burn standards of care

[laurin_p]

Hi Recently started working as charge in a brand new burn ICU. We have not yet developed standards of care when it comes to anything like burn precautions, debridement and dressing/changes wound care, etc. And there are very few of us with any burn experience. At this point we are learning day to day based on the docs orders. When we get a big burn, they go to the tank room and after that we mostly follow MD orders. Our orders for wound care are however NEVER clear and change all the time, if we have a specific order at all. I am looking to help develop a standard of care hand in hand with docs hopefully to help standardize this as much as can possibly be done. Do any of you have copies of your unit's standards of care that we could potentially use as a starting point? my email is [email protected] if anyone has any examples! :)

[LV3677]

Emailed.

[Kooky Korky, BSN, RN]

One thing that seems like it should be standard is general anesthesia for every dressing change. Why is general not used? In this day and age, we surely have the means to not inflict torture chamber procedures on burn patients several times per day?

Talk about pain relief, please. Lack of it is just ghastly when you hear burn patients tell about dressing changes. It's hard to believe people are still being tortured every day for hours in burn units.

[marienm, RN, CCRN]

One thing that seems like it should be standard is general anesthesia for every dressing change. Why is general not used?

One of our docs like to use wound vacs on extremity burns, and these are often changed every 3-4 days under general anesthesia in the OR. However, there are some practical problems with "GA for *every* dressing change"...the pt must be NPO, depriving them of nutrition for 8-12 hours (or more...we know how OR schedules work in a busy hospital), there are risks with anesthesia & intubation that aren't taken lightly, etc. We usually do dressing changes once daily or once every other day (depends on the pt & the burn) but on some units they do them twice a day. Effectively, this would require intubating and sedating patients for their entire hospital stay.

Is there a burn unit that does what you're suggesting? How do they make it work?

For some patients, we do moderate sedation at the bedside, which gives us a little more control over *when* the dressing is changed & when they can eat again. But moderate sedation is not appropriate for all pts, and they still need to be NPO for a while beforehand.

[Jpow]

We use lots of PO and IV pain meds and it seems to work just fine.