Disaster!!! Bad order

[Bambi]

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. (I am a new nurse :)) I have learned my lesson the hard way.

Thanks for letting me vent:imbar

[P_RN, ADN, RN]

I've been taking out staples and sutures and drains my whole career. Now if the wound looks like the edges are not approximated.....I believe that I'd double check with the doctor by calling with this information....you could say you will leave the staples in because the wound will dehisce. (implying that HE can take them out if he insists)

[mattsmom81]

We live and learn. It's always a risk to take a third person order like this...and it's apparent neither the doc nor the nurse who took the order knew what the wound looked like.

I have learned over the years to MAKE that surgeon inspect his own wound if I'm unsure. Too many surgeons are anxious to blame the nurse for ANY problem with their postop patient's non-healing or infected incisions, I've found, so I'm not afraid to make them accountable..

[ayemmeff]

Really good point, Mattsmom81.

[hey_nurse]

I have taken out staples and sutures many times. First thing i do is check the order for myself. Then when taking them out i do every other one, if i notice a problem i stop, seri strip the area and notify the doctor. If you do every other one u still have staples in place to hold wound togeter if it not approximated. :) :roll

[RN always, BSN, RN]

Bambi, I am a new nurse too (6 months), I so can relate to what you are feeling. I have made mistakes also! If we all lived in a perfect world, then we would all be perfect huh? Don't beat yourself up over this, kinda sounds like it happened for a good reason, like someone said earlier mayabe the wound needed to drain. Keep your chin up! You are an awesome nurse to even care!

[Audreyfay]

I have taken out lots of staples. In fact, I was working in the Operating Room when they first started using staples! I recall one event when I was working on a med/surg unit, a patient who had undergone a lung resection, was to have his staples removed and sterstrips if needed. The skin was well-approximated and he was 5 days post-op. I started taking out the staples, and it looked so good, that I figured he probably didn't need sterstrips. A couple hours later he put on his call light. His would had totally opened! Then....I went to use steristrips to try to get the edges back together. Unfortunately, I did not realize how poor of a job I did. He came back a year later, as a patient, and said, "Oh, you're the one who did this." It was the worst scar I had ever seen. I imagine that if he had chosen, he could have sued me or something. I learned from then. Always steristrips after staples are removed in the hospital.

[imn2nursing]

:roll Oh Bambi, so sorry for your troubles. I am an LPN an the office that I have worked at I have removed sutures, and when I was working at the hospital we removed sutures and staples on the floor also. I would just chalk it up to a something new learned. Now, you have a little idea what surgical sites look like and maybe the healing stages. Hang in there, I'm sure you are an awesome nurse.

[imn2nursing]

Originally posted by imn2nursing

:roll Oh Bambi, so sorry for your troubles. I am an LPN an the office that I have worked at I have removed sutures, and when I was working at the hospital we removed sutures and staples on the floor also. I would just chalk it up to a something new learned. Now, you have a little idea what surgical sites look like and maybe the healing stages. Hang in there, I'm sure you are an awesome nurse.