D.O.N. tells me NOT to describe wound???

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Specializes in NICU, Peds, Med-Surg.

Yeaaa, I know what you're thinking...WHAT???:no: I charted a resident's two Stage III decubiti like this: "previous dressing saturated and seeping. Drainage is yellow tinged with red with mild odor".....then continued with the cleaning, treatments, new dressing, blah blah blah.

Couple days later, D.O.N. tells me "you don't need to say the old dressings were "SATURATED" and you don't need to DESCRIBE the drainage....just chart "dressing changed". :roflmao:

My reply: "ummm, with all due respect, isn't part of nursing DESCRIBING what we see thoro

ughly....I HAVE to say what the drainage looks and smells like!"

And, if you feel like reading even MORE ridiculousness, the Full-Time wound nurse also questioned me giving this resident 0.5 ml of Roxanol before these HORRIFIC dressing changes!?!?! The res. is on hospice, and has NEVER been given the Roxanol before....Upon noticing her facial grimacing, tears, and (she can barely speak), saying "You're HURTING ME", I decided that the scheduled ONE Lortab she gets Q 6 hours was obviously NOT covering her for the pain of these dressing changes! (Ya THINK?!!??!)

And, she has more than just the two Stage IIIs to each ankle......horrible wounds. Wound Nurse says "I just make sure and do the dressings soon after she gets her Lortab".....Well, so did I, and she's crying and whispering that I was HURTING her....

Many other nurses I work with are anti-Roxanol because "Hospice is just trying to kill them off"......The ONLY order I could find from hospice was giving it for "Air Hunger".....I asked my DON if I could clarify the order and add "and/or for PAIN" without having to call this snobby Hospica company or the doc, and she said yes....( I had to be SURE that was okay, cuz God forbid I use my brain and just give it before I cleanse her and treat 2 cm deep wounds!!!)

Well, like I said, she NEVER gets it except when I do her dressing changes. Only TWO of my coworkers agree that she should get the Roxanol before these dressing changes, and one of them said "Ummm....if this resident was MY Mom, I'd WISH you were her treatment nurse!"

Looking forward to hearing what y'all think....thanks! :smug:

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Specializes in Dialysis.

I was taught in LTC/SNF I could describe a wound ie: drainage amount character odor etc wound bed color periwound tissue appearance blanching and if any slough or eschar. What I couldn't do was call it a "stage X pressure ulcer" unless it had been previously staged by wound nurse or Doctor. Documenting a thorough wound assessment is VERY important. I haven't the slightest idea why you would be told to do otherwise.

I would most definately premed with the roxanol if the lortab isn't effective. Not doing that when the dressing changes cause so much pain is inhumane! Please continue to advocate for your patient!

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Specializes in Gerontology, Med surg, Home Health.

Always describe the wound, periwound, pain during and after treatment. As for morphine it sounds like your co-workers could use some serious education on morphine and pain management. Good for you for doing what's best for your resident!

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Specializes in Rehab, LTC, Peds, Hospice.

Pain management is 50/50 where I work now. Docs are very cautious, a lot of our nurses are fairly new and one supervisor always characterizes people on narcotics as 'addicts. ' It can be pretty frustrating at times for me as former rehab nurse watch my rehab patients be under medicated all too often as the docs refuse to order what they were on in the hospital or even what's in the transfer orders, or the nurses hesitate to give what is ordered.

. In addition I worked as a Hospice nurse for a few years on an inpatient unit as well. So I've been fortunate to learn quite a bit about pain control. If some of my coworkers could have only seen some of high doses people got on my unit ...!

While I respect narcotics side effects the fact of the matter is quality of life should really play a much larger part of the decisions health care workers make in regards to prescribing and giving them.

Thank you for stepping up and managing your patient's pain the way you did.

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It's so disheartening to realize that pain management is not being met for our patients. She's on hospice, she should be made comfortable. During her dressing changes. Like someone else mentioned - pain management needs to be addressed in your facility. That's really sad.

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Specializes in retired LTC.

There's freq a lot of subjectivity when description of wounds occurs. How much 'saturation' is there if only one 4x4 gauze pad is used versus 6 pads (4x4s and ABDs)? Fresh blood or old blood? And 'mild' odor to you might make me gag & wretch. So I can understand the problem with multiple people trying to describe the same thing. Your DON probably does too, and wants the wound nurse to be the official 'document-er' so there's no discrepancy with admission status and subsequent improvement or decline of the wounds.

I'm HORRIBLE describing wounds so less is best with me. Most places I've been wanted the wound nurse to do the documentation and that's fine with me. I've been to multiple wound care programs/cont ed, but I still don't do well. I'll write a wound care order and it'll be ultimately changed the next shift. Just tell me what to do and I'll do it. I can tell when a wound is looking better than last I saw it. I don't take it personally anymore.

Now pain mgt is absolutely imperative as others comment.

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Always describe the wound periwound, pain during and after treatment. As for morphine it sounds like your co-workers could use some serious education on morphine and pain management. Good for you for doing what's best for your resident![/quote']

Yeah really.

OP your coworkers sound dumber than a box of rocks.

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Specializes in Gerontology, Med surg, Home Health.
Yeah really.

OP your coworkers sound dumber than a box of rocks.

And I thought I was blunt!!:sarcastic:

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Specializes in Clinical Research, Outpt Women's Health.

I wish each of your co-workers could experience those dressing changes personally. There is no excuse for that kind of brutality in care. My God, what kind of hospice staff allow this to occur?

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Specializes in retired LTC.

Re pain mgt - My facility once got zinged during survey by an inspector during a wound drsg observation. The nurse was an excellent clinician who had done that lady's wound care numerous times before with no previous problems. The pt grimaced during the drsg change - it could have been due to a gas GI bubble or an oncoming sneeze (who knew?). But the surveyor felt the pt had not been properly assessed for pain during wound care and we got zinged.

Since then, there and most places I've been since, have care planned pain med administration routinely given prior to wound care and the care is usually timed also just to coincide with the med admin.

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I work in corrections nursing. We had a patient with horrible wounds on her hands. Even WE medicated her for pain with codeine before dressing changes! This in an environment where almost no none gets any pain medication stronger than Ibuprofen. Isn't that BASIC nursing - medicate your patient before dressing change or even before their painful PT. I think I learned that in nursing school.....

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Many times the way that the floor nurses chart wounds messes up the MDS for the patient. The facilities where my wife has been the MDS they usually just have the wound nurse, or a designated nurse, chart on the wound in a prescribed manner. That way the terminology and method for wound assessments stays the same. Things can get real messy when 10 nurses chart different things on the same wound.

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