Am I in trouble?

[nursiestariray]

I am newly hired staff nurse in a nursing home. I have been working by myself for the past 2 weeks now. I need your advice fellow nurses regarding the situation. One of our resident who has generalized weakness had his tooth pulled at 5pm. When I arrived for my morning shift the next day, I got the report regarding no swishing, no spitting, and no use of straw. At around 8am I gave him his meds, and he took it, but the problem was, the wife noticed that there was something different in her husband's appearance. She found a gauze left from yesterday and she was really upset about it. I know the wife will report the incident to our manager. Now, I know that I should've check the inside of his mouth but because I read the last 2 shifts notes, it stated there that there were no bleeding. I would've not thought about a gauze being left there overnight because he could've swallowed it. It was not stated in the note and I did not get a report regarding the gauze being left overnight from the outgoing shift. How can I cover myself and not get in trouble with this. Please help!

[KellyRPNinOntario]

I'm a new nurse and can't say what will or won't get you into trouble. If it is exactly as you stated then I would report the issue immediatly. If you address these things as soon as you become aware then it greatly reduces damage (IMHO). I also would not have thought that gauze would be still in his mouth?? Call whoever you need to and report the incident...nothing happened thankfully and you shouldn't lose your job!!

[mazy]

I don't think this is a huge deal, other than that the wife is ticked off...if it were to come back on anyone it would probably be a previous shift or anyone who had done oral care on him. Shouldn't have happened, and it looks like the person responsible for doing his care didn't do it, which management might want to address if it's a facility wide problem.

But on the other hand, I'm not sure what the intructions were when he came back from the dentist -- were you supposed to do some kind of specific care? Or were you just supposed to let him recover and not mess around with anything?

Sometimes when patients come back from these consults the instructions are : DO NOT mess around with dressings/surgical sites/ears, eyes, nose mouth, etc. etc.

I imagine management will probably calm her down, maybe follow up with staff, but I'm sure they have much bigger fish to fry.

One thing I learned early on in LTC is that however worried you are about one crisis, within a few days it will be replaced by another and completely forgotten, then another, then another....don't let this stuff get to you.

Seriously, you will wear yourself out.:heartbeat

[kayern]

I have some advice. When something like this happens, first, SELF REPORT and second, apologize to the patient/family.

I work in an acute care setting so I don't know the assessment requirements for a nursing home. In acute care, I would expect my nurses to check the patients mouth after a dental procedure and before giving meds, but again that's in an acute care setting.

Good Luck

[nursiestariray]

Thank you! What you guys said made me feel better! As soon as I found out about it, I reported it to the supervisor and I sent an email to our Unit Manager. But even if 2 shifts had past, I am still part of the scenario wherein I know I have to submit my statement. I'm pretty sure the investigation will start on Monday as soon as the Unit Manager comes in. Now, I have to prepare my explanation.

[kesr]

Just tell the truth, no embellishments - just like you told us. No blaming other shifts, just the facts. You reported it properly, you have good instincts; I'm sure it will all be fine after the dust settles, and you have learned a valuable lesson. Always check for yourself.

[nurse2033, MSN, RN]

This sounds like no big deal. There was no harm or potential harm to the patient. Sounds like the gauze fell out of his mouth or he spit it out. Yes, you should have looked in his mouth as part of your assessment. You can never predict what will set family off, just chalk it up. I agree with the other posters, your boss always wants to hear it from you first.

[sevensonnets]

I hope the lesson you've learned is that YOU must assess the patient yourself. Somebody else's nurses notes do not count as an assessment.

[GHGoonette, BSN, RN]

At the end of the day he should not have left the dentist's rooms before the bleeding had been controlled and the gauze had been removed. If bleeding occurs later on the nurse caring for him could use a rolled-up gauze swab and apply local pressure PRN, as long as she removes it as soon as the bleeding stops and does not leave it in the mouth.

Intra-oral bleeding usually stops very quickly, and with haemostatics there's very little bleeding anyway. As previously mentioned, the OP should simply report it to management and let them take it up with the dentist.

[ocean waves]

Hello. Thanks for sharing your challenging situation. I agree with some of the other writers in these ways: (1) Most important--from your description, your patient seems to be ok; (2) "Cover self " with professional documentation of finding the gauze and that the patient did not seem to experience any complications; (3) Assessments--all of us nurses hopefully learn something from challenging experiences---use this situation to remind you to enhance your assessments of each patient--ask experienced co-workers for tips on assessments of patients in nursing homes. Best wishes!

[nursiestariray]

Thanks for the replies....I will charge this to experience!