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Discussion

Carrying an order

My patient had a skin tear this evening, the family is aware about it. But this is like 8pm. The primary Doctor is our house doctor. What I usually do with open skin is: Cleanse with normal saline, pat to dry, apply bacitracin, then cover with bandaid. I haven't called the MD. But in the past, whenever I call this Doctor, he always say "In this kind of situation, don't call me, I'll take a look at them tomorrow".

I did the "Change Condition" of the patient. The family is aware, I did my initial treatment as mentioned above. But I did make a note in 24 hour report to get an order from MD tomorrow in AM.

In my opinion, it's not a life threatening situation. So, it make sense what the MD is been telling me that he can be notified in the next morning.

If it's life threatening, then it's a different story. I will definitely call the MD. But for open skin? A lot of Doctors don't like to be bothered around 9pm. Also, this MD is our In-house MD. He goes everyday in the facility.

What bothers me....is this a safe practice? I mean, what things can go wrong that can threaten the patient in this kind of situation. The patient looks fine to me. Vital signs are stable, also I endorse it to the next shift.

I have done this a lot time in this kind of situation. I did my initial treatment. All it need is an order.

Anybody else in here had a different action?

Thanks, and I will go to bed now. And probably I will get something feedback when I wake up.

ZZzzZzZzzz (-.-)ZzzZZzzzzZZ:zzzzz

Featured Replies

Does your facility have a protocol for skin tears or basic wound care? If not, you should be okay with basic wound care until the am.

BTW, we don't use bandaids on skin tears. We wash gently with NSS, try to gently work the top back over the skin tear smoothly, then apply antibiotic ointment, a nonstick dressing like Adaptic or Telfa, then secure with a kling wrap. No tape to the skin. It's already thin enough to tear.

You are right that a simple skin tear is not a reason to call the doc. Now if they got the skin tear when they fell out of bed or got the skin tear because of some big trauma due to a mental status change, that is different. You could always check with your charge nurse.

That is, unless you are the charge nurse. :p

  • Guides
Does your facility have a protocol for skin tears or basic wound care? If not, you should be okay with basic wound care until the am.

BTW, we don't use bandaids on skin tears. We wash gently with NSS, try to gently work the top back over the skin tear smoothly, then apply antibiotic ointment, a nonstick dressing like Adaptic or Telfa, then secure with a kling wrap. No tape to the skin. It's already thin enough to tear.

You are right that a simple skin tear is not a reason to call the doc. Now if they got the skin tear when they fell out of bed or got the skin tear because of some big trauma due to a mental status change, that is different. You could always check with your charge nurse.

That is, unless you are the charge nurse. :p

I agree - and no bandaids.

steph

We have a skin tear P & P in place, but since it would be an incident report and we would technically need to call the doc ASAP....BUT....no. I'm not calling them at night for this, unless I know the next nurses are not reliable to carry it over.

  • Author
Does your facility have a protocol for skin tears or basic wound care? If not, you should be okay with basic wound care until the am.

BTW, we don't use bandaids on skin tears. We wash gently with NSS, try to gently work the top back over the skin tear smoothly, then apply antibiotic ointment, a nonstick dressing like Adaptic or Telfa, then secure with a kling wrap. No tape to the skin. It's already thin enough to tear.

You are right that a simple skin tear is not a reason to call the doc. Now if they got the skin tear when they fell out of bed or got the skin tear because of some big trauma due to a mental status change, that is different. You could always check with your charge nurse.

That is, unless you are the charge nurse. :p

Thanks for the reply. Actually, it's not a skin tear, more like open skin.

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