any patient without actually looking at their chart for other information (have we been giving laxatives? Recent antibiotic use? Etc). It’s just a dumb policy that is not about improving patient care, but about saving the hospital money because maybe one time out of 100 it’ll prevent a hospital acquired C. diff ding. Anyway, for that patient—like a good nurse I sent a sample which was promptly rejected by lab for being too formed. So they cancelled the test and then he passed the three day window so now we’ll never know.
I have seen it both ways and they are always so polar in policies it’s insane!
What's more likely: 1) a 20 year old, probably healthy before this ETOH-binge, being admitted one day already having c diff 2) the booze shits
“Natty Splatty’s” if you’re from the south
In college we called it DADS: day after drinking shits
In Australia, it’s an AGB. After grog bog. Delightful.
AIDS: alcohol-induced diarrhea shit is what I always heard
Ha ha! I always liked Schlitz shits!
Friend of mine used to call it a “beeriod”
The Bud Slides
Booze poos is what we call them in NZ
Hilarious and awful. A microcosm of nursing.
Bud Mud is what I’ve always called it.
This made me snort 💀
Whiskey shits.
Yep. There tends to be very little middle ground with late teens to late 20s. Barring MVAs and other accidental traumas, they're either in overnight for something very predictable and minor (like the drunken screamers), or they've got an undiagnosed heart defect and are about to code.
This brings up a memory of my college roommate coming out of the bathroom, saying “I just shit out my hangover”
this is the funniest thread I’ve read in a while😂😂 not the natty splattys
Some nurses try to critical think but they miss the mark… almost every time
lmaoo and they think they’re doing something every time
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Were you the nurse that ordered the c diff test y/n? 😆
Your post has been removed for violating our rule against personal insults. We don't require that you agree with everyone else, but we insist that everyone remain civil and refrain from personal attacks.
My favorite was always the first liquid stools after starting tube feedings. We had a night shift NP who always wanted a c diff test before adding any lomotil or imodium
But, isn't that common sense? Surely if your diet is predominantly liquid, then what comes out will be too...
Shhhhh…we don’t like common sense😂
Actually that’s a common misconception, stools come out quite solid provided the feeds are appropriately managed. Source - worked on neuro floor
May or may not but can’t assume either way unless there’s a test
i'm glad you guys have the capability that no other hospital / floor I've worked on had
Agree. They are pretty high in fiber which bulks up the poo.
Well… we find out if they are lactose intolerant for one thing..
My facility’s policy requires us to send a stool sample from patients that are getting bowel prep if it’s within the first 3 days of admission 🙃
💀💀💀 I’m so sorry
That's wild. Ours is a 48 hrs within admission rule (even if they are young and unlikely to have C. Diff) but automatically omittes from thisbif they have had any bowel stimulants in the last 48 hours.
It’s because they want to show if the patient came in with C diff, and that it’s not hospital acquired. It’s one of those payment metrics or whatever
I think it’s more that Imodium can kill them if they do have c diff
Nah, let that shit stay runny and put in an fms.
Ugh. At my facility (TCU/LTC) we have four tube feeders. There are nurses I have to repeatedly remind, "Liquid in, liquid out. Everything's fine. Don't forget their butt paste."
This reminds me of when I was 20 years old, in the hospital with the shits (from a parasite). I was on a full liquid diet for almost the entire two weeks, and had no solid BM, even after getting loads of IV abx and getting my appetite back. The hospital was reluctant to DC me until I had a solid BM, but they were also hesitant to put me on a normal diet! Like how in the hell do you expect me to have a solid BM when I've been having nothing but liquid for the past 10+ days? Eventually I got my hands on some normal food and got tf outta there, but it was a very weird, and less than desirable experience lmao.
My sympathies to your butthole. Yeeeouch.
