What does bubble gum have to do with patient safety? By the end of this article, we hope you’ll see how they’re connected.

The following report was submitted through PA-PSRS:

A patient was ordered a “bubble gum” enema. The nurse had a nursing assistant obtain bubble gum and give it to the patient. The patient chewed the bubble gum, which stuck to the patient’s dentures. Thereafter, the unit coordinator spoke with the patient (without dentures) as the patient continued to roll the bubble gum around in her mouth. [Afterward, the patient received the enema as ordered.]

Many healthcare workers may be unfamiliar with a bubble gum enema. It is an intervention used to resolve a fecal impaction. The facility’s drug formulary lists the ingredients of this enema as equal parts mineral oil and docusate sodium (Colace^®) syrup. There was only one reference to bubble gum enema located through a search engine—it was a comment on a listserv, in which the recipe includes a fleets enema, liquid Colace, hydrogen peroxide, and water.¹ While we cannot attest to this concoction, according to the registered nurse commenting on the listserv, it is extremely effective in breaking up this “log jam.”

While this report may seem amusing, it also reflects a critical patient safety issue. It is obvious that a healthcare worker was unfamiliar with the facility’s unique definition of a bubble gum enema. What factors were present that prevented the nurse from seeking an appropriate resource to learn about this intervention? Or, to determine whether such an intervention is even appropriate?

Here’s another PA-PSRS report:

A laboratory technician placed a patient specimen for anaerobic culture in an aerobic environment for incubation. When questioned afterward, the technician stated he had not been trained how to process anaerobic cultures. [Yet, an experienced technician was on duty at the same time as this inexperienced technician.]

Again, what prevented the new technician from asking for guidance? What degree of supervision was provided?

Now, here’s a third PA-PSRS report:

A physician ordered a Jones dressing to be applied to a patient’s wound. The staff was not familiar with this dressing and contacted the physician, who would not explain what this dressing was. The staff obtained appropriate information from another source.

While these reports are from different facilities, they evoke similar patient safety issues. Much has been discussed about creating a culture of safety, in which reporting of occurrences that actually or potentially threaten patient safety is encouraged and viewed as opportunities to make the healthcare system better, rather than blaming individuals.² Another aspect of this culture, however, relates to teamwork—an environment in which questions are actively encouraged and effectively responded to for the sake of better patient care.

The American Association of Critical Care Nurses conducted a study called Silence Kills.³ This survey of more than 1,700 healthcare workers revealed that 75% were concerned about a peer’s poor teamwork, to the point that one-fifth of the respondents could not trust that patients in their area were receiving the correct level of care. Just as disturbing, more than three-fourths of those surveyed had experienced disrespectful and verbally abusive behavior from another healthcare worker, 44% of whom indicated that such behavior had continued for a year or more. Such behaviors have a chilling effect on communication and working together for the benefit of the patient.

Errors can be prevented and patients assured of receiving appropriate interventions if healthcare workers feel comfortable in asking questions—remember, no question is stupid, unless it is never asked. Just as important, however, is that questions (and the people who ask them) receive an appropriate answer. If the person who is asked the question does not know the answer, say so! And, work with the questioner to find the answer together, so that two people will learn something new, rather than just one.

Notes

1. Re: Impactions. In: EM-Nsg-L [listserv online]. 2002 Jan 24 [cited 2007 Feb 9]. Available from Internet: http://www.ucsf.edu/its/listserv/em-nsg-l/4357.html.
2. Agency for Healthcare Research and Quality. 30 safe practices for better health care [online]. 2005 Mar [cited 2007 Mar 2]. Available from Internet: http://www.ahrq.gov/qual/30safe.pdf.
3. Maxfield D, Grenny J, McMillan R, et al. Silence kills: the seven crucial conversations for healthcare [online]. 2005 [cited 2007 Mar 2]. Available from Internet: http://www.aacn.org/aacn/pubpolcy.nsf/Files/SilenceKills/$file/SilenceKills.pdf.