Just following the Dr's orders?

[DutchgirlRN]

Yesterday I had a patient who is 10 days post-op a ruptured duodenal ulcer. He is still on TPN, Lipids, and NGT to low intermittant suction.

His kardex clearly says "daily dressing change, cleanse with H2O2, apply neosporin and redress with abd's".

I said to the patient I'm going to change your dressing now. He said why? I said because your doctor has ordered a dressing change everyday. He said they change it once in a while when it leaks but no one has ever cleaned it with peroxide or put neosporin on it, it hasn't been changed every day, are you sure you're supposed to do this? I said yes "I'm following the orders your doctor has written for you". He was fine with it then.

This patient is totally orientated. I know the nurses I work with and I know we get really busy but I find it hard to believe that not one followed the doctors order regarding the daily dressing change?

This patient struck me as the type to ask the doctor why no one was following his orders? I really don't care about that because my conscious is clean and his wound looked fine but I'm really puzzled? His surgeon is new to our hospital so I don't have any idea how he would react. At the end of the shift the patient thanked me for taking such excellent care of him. Any thoughts?

[Burnt Out, ASN, RN]

i hate when i do things like flush ivs, do trach care, dressing changes and the patient says "no one else does that". ugh..........don't get me started.

i hear that...i hate hearing that too!

and we all know..."if it ain't charted, it ain't done."

[Town & Country]

I've never heard of anyone changing a dressing without signing and dating it.

I thought that was done everywhere.

Yes, sometimes nurses chart that they changed a dressing when they didn't - that's why the signing and dating.

Also, sometimes patients will say that their dressings haven't been changed when they have - it's a game. Good Nurse/Bad Nurse.

[DutchgirlRN, ASN, RN]

This patient developed a nasty post-op wound infection. The incision line became very reddened and swollen. The surgeon opened it back up and wrote in the notes that the drainage was copius and purulent. Some heads were rolling over why his wound has not been taken care of as ordered with H202 and neosporin. There was a list with all the names of the nurses who had cared for him over the course of those 12 days. My name was not on the list. The super told me it was because I was the only one who had documented that I had followed the doctors orders. I have written up a proposal that all dressing changes be dated and timed. Thank's for all your wonderful suggestions and support.