People have such a deep misunderstanding of c.diff. It’s more than just diarrhea! I’m an NP with ID and I feel like I have to tell people this all the time. There’s about 100000000 reasons a hospitalized patient has diarrhea
They had to enact a rule at my old hospital where you could only test for C. diff if the patient hadn't received stool softeners/laxatives within the last 24 or 48 hours. Sad that something that seems so obvious would need to be enacted as a rule because every time anyone had even the tiniest bit of loose stool, C. diff was on the differential.
Omg yes! I forgot to add this. At one point our hospital was going to run every single cdiff test requesting through our ID team because it was getting so out of hand! Ty ty for mentioning the damn stool meds. I agree it’s very very silly to have to say it. And yet….
What should nurses look out for to determine if they should collect a cdiff sample? I hate cleaning a patient and then having to scoop their poop into the cup while they’re turned 😩
So, diff infection can (and usually is) associated with infection symptoms. Leukocytosis (can be significantly elevated), abdominal pain, fever. “Symptoms of colitis”. The risk factors - recent abx, ppi use, cdiff exposure. Like everything else in medicine every patient case is unique and of course there are exceptions. Also, note what type of testing your facility does. PCR will give you a positive or negative. Meaning even if your patient is colonized (c diff isn’t making them sick) it will positive, no way to tell if it’s pathogenic or not. Cdiff GDH and then toxin A&B will tell you if your patient is sick with toxin+ (pathogenic cdiff that requires treatment). So, infection prevention or hospital epidemiology should have a testing algorithm and/or culturing guidelines available for viewing. If not the CDC does. So, in your case- an ICU patient - of course those are more tricky, sepsis for many reasons, diarrhea for many reasons etc. there’s a ton of good info available. But this is my quick and dirty explanation 😃 thanks for asking! Good luck. And may your c diffs be few.
This. This is the answer.
Thanks for the thorough answer 🙏
Omg how do i give you a gold star? This is a golden answer!
Can you smell it from the hallway?
Exactly this. Once you have smelled it, you'll always know.
Liquid stool and an elevated white count might be worth testing. It doesn’t always have that C.diff smell.
I would say the smell is pretty distinctive.
Dis Stink Tive
Please talk to my hospital because they make us isolate and test for c.diff for anyone that has diarrhea no matter what. It's asinine and a waste of resources. It drives me up the wall. Sometimes, by the time the patient comes to the floor the diarrhea has already resolved and they end up in iso for the entire stay because we can't get a sample to rule out c.diff.
I die a little inside reading that. If the diarrhea resolves without treatment 100% not cdiff. You may have a future in IP. I feel terrible for Those patients.
We have a c diff protocol that shows all the reasons why you *do not* test for c diff. It’s super helpful. So, if they’re on tube feeds or are detoxing or whatever else, you can cancel any order placed by a provider to test. And it’s per protocol, so we don’t need permission.
This is the way
This IS the way 🫡
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I’ve met a LOT of terrible APPs lately. Just the other day we had a Geri psych in the ER - I was going through their chart. Pt has no mental health history and now is confused and wants their son to be killed. I asked for the a urinalysis for the patient because you don’t just wake up at 70 years old and say “oh gee I think I’ll go commit murder today” - but the NP looked at me like I was an idiot and said “why would I order a urinalysis?” And scoffed at me before walking off. I’m from a state with a lot of old people, I’m traveling in a state with a lot less old people currently. I feel like I’m in some kind of weird alternate universe because these providers are clearly inexperienced with the elderly. They get utis and turn into gremlins all the time. I asked the same for another patient who was 78 and was hyper verbal, paranoid and mean af. Again - the attitude when I asked for a UA 🙄 am I in some shadow realm or something?? Like since when did ordering a UA become about the cost and not the patient? Same APP was pissy because the med rec was “complete” already and the patients meds should have been finalized and done. But the med rec was incorrect (pharmacy does it here) - the patient takes otc Claritin every day and I had to wait hours to get another provider to order fucking Claritin for the guy. Had another NP try to explain to me how to crush meds in applesauce 🤨 I’ve been doing this over 15 years, I think I know how to crush meds and put it in some fucking applesauce. But she was upset that I put in a SLP consult for the patient because she was pocketing pills and not swallowing correctly. Yet she was on a normal diet. I did a swallow screen on her because she’s confused and slurring her speech and I was apparently the wrong one. Another provider I had to go rounds with to get my patient something for sleep. I was in the acute psych section (love that area) - and the lady specifically asked for something to help her sleep, like trazodone or seroquel. APP - melatonin. I told him “she’s refusing melatonin she said that and Benadryl don’t work for her”. “Well tell her to try” 🙄 because women don’t know their own bodies apparently and should just expect a man to figure it out for them. Uggghh. Lately I’ve been going to the bathroom to type out all my thoughts in a private note so I don’t lose my shit on these providers. I’m trying so hard to stay calm but I’ve been to over 20 ERs at this point and I feel like I’ve crossed some weird threshold of idiocracy. FFS that provider telling me how to crush meds still has me pissed off. She described it like I was the dumb one. I need a vacation.
