This Burns My Britches!

Nurses General Nursing

Published

My mil was in the hospital around 1 month ago and had an emergency knee replacement. She was quite sick for awhile, as the plastic in her knee from the replacement 12 yrs ago caused a local then systemic infection.

This hospital she was in, has been consistently voted in the top 10 nationwide.

In this hospital, her buttocks and coccyx broke down; by the time she was transferred to a rehab hospital, it was stage III-IV and approx 10cm diameter.

This was totally from her not being repositioned.

When I spoke with the DON in this hospital, I told her how preventable this was.

That day they got her on an air mattress.

The rehab hosp discharged her home last week.

I've been doing the dsgs 1x/day and visiting nurse, 1x/day.

I told the visiting nurse that mil needs aggressive surgical debridement as the tissue is non-viable.

So now the visiting nurse is going to get a plastic surgeon involved.

GRRRRRRRRRRRRR. I am so freakin' upset.

My neighbor, who is a very sick and brittle diabetic, had bil aka because of heel ulcers he got in this very same hospital.

And my mil's roomate in the rehab hospital, also had decubs from this hospital.

How long does it take to reposition a patient??????

What the hell is it with these nurses that just don't get it?

Repositioning a patient has to be one of the easiest yet most effective interventions we can do to prevent skin breakdown, never mind STAGE III-IV DECUBS!!!!!!!

Now I am sure that my mil will be going back to the hospital for surgery to remove all of this necrotic tissue. And she's on oxycontin for pain with only moderate relief. :angryfire

Why does this ignorance exist?

There is no reason for something that takes 1-2 minutes q2-3 hours.

leslie

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Specializes in Critical Care Baby!!!!!.

i agree 100%!!!!!!!! this is one of the first things i teach new orientees! did you know that it takes only 20 minutes for breakdown to start!!!!!!??????:uhoh21: of course we can't "visualize" it this soon, but it is occuring in the tissues. i about fell over when i heard this, and what's more........patients on specialty beds and beds that rotate still need to be turned a minimum of q 2 hours!!!!!!! that is straight from a rep for the beds we use. he said that these beds are to assist in the prevention of breakdown, they are not to replace turning and repositioning. scary huh? i am so sorry that this happened to your family. it is unacceptable.

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Specializes in Telemetry & Obs.

earle58, this summer i had a patient with breakdown on his buttocks that worsened over ONE day....thing was, he was perfectly able to reposition himself and even though i reminded him hourly and explained what was happening to his backside and how preventable it was, he just DIDN'T want to so much as shift his weight :o

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Specializes in Critical Care Baby!!!!!.
earle58, this summer i had a patient with breakdown on his buttocks that worsened over one day....thing was, he was perfectly able to reposition himself and even though i reminded him hourly and explained what was happening to his backside and how preventable it was, he just didn't want to so much as shift his weight :o

that's another thing i have seen too. patient's that refuse to let you reposition them. they know that they can breakdown but they refuse to budge. what do you do then? document, document, document!!!!!

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This is a sign of a hospital poorly staffed. I'm sure this basic of all nursing care is not unknown by the nurses in this hospital. To have so many incidences of this is very telling.

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i work in ltc facility we have received residents back from hospitals in area with decubs we have three hospital in immediate area two private hospitals and one chairity....all are remiss in pt care...

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Well I work on an Ortho floor and we see this alot... We TRY to turn every patient every 2hrs, usually do really good, but on bad days it might do good for twice a shift... And we do have several that refuse to let us turn them, so we document and inform the doctor, so they know... We have never had any get to stage 3-4, usually just stage 1... Our aides are very good and when they are giving baths to call us if there is ANY kind of breakdown..

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i agree 100%!!!!!!!! this is one of the first things i teach new orientees! did you know that it takes only 20 minutes for breakdown to start!!!!!!??????:uhoh21: of course we can't "visualize" it this soon, but it is occuring in the tissues. i about fell over when i heard this, and what's more........patients on specialty beds and beds that rotate still need to be turned a minimum of q 2 hours!!!!!!! that is straight from a rep for the beds we use. he said that these beds are to assist in the prevention of breakdown, they are not to replace turning and repositioning. scary huh? i am so sorry that this happened to your family. it is unacceptable.

wow! thanks surgical hrt rn. that's wonderful useful information. i had no idea that it only took 20 minutes for breakdown to start!!!

earle 58 i am so very sorry to hear about what happened to your mil. how awful! and then to realize how easily it could have been prevented in the first place!! :angryfire

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this is exactly why my blood is boiling.

it should have NEVER gotten to these stages.

there's an opening/hole that is 3cm deep and when i look in it through a flashlight, it is white and hard.....bone?????

and yes, many patients do refuse to be turned because of the pain.

and even when patients have refused, i still have gotten them to consent.

i round up 2-3 cna's and even minimally turn them....slowly, gently and supporting all body parts, especially the areas that are injured.

no matter how busy i've been, i recognize those that are at high risk for breakdown and make it a priority to turn them.

mil's skin broke down in the icu....the nurse had 2 patients.

and dh went there one day with mil's nurse at the desk eating a bagel.

when dh stated that mil was in extreme pain, icu nurse said she'd be in there after break.

and she stayed at that desk for 30 minutes. :angryfire :angryfire :angryfire

i gotta calm down.

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i have been in nursing school for one week and we talked about this very thing today! our instructor stressed that it only takes a VERY SHORT time for tissue to start breaking down. Apparently this is one of the very first things you are taught in school so why should it be so hard to do? So much emphasis was placed on it today in lecture that I don't think I'll EVER neglect to do this for a pt.

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I understand there is no reason for it to happen.... Especially to the point of what you have experienced... We have signs posted in our breakroom reminding everyone that patients need to be turned... It's sad that we have to do that... But it has actually helped things on our floor very well. People don't seem to utilize specialty beds like they should, due to cost and hassle... But we have used them more lately and we have noticed a difference....

Our big problem lately has been with TED hose.. No matter how correctly you fit them, we are having problems with them causing sores on the legs at the top..

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Specializes in NICU.

I did an ICU clinical on a unit that, apparently, trusted those air beds with the turning feature to do the turning. I only saw a nurse turn a pt once and it happened to be a regular hospital bed. Even as a student I could see that those turning beds weren't fully effective. And it didn't look very effective when the HOB was elevated, which most were there.

They had many decubs in that unit and my precpetor actually told me that it was expected because they were bedridden ICU pts. I remember from school that decubs are almost always preventable and their attitude was oh, well, can't prevent them. I saw so many horror stories there. After I graduated a few months later they offered me an interview and I flatly refused.

This was a fairly well-known hospital that I had a lot of respect for prior to this clinical.

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