Disaster!!! Bad order

Nurses General Nursing

Published

Hello,

Got an order from evening nurse to take out staples out of staph infected hip wound that had opened up right in the middle. Evening nurse received order in afternoon around 3:00 p.m.

Left for me to do. No problem. Order to approximate open area with s/t. End of order saids (ok to take out staples) Impossible, to approximate, skin folded over in open area and tight. Nurse told me in report to do this to take out staples. Call Dr in am to tell him could not approximate open area. Told him I took out staples, he was livid to say the least. I was not suppose to take out all of the staples and Blaaaaaaaaaaaaah, blah, etc. Went to sterri strip and guest what? The whole incision had dehisced. I was horrified to say the least. In addition (pt has had 2-3 operations to relocate hip previously. I was soooooo upset. For the life of me I could not remember the conversation I and the other nurse had about this pt in report, I guest I was in such shock. :o (I am a new nurse :)) I have learned my lesson the hard way.

Thanks for letting me vent:imbar

If it was ordered and it was within your realm of pratice and you saw no reason not to I don't see the fault. S#%t happens. Could have happened to the surgeon even.

I too have never woked at a facility where the RNs removed staples. Only the surgeon. Kinda like "only the surgeon does the first dressng change" thing. Sounds like a good practice in this instence.

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We learned in nursing school how to take out sutures and staples and we've always done it. Most pts nowadays go home before time for them to come out (med/surg floor). They are removed in the docs office, many times by the office nurse, after the doc has looked at the wound.

You followed an order present on the chart, 'nuff said.

When I was a 'brand new nurse', I had an order to remove 1/2 the staples on this ladies abd. wound. So I took half of them out- the 1st half of the incision! I left them in in the last 1/2 of the incision! Boy,did I feel stupid when it suddenly dawned on me, the doc meant, every other staple! Oh, what a dreaded phone call that was to inform the Dr what I had done!

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Specializes in MS Home Health.

I have been an RN over 16 years and took out tons of staples. I am sorry your wound opened up.............

Hugs,

renerian

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I routinely take out staples, also...with an order to apply steristrips....I take out every other staple, apply steristrip, then do the other half....

Sorry about that wound opening, but sounds like it needed to drain, anyways.....**it happens....If doc was so worried, he should have come in and done it himself.......and i bet dollars to doughnuts, he would have taken them all out...

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Honest folks, I have never taken out a staple. Never have been asked to take out a staple. I feel real bad for Bambi, believe me I know how terrible it feels to make a mistake.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

I too have taken out hundreds of staples and we routinely get orders for our homecare RN's to do this.

Word of advice:

Only remove all staples on WELL HEALED, NON INFECTED appearing incisions. Steri-strips are used by some docs and not others. If large wound over 6 cm, I tend to use steri strips.

Hip areas I tend to remove ever other staple since weight bearing area. Big belly wounds, I do the same thing.

I suspect in this patients case with TWO prior hip surgeries, this was bound to happen. Don't beat yourself up. This happens even to us seasoned RN's too.

Kudo's to you for accepting the responsibility for your actions. Almost all of us have a moment we would like to take back in our careers. Good luck in the future.

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I've just finished my first set of clinicals and I took out abdominal staples twice. Apparently its a routine task for RN's at my clinical site *BUT* the incisions were well approximated and healing well in both cases. Sorry about your dehis, but hey, it was an order so don't beat yourself up! :)

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Specializes in Med-Surg Nursing.

I've taken out staples and removed sutures before but usually ONLY with a Dr's written order. Sounds Fishy that this nurse took the order at 3pm and NEVER got around to it in her 8 hr shift? Something aint right in Denmark.... Oh well, Bambi we all make mistakes, new grads and seasoned vets alike. Learn from this and move on. Life's too short to sweat the small stuff.

Kelly:)

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Like Karen, I've taken out tons of staples in the community. The fun ones are the postop CABG patients, with staples from groin to ankle! We learned to remove staples in college, in our clinical, and I already had quite a few removals under my belt before graduation.

If a wound is infected, it has to be opened up anyway to drain as the others have said, but if it was not well-approximated, I would have left it until the MD had a peek at it. 8 more hours with the staples/sutures in never killed anyone....

Don't beat yourself up. For some reason, I keep remembering the postop masectomy pt. I sent back to hospital with staples in situ, and all the symptoms of a raging infection in her axilla where they'd done the AND (removal of lymph nodes). THEY SENT HER BACK HOME AGAIN!!!

I sent her back to the ER AGAIN the next morning, and the doc removed the staples from her axillary incision, and gave her IV antibiotics (too late for oral by then!) We were doing BID dressings on her, there was SO much purulent crud draining out of that wound. Delayed her chemo by nearly a month.... :(

So, there's worse mistakes than taking out staples too soon!

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I took 62 staples out of a guys scalp once...was kinda cool (was s/p MVA...mult scalp lacs and 2 craniotomies). When I had to have staples removed (22 in my back) I discovered they STING coming out, since then I always offer a pre med before removal, then when I get ready to take them out I count them, tell the patient how many then count them down as they come out so they know how much more there is to do (also left over from having mine out...I was just short of puking & passing out...every time I would think it had to be over she would grab another one)

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Originally posted by oramar

Take out staples?? Never once in my career have I ever recieved order to take out staples....If floor nurses are taking out stitches and staples it is new development.

pmsl I must be one of these new radical floor nurses. I have been taking out stitches and staples ever since I started working as a nurse six years ago! :chuckle Usually there is an order in the post-op notes, removal of clips/sutures/staples in x amount of days by NURSING staff. It is not so unheard of in my neck of the woods....registered nurses must have more autonomy here I guess.

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Im with Ausnurse on this-if that wound was infected those staples were doing no good anyway.

We have a big problem on our ward with m.r.s.a getting into our arterial graft wounds(also often groin to ankle)-it shames me to admit.

If the wound is infected,staples come out to enable drainage of the wound(usually 5-10 staples in the groin end),and then we practice open wound healing in that area.

Our usual orders is for alternate staples on alternate days. Even when i'm taking all staples out in a "oner",i still tend to do alternate ones-just in case!:)

Don't beat yourself up on this,consider it a well-learnt lesson.

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