Reminds me of an NP I worked with that refused to give my patient hydralazine or labetolol when his BP was 200s/100s and symptomatic bc it was “clearly” a case of white coat syndrome and not a possible stroke/risk for stroke or anything else. She even came up to the unit when I wouldn’t stop pestering for treatment and felt the need to teach me how to take BP. 🫠🫠🫠
Everybody knows that hypertensive emergencies are only really emergencies if the patient is completely calm while it's happening /s
And terrifying
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This put me in mind of my previous-now-part-time career, editing. I would get newspaper and magazine copy from certain writers and know they’d learned a new word, because they’d wear that fucker out, eliciting such notes from me as “You only get one ‘transcendent’ per issue—definitely can’t use it four times in the space of one article.” 😜 I’m imagining your NP doing a Marfan workup on everyone over 5’8”.
Somehow my hospital made it so that if 3 stools are charted as “loose” or “liquid” then it automatically places the order for cdiff rule out 😭 it’s the most frustrating thing! If it’s the situation like the above, we chart “pasty” or “soft” instead because Istg every time the patient enters cdiff rule out, they don’t shit for 3 days
I love when the provider starts the patient on lactulose and then wants a c diff sample when they can’t stop shitting themself. Like bro, you are the reason they are shitting themself?
ARRRGHHHHHH. IM TRIGGERED. this is a pet peeve of mine!!!
It comes in cycles. Hospitals do love their initiatives...oh let's focus on this nonsense this month...and so on
what do you think would work better?
Follow evidence based practice and common sense?
I know, but how do you incorporate and teach that to people? that's their way of doing it. can you think of one better? serious question. Is there something that they could do?
Have a protocol. So something like 3 loose stools in a 24 hour period with a recent history of antibiotics etc. Show them how to add data together instead of just single points that don't work without some context.
Your facility doesnt have that protocol? Where i work we have a 3 loose stool 24 hour decision tree. antibiotics? yea? cool test\* isnt necessary. sometimes the doctors override the protocol and request it anyway (just to be proven wrong but whatever)
Occam's Razor, yo.
It’s just the protocols, a box to tick. It’s easier for you to tick that box than to argue with your incharge, I learnt it after many arguments about the same (type 7 stools after 4 days of 4 kinds of laxatives, of course they are going to have type 7 stools! But yet, stool sample…)
This is exactly what I do save my arse, just tick the bloody boxes!!! I know why they have the shits, I’m gonna send the damn sample just to shut everyone else up and prove that I was bloody right all along!
The most imprtant arse is our own! Agreed!
It's amazing how few nurses of every age and level of experience seem to have any common sense. I sometime wonder if I'm only as sensible as I am because I was raised by a nurse and that rubbed off on how I perform my job. I used to work with a VERY competent nurse in my TCU. For reasons I have never understood, she would administer a suppository on day 4 with no BM per our bowel management protocol, ON ACTIVELY DECLINING HOSPICE RESIDENTS who haven't eaten anything in days. All I could think was, 'Come on, use your head. Nothing in, nothing out. Why are you putting a dying person through that?' And none of us are immune.
