DVT interventions

[Bronxand]

So I got talked to by my DON today because I didn't follow the proper protocols in nursing interventions involving a resident and possible DVT. Therapy brought to my attention that resident was experiencing pain to BLE. this isn't new. Resident has hx. of gout and chronic generalized pain r/t being in a car accident. Pain is typically relieved through PRN pain med regimen. Therapy asked if it was possible for DVT. I assessed and noted that there was no swelling, redness, or warmth to either extremity. Capilarry refill within normal limits. When homans sign was assessed, resident did not explicitly state specific discomfort behind the knee when foot was dorsiflexed. "Its just painful all over" when attempted to assess if onset of discomfort was occurred specifically when foot was flexed, resident continued to complain of generalized BLE as opposed to specific discomfort behind the knee. I made a simple progress note of findings of assessment and requested an ultra sound just to rule out possibility of DVT.

My DON said my error was that I didn't fill out a specific documentation and stressed that my interventions were not enough to cover myself and to protect my license. I understand completely where she was coming from and I'm going to make sure I follow protocol more closely, but in terms of putting my license in danger, were my interventions really lacking enough to the point where the clinical concern was going to go unaddressed? I made my assesment, documented, and notified MD with recommendations.

I'm a little embarrassed really because I thought that I covered my channels. Any insight? I would love to grow from this experience.

[oncivrn]

Sounds appropriate to me. As long as you documented.

I thought we weren't supposed to check homan's sign?

[Bronxand]

Uhoh that's news to me

[oncivrn]

It's not sensitive or specific and also, eliciting the homans sign could potentially cause a clot to be dislodged.

[SmilingBluEyes]

And it is considered inaccurate and unreliable.

[brownbook]

It's extremely difficult to catch DVT's. They have been and will be missed by new RN's and cardio-vascular surgeons with 40 years experience.

That some specific document wasn't filled out, ok, now you know. That your your DON would imply your license is in danger displays her stupidity!