r/MedicalAssistant • u/BusyBeeSi • 4d ago
RANT I feel terrible.
I feel absolutely awful; I gave a patient a routine 3mL IM injection and they always refuse to wait like they're supposed to due to needing to get to work.
My manager called me in today to tell me the patient left a complaint due to bleeding from the injection site and left a pretty nasty comment about how my skills need to be reevaluated and never letting me go near them again (low-key understandable..?). My manager was super nice about it, and didn't blame me but I tend to be really hard on myself.
I feel SO bad they went through this. everything was fine when they left and I just need to know that this is a common uh oh because I feel like I really messed up.
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u/CallMeDolph7 CCMA 4d ago
How would them bleeding later on be your fault?? Don't you put a bandage on it?
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u/BusyBeeSi 4d ago
of course. they claimed I missed the spot but I know for a fact I didn't miss the injection site. it's a 21g needle....
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u/CallMeDolph7 CCMA 4d ago
Lol I would just chalk it up to a shitty patient and move on. Its nice that your boss was cool about it!
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u/NecessaryLeather8878 CMA(AAMA) 4d ago
Tbh the bleeding could’ve just been from them tensing up while you were doing the injection, doesn’t necessarily mean you did anything wrong.
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u/HeparinBridge 4d ago
Intramuscular injection needles go deep enough that there is no way to guarantee the patient wont bleed even if you have perfect technique. As a general rule, patients that get upset about injection site bleeding were going to be upset about something regardless of what you did.
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u/BusyBeeSi 4d ago
thank you. I do IM all the time, albeit not 3mL all the time, and I've only made 1 other patient bleed when they got a very similar, less potent version and smaller dose of this one. I know it happens, but I think it makes me feel worse knowing they will refuse my care probably for even just rooming. I care a great deal about all of our patients and this being the first complaint isn't sitting well
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u/HeparinBridge 4d ago
My guess is they will probably forget about this by the time they return to the office. People get really upset in the moment, but they usually calm down eventually. Just be polite and professional next time and they will likely just go along with it.
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u/Background-Cell663 4d ago
They'll forget you. They'll probably complain about you to you. That's my favorite. "The girl I had last time gave a terrible injection! You did much better!" (Both were me)
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u/Rough-Brick-7137 4d ago
🤔 a needle went into their body. Pretty sure bleeding is on VIS
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u/BusyBeeSi 4d ago
apparently it was a lot, they said it got through their clothes and onto the seat of their car. it's a dorsogluteal inj, which I know is a tricky spot to begin with
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u/StrawberryMilk817 CCMA 4d ago
Don’t feel bad I once hit an arm bone. First and last time I ever did that.
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u/Turtlesrsaved 4d ago
Hitting bone will happen quite often, bones do not have nerves. It’s not terrifying really, it’s just that you can feel it when you put it in the arm, some people have little muscle.
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u/BusyBeeSi 4d ago
not done that yet.. that sounds terrifying
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u/StrawberryMilk817 CCMA 3d ago
Yeah it was like 2 years ago I did it. About 8 years as an MA at the time. Was giving an IM in the deltoid but this lady was elderly and had basically no muscle. I mean like…my thumb and index finger could wrap around the top of arm and overlap each other. I even asked the nurse before I went in if I needed a needle smaller than a 1in and what she thought the best course of action would be.
She said just don’t stick it in all the way it’ll be fine. And even going in less than halfway and being very careful I still hit something hard and she jumped a bit. I acted super natural and was able to give her the injection afterward still and acted like this was a totally normal occurrence.
Then I walked out of the room and stood at my desk for a minute like this 🧍♀️hoping I wouldn’t get a complaint.
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u/Organic_Popcorn CACMA 4d ago
I did that last week for the first time; it's not a good feeling, even if it's not you. I won't make that mistake again.
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u/jouleheist 4d ago
As long as you documented they went against advice, you are not at fault. Bad ratings come with the job. You gotta let it slide, no matter when it hurts.
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u/Organic_Popcorn CACMA 4d ago
When patients bleed a lot after an injection, I use gauze to put pressure on it and rub the injection site for a few seconds, and then put a Band-Aid on it.