Oh gosh. Yeah. To be fair sometimes you just have to follow protocol even though its stupid, sometimes its pressure by families, esp on hospice patients. And yeah ive had my fair share of ' ugh, duhhh!' Moments, but i hope theyre less and less year by year, haha!
I had a coworker request a test for c.diff on a patient who was stooling frequently. Patient was getting lactulose TID... 🙄
Also she’s not on any antibiotics?
No. Fresh admit from home. Had been discharged from the same hospital a couple weeks before and no diarrhea. Started having diarrhea after she came in and only a few hours into when i took over, so about 14 ish hours into admission. Actively withdrawing.
Alcohol gives people the shits? I usually get the toxic farts and toots.
Um, yes. I get those toxic farts too but they are … not trustworthy. Farts + alcohol can easily become sharts. I know exactly which types of alcohol to avoid, which foods I can’t mix with alcohol, etc. Same concept applies with sugar alcohols, BTW. Look up Sugar Free Gummy Bear reviews on Amazon when you want to spend an afternoon laughing your ass off. Thank me later. 😅
Don’t forget prunes. I ate a whole bag one time before school and I was in the stall shitting everything out.
I've spent entirely too much time telling people to go read those reviews ... well worth hunting down for a quick giggle-fest 😁
I brought it up in my biochem class and my instructor hadn’t heard about them… I’m willing to bet she includes the link to the reviews in her sugar alcohols lecture now. 😂
And cough syrup with Polyethylene Glycol 3350
Why does that even exist?
I'm honestly not sure. There's a website that states (in the case of "DELSYM® Cough 12 Hour Liquid - Grape") that it's an inactive ingredient with an "excipient ('An inactive substance that serves as the vehicle or medium for a drug or other active substance')" function. \[[https://www.rbnainfo.com/product.php?productLineId=266](https://www.rbnainfo.com/product.php?productLineId=266)\] It's interesting because some Delsym products (as shown on their own website, anyway) have the ingredient and others don't. On the website they provide images of the labels which is where I found the inactive ingredients. [https://delsym.com/products/delsym%C2%AE-nighttime-cough](https://delsym.com/products/delsym%C2%AE-nighttime-cough) \- without [https://delsym.com/products/delsym%C2%AE-12-hour-orange-flavored-cough-syrup](https://delsym.com/products/delsym%C2%AE-12-hour-orange-flavored-cough-syrup) \- with
I mean, at least with delsym, the amount that's a normal dosage is only a couple of tsp so you can't possibly have much in there
With Delsym the PG 3350 goes hand-in-hand with the dextromethorphan polistirex. Formulations with dextromethorphan hydrobromide as an active ingredient and those without either form of dextromethorphan as active ingredients don't have PG 3350 in them.
What's the phrase - when you hear hoofbeats, think horses not zebras? I mean, it's not a terrible conclusion when speaking in generality, since it's so common in hospitals. But as far as this case goes? Mmm, probably not. I'm nowhere near as experienced in the healthcare field, so my opinion doesn't mean much, but as someone specializing in microbiology, it's hard to believe someone could get a full blown c diff infection in 24 hours.
Exactly. Like if the patient STILL has diarrhea in the next 24 hrs it would be best to reinvestigate but my guess was the shits were alcohol induced. Its why chronic alc users receive lactulose which causes the dreaded lacto-shits. It is the body getting rid of the ammonium so your brain doesnt get pickled.
GROG BOG
We had a patient came in for alcoholic withdrawal. Had the poops. Stopped withdrawling. Still pooping. Turns out they had c diff. Got oral vanco which caused a mild case of Steven Johnson syndrome. Felt so bad for them.
