Quote from dinkymouse
"..... She is constantly locking all the treatment supplies in a locker that none of us has a key to. Some of our current wound patients are not healing as good as they did before she started.
By the way, the family of the patient above took care of her at home and said that "It has only been like that for a week." :angryfire
You raised some really points. Many facilities do not want to pay for someone certified. By the way there are some nurses out there practicing wound care without any training. More alarming - there are NP's doing the same. I dont believe in week long crash courses - or similiar programs without a practicum. I attended a graduate level course (one semester of wound and one semester of ostomy and continence). While I realize this is not an option for everyone - it is the standard.
Its interesting because I have seen the "dangerous" results of erroneous staging. When you Stage a wound - you are basically telling me (BTW an expert witness and LNC) that the wound is not infected - and also telling me that it is not a wound from a cutaneous manifestation of chronic disease. I have seen doctors mess that one up. Staging also gives clinicians a false sense of security - if I had a dollar for everytime I heard "its only a stage I or II" without takign into account the chronicity of the wound (Osteo) or colonization or infection. I feel that there is a component of diagnosis involved and therefore in the hospital within the role of an APN.
Legally I see your responsibility as no different than a doctor practicing incompetent medicine. If the doctor prescribes the wrong treatment you are obligated legally and ethically to intervene.
Remember patients families do not "see" the same thing we do when we examined the patient. In my practice I have doctors and staff nurses all the time not recognize the severity of a wound that gradually evolves. One successful approach is to make sure your facility documents a complete "naked" exam on any admissions. Some elder are incontinent and dont tell anyone and lie on admission assessments. This could be disastrous from a PR perspectice when in assisted living you are asking the family to bring in Depends two days after admission. I have witnessed some adult children do care - they stand in the door way of a bathroom, arm outstretched, with a wash cloth, and handing it to mom.
I recognize sometimes a wound that is likely stage IV but has not opened up yet. This is the reason if I see purple or dark discoloration I document "...likely Stage IV - presentation heralds a much more serious lesion."