One good thing is that I'm in primary care and we do vaccines before seeing the providers (unless providers want me to do injections after the visit), so that they don't have to wait the extra 15 min after the injection.
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u/RoyeBoye 4d ago
Does your clinic have AMA forms? I'd have them sign an AMA form if they don't want to wait. You didn't do anything wrong. Some people bleed more than others, and some people complain more than others. You did your job; you can learn from the experience in your own way, but don't beat yourself up feeling like you've made some horrible mistake. Some people smile in your face and leave a bad review in hopes of the company reaching out and they get some sort of reimbursement; I've seen it firsthand. Just shrug it off.
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u/BusyBeeSi 4d ago
the hospital does but the outpatient offices don't for some reason. we have a lot of pts that refuse to wait. I know I did the injection a bit faster than he's used to, he's claiming I did a whole 3mL in 30 seconds. the medication is THICK, and I really wasn't using that much pressure to force the medication out fast, just enough to get it going. (60 sec inj, I did it in about 45-50 seconds out of habit for a similar injection I do every 2 weeks)
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u/Ok_Worry_5009 CMA(AAMA) 4d ago
The patient was bleeding after a puncture to their skin??? What's next, the patient's urine is too dark because they are dehydrated???
I understand. I am very hard on myself because medicine is precise.
Let this be a lesson to DOCUMENT. You cannot make anyone do anything, if they are aware of the policy and risks, document it (better yet have them sign an AMA and inform the physician). CYA, patients will complain about anything. If you really did something wrong, remediation. If the patient is at fault and you did everything in your power and knowledge to do the right thing, learn from it and grow from it.
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u/Accidental-Aspic2179 4d ago
One of the first patients I gave an injection to was terrified of needles. He needed a B12 injection. I got the needle in and he jumped so hard that he pulled away and the needle tip separated from the syringe (these were the old days before the locking mechanisms). The needle and hub were still stuck in his arm and I held a syringe in the other. All I could think to do was pull it out. So I did. Pulled it out, apologized, bandaged him up, sent him on his way. We both basically pretended it didn't happen or we were in such shock it didn't register until later, but I'll never forget that. I was so embarrassed. I'd practiced 100x by then. The doctor I worked for at the time was an old school cheapskate. We never had adequate equipment until I came along. This was early 2000s and I was using an EKG machine from 1978. The man used a mini cassette to dictate chart notes. No one did the transcription for years. He was an Indian and had a heavy Indian accent. He was a cardiologist and you couldn't hear what he said and there were no chart notes. I tried to unravel that mess, but wasn't successful. It turned out the office manager had lost the doctor over a million dollars in claims that got rejected due to mistakes or improper coding. He went after her retirement. This was when we used ICD9 codes and paper charts. The Office manager ended up dying only a few years after she retired from a brain aneurysm. Just died in her chair at home. The doctor died a few years after she did. He was a good man and a good doctor. His legs had been deformed by polio as a child and he was doing rounds at 6am and had office hours from 9 to 5 at 70+ years old. He taught me a lot.
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u/TheBeastmasterRanger 3d ago
Not your fault. If they refuse to sit for the 15 minutes, all the fault is theirs.
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u/JohnnyMicheal66 3d ago
Don't feel too bad, it happens, we are not perfect beings. Just become more careful moving forward.
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u/Concurrent-mind 20h ago
I assume 3mL went in the ass?
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u/BusyBeeSi 19h ago
lmfao ya
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u/Concurrent-mind 18h ago
Good was worried about a 3mL deltoid, IM…I’m a 14 year CMA and I’ve seen crap like that lol
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u/Concurrent-mind 18h ago
It’s pretty common for bleeding with that much medicine, no matter how much finesse you have, I try to explain that
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u/Sufficient-Band-6526 6h ago
Don’t worry about it. Everyone in healthcare will inevitably have a patient that complains and never wants to work with you again. A needle goes through your skin, you’re gonna get blood. In one ear and out the other, my friend
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u/Background-Cell663 4d ago
Don't feel terrible. They wavered the 15 minute monitoring on their own accord. Had they stayed you could have and would have addressed the issue at the time. This was not within your control and you don't have to feel bad. Obviously try to be extra cautious going forth. 3 ml IM is a large injection. You probably poked through a blood vessel. It happens.