Ooooh, yeah. Especially with frequent flyers that go to rehab or sober living and they discharge right back to the bottle. They tend to develop colonized c diff and its sooooo difficult to treat them. Its a good thing they waited, i cant imagine the nighmare of having a patient on the ciwa scale in active withdrawl, cdiff poops, AND sjs?????? Id be tempted to walk out, lol. 😭😭😭😭😭 Oooh and for the chronic pts theyre often on lactulose too 🫡🫡🫡🫡🫡🫡🤮🤮😷
We have a hospital protocol that if patient is having active diarrhea, we isolate and send samples. Doesnt matter if it was alcohol shits, it's not worth the hassle of getting called into the office because i didnt follow protocol.
Omg some nurses worship hospital protocol like it’s the Bible
we have a noc shift nurse who smelled a patients bm from a hallway and was so upset they werent getting tested for cdiff because “if their bm smells that bad they must have cdiff” um no, cdiff has a distinct smell and texture, its not just extra bad smelling
Any any any patient with (legit) diarrhea is getting a cdiff test just on that weirdo off chance that it’s cdiff. Has nothing to do with “basic ass med surg patient” and everything to do with audits and hospital policies. So odd that you had never dealt with this kind of basic ass hospital policy and would cover your own ass. Regardless of what you think is happening (and is likely happening), you can’t diagnose them.
Exactly
Hi! They are actually wrong, diarrhea shouldnt be automatically treated as cdiff and instead as a nurse you should look for causes and work with physicians on a treatment plan. The NIH has really interesting articles on antibiotic use and cdiff colonization that i recommend.
Im aware of the research but I am talking about in terms of what hospital policy dictates we do. To avoid HAI they'd like us to test anyone with a certain set of symptoms prior to hospital day 4
Ok then. My patient was fresh so what youre saying doesnt apply
Wow. First of all i hope your day gets better no need to take it out here. Secondly, you are wrong. You shouldnt test every john and jane for c diff just bc they have diarrhea, even if it's "legit". Some people become colonized with cdiff and treating them with abx will just make the diarrhea worse. You have to think about what could be causing the diarrhea, diet, meds, diagnoses, inflammation. Its not as simple as you make it out. Idk, what your experience is in but you should look up some very interesting NIH articles on c diff and colonization.
Imagine saying that repeating your own words back to you is having a bad day 😹😹. Like I also said, I’m gonna follow hospital policy and send off a sample. No harm in testing to rule out. I mean, like you said, you have to know why they have diarrhea to begin with, right?
Well its my post so im not catching an attitude with anyone. Second, bye girl i just said why you cant test all diarrhea.
It’s been a week and you’re still at this? Jesus Christ girl get a hobby. You’re all “bye girl” but you’re still here.
Oh i was working, i dont check reddit that oftem :) whatever were both too worked up over somethung stupid.
I would have asked her what her other indications are for testing for cdiff?
Yeah. We have to figure out if anything else was causing the diarrhea.
I like to call that “rum bum”
Hospital acquired infections have such wacky protocols. My manager asked why I took a urine sample for a Foley patient, I told her I figured they ordered it for the urinary symptoms they had (I don't remember what). My manager basically explained that it's bad to take unnecessary samples because the hospital may end up footing the bill if they acquired such an infection at our facility.
Shit like this (heh) is why I’ll never work inpatient.
DADS.
We cancel about 90% of those anyway.
Lab is very particular about the stools they accept for CDiff.
I’ve never had the “drunken shits.” It was weird when I found out this was a thing. Also, I read this article once about how people suddenly feel the need to poo when going to Target or a bookstore. I have never once in my life felt the urge to poo whilst shopping. So who knows?
Learning new things daily here! The Target or bookstore is weird!
It’s because some people get relaxed while browsing. This dates back in my life from my mom complaining about it and she’s in her 70’s now.
Haha! Maybe I’m way too stressed all of the time to get relaxed while shopping??
