Disaster!!! Bad order

  1. 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
    Last edit by Bambi on Dec 12, '02
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    About Bambi

    Joined: Nov '02; Posts: 112


  3. by   ptnurse
    Bless your heart. I just feel so bad for you. It is at times like this that I wish I worked at Wal-mart. At least there when you make a mistake it is not overwhelming. No advise for you, but to say that as long as nurses (and doctors) are human there will be mistakes. I am thinking about you and your patient. Try not to be too hard on yourself.
  4. by   oramar
    Take out staples?? Never once in my career have I ever recieved order to take out staples. If you are new and no one ever told you nurses don't do that I can't blame you. However, an experieced nurse would have gone to chart and checked order. If floor nurses are taking out stitches and staples it is new development. Everybody I know and I am talking about people with 20 or 30 years experience would refuse to take out staples. I think in some instances in surgeons offices other people than MDs are taking them out but I object to that. Those surgeons need to get in there and look at those wounds and taking out staples is their oppurtunity. Teaching hospitals assign interns to do it of course. I haven't worked in 3 years and I guess things are changing.
  5. by   cindyln
    I have and do take out staples on my c-section patients before sending them home.I have been a nurse for 19 years also and have been doing this for several years.I would have checked the orders myself first before following that order though.Live and learn
    I also take out staples on our post op c-sections before they leave the hospital. Not all of them, but there are some docs that just leave it for us to do.

    But I never do it without visualizing the order.

    Good luck to you. You're right, this is a lesson learned the hard way, but it's one you'll never forget. It does feel better to vent, doesn't it?

  7. by   Bambi
    Bambi again. I did check the order, and it was a T.O. from the doctor to this nurse. Last instructions: "ok to take out staples"
    P.S. Dr told nurse manager that he said if she would look at anyone it would be the nurse that took the order. She had almost the whole shift to do this tx, instead left for me with
    poor instructions. Also it was not like she was swamped, she left immediately after report. I am not down on her (very nice person)
    she is always in a hurry to leave, I am not the only one who has said this. She is a new nurse also. Moreover, if I am partly to blame, than I am woman enough to admit I was wrong. I just don't know for sure if it was my fault. Some creative criticism might make me see this situation a little clearer. Help me out if you can. Thanks for all of your input.
  8. by   WashYaHands
    Removing staples and sutures is a routine task for RN's where I've worked. Bambi, don't be too hard on yourself, consider it a lesson learned.

    My adivce: check the order yourself. If the wound edges are not approximated or you see anything indicating infection, call the doc to clarify the order to remove the staples. Many times the MD prefers that half the staples be removed one day, and half the next day (just in case). Don't beat yourself up over it.

    So, he did want the nurse to take them out, just not all of them?

    Is this standard on your floor/unit?

    I guess our little c-section incisions are just smaller. I take them all out and steri strip as I go, about every 5 staples or so.

  10. by   911fltrn
    I have taken out hundreds of staples. If the order said to take them out you did nothing wrong. It seems the nurse who took the t.o. took it wrong. Or the m.d. ggave sloppy order.
  11. by   hapeewendy
    I take out staples all the time
    staple remover that I am
    okay that was a sucky pun but anyway , yeah its common for nurses to take out staples
    sometimes for big wounds we take out alternate staples first just to see how that goes
    always check the order yourself before doing it , then if it doesnt look right - dont do it!
    explain your concern etc....
    better to be safe than sorry
  12. by   aus nurse
    You did OK Bambi, you were just the victim of poor communication by the sounds of it.

    Oramar, I have been nursing 20 years and have always taken out staples/sutures. In fact, I have NEVER seen a doctor ever do it. Usual practice, like WashYaHands said, is alternates out one day and remaining the next.

    Bambi, if the wound was infected anyway, leaving the staples in would not have helped one bit. So all in all you probably didn't affect the outcome of the wound dehiscing. They would have needed removing anyway.
  13. by   tiger
    we nurses on my unit are always the ones to remove staples or sutures. had no idea that in some places nurses didn't do it.
  14. by   dawngloves
    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.