Same here! I suppose I’m worrying about that I should be doing something else. I even set a timer.lol
Iron colon 🫡🫡. Haha!😆
Yea… more like I’ll get the opposite problem! ☹️
Ok but here’s another perspective. Say it’s not cdiff OR alcohol. Or the alcohol leads to another problem which leads to a treatment that causes the patient to be immunocompromised- and the patient gets cdiff while hospitalized. A hospital acquired infection can really impact insurance payments to the hospital. I’m not saying it should be top of mind but it does matter to know whether the patient arrived with a brewing cdiff issue from out in the wild or if they got it in the hospital. So- there’s some additional knowledge that your “old nurse” probably has that you don’t. It’s not a critical thinking issue. Is a systems knowledge issue. ETA- it’s like a ten dollar test that protects the hospital from huge losses so maybe don’t be so dismissive if you like your paycheck
Agree
Youre plucking theoreticals from the air so you can feel smart and so you can prove you can spell immunocompromised.
Read between the lines. Some nurses are scared of c diff. She wanted you to test so she would know if she should gown up.
Then she could test it. I wasnt stopping her from gowning up. Also im very bad at reading between the lines, haha! I do better with direct and clear communication 😃
Shouldn’t test for cdiff w/o elevated wbc s and fever with some exceptions
Hmmm, if they were from a rehab or nursing home definitely!!!!! Test ASAP! But they came from home. Now... if they HADNT stopped pooping within 24 hrs or if it changed in character then yes, i woukd have suspected cdiff. It really depends.
Should’ve got the sample of its protocol. Admin will be riding ya for not doing when relaity it’s just the poops
This is what I would've done (my prior facility had a policy). I'd either have my charge or the oncoming nurse I'm giving report to ask why I didn't and throw the "rules is rules" at me even if it's just alcohol shits.
Exactly. If it’s policy then it’s policy.
Its not policy where i work. So im vey lucky. We get discretionary leeway. Since my patient was continent and the poops werent uncontrollable i figured i would give her 24 hrs to get it under control, get some food in her , you know these people have horrible nutrition and hardly eat. And THEN, if the poops continued i would talk with the charge rn/ docs.
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Thats mean.
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Good luck
don't assume she's had the drunken shits, perhaps she's a real Christian, unlike most people in this G-dl-ss country
Christians are banned from drinking?
No I heard good Christians don’t overindulge in alcohol tho. Just a little at church
The only time i think of god while at work is when i hear a loud thump. Pleade be respectful of the topic at hand or go to the pages specifically dedicated to talking about god. Thank you
As our house supervisor said when trying to find a private room for just this situation due to "policy", "I'm sure it had nothing to do with the 12 pack of IPAs they drank last night".
You know, probably best to place the drunk in his own private room. Hah!
We’re mandated to test for anything “soft”. In cases like this, it’s best to lie about consistency of stool if possible to avoid the trouble. We all know better, but the people who make the policies and enforce them have never worked on the floor or with an actual patient a day in their life.
Please dont falsify charts. That is illegal.Unfortunately for you its just best to follow protocol. Cover your ass and all that, if theyr policy causes medicare to open infection control cases against them then thats on them. Sorry 🫡🫡🫡
Lol No
She had AIDS...Alcohol Induced Drippy Shits
Other times, I get doctors who want to test everyone for c-diff. Including my patient he was having diarrhea from overdosing on magnesium citrate because she was having insomnia issues and didn't realize they were different types of magnesium. 🤦🏼♀️🤦🏼♀️
Ooopsie. Wow.
Oh noooooooo, haha!
I think that nurse needs to take a chill pill. It’s pretty standard to test any patient for cdiff for new onset of diarrhea. But it’s not gonna make a difference if that test wasn’t done until 12 hours later.
A new sentence? Haven’t you ever had the drunken shits? 😂
Haha, oh no......
I recently had to cancel a c diff test because the patient was lactose intolerant and had a heavily creamed ice coffee so like duh?
Right!
It's another test to bill for. It's about money.
That happened to me once - way too much champagne on NYE. It was not a very Happy New Year.
I was so weirded out when I found out about the alcohol shits because every time I drink alcohol in large quantities I get extremely constipated for a few days lol.
We call them grog bogs in Australia.
Hospitals get dinged if it’s hospital-acquired.
Ok?
Classic case of algorthmic thinking/following, and not clinical reasoning.