should i be held responsible

[rehabnUr3e]

Okay I am really upset about what has happened to me. I work in a LTC facility. A resident was admitted on Friday night. I worked Sunday night and found that this resident had multiple wounds that had not been addressed. The dressings were completely saturated from when the resident was admitted from the hospital. I did not get report of any of these. I treated all of the wounds except for the coccyx wound which I did not get a chance to look at. I had the treatment nurse come by in the morning to take a look. Well on my way out the treatment nurse stopped me and had me come look at the coccyx wound. It was about a stage 2 ulcer. She yelled at me for not looking at the coccyx all night and wrote me up. Yes I should have looked at it but really, i just don't know how I feel about this.

[TheCommuter, BSN, RN]

As soon as you receive report for your patients, you are responsible for every aspect of their care during your shift (including wounds not discovered by the previous shift).

[Jolie, BSN]

As soon as you receive report for your patients, you are responsible for every aspect of their care during your shift (including wounds not discovered by the previous shift).

I agree, Commuter. You share responsibility, along with every previous nurse who failed to assess, document and treat these wounds.

[rehabnUr3e]

the other thing is I had my supervisor in the room and she told me I should just wait for the treatment nurse to look at the coccyx wound

[Jolie, BSN]

the other thing is I had my supervisor in the room and she told me I should just wait for the treatment nurse to look at the coccyx wound

I don't understant this logic.

If a patient reported chest pain, would you wait until Monday to assess it and report it to the physician simply because other nurses had failed to address it? Would you ignore it at your supervisor's request?

Would you document in a chart, "Patient admitted on Friday. Wound on coccyx noted today (Sunday). Nancy Nurse, supervisor, states not to assess, document or treat wound until treatment nurse is available tomorrow."

Of course you wouldn't do either. Because it would be negligent.

You are a licensed practitioner. You are responsible for your decisions and actions based upon your licensure. That someone else did or did not respond properly to a situation does not relieve you of your duty to do so.

[LPN01112005]

Although the first person to address the wounds should have been the admitting nurse, the fact that she or he didn't do it, does not let any subsequent nurse off the hook.

I am the Wound Care Coordinator for a LTC facility. I would have written up every nurse who had been assigned that resident from the time of admission to the time all wounds had been documented and appropriately treated. A head to toe skin assessment is to be done upon admission with photo documentation of any wounds present on admission. The appropriate tx orders are to be obtained, and the treatment record completed. This has to be done within 24 hours of admission. To not do so is simply negligent. What one shift couldn't complete should have been completed by the next shift.

Wounds are a big deal. They progress very quickly when left untreated, especially in ill residents. What is a small area of discoloration on Friday evening could be a Stage III or more on Monday. To wait on the treatment nurse is nothing more than laziness on the part of the nurse doing the "waiting".

I am simply appalled that your facility doesn't enforce a 24 hour rule on admission and readmission skin assessments. Just a tag waiting to happen if you ask me.

Let this be your tough lesson. Take your write up, and learn from it. You are there to serve the resident, and sometimes that will include picking up the slack of the nurse you relieve.

[kiszi, RN]

Sure, you should have looked at it. But you've already owned up to that. I would hope that the tx nurse also wrote up the admitting nurse who failed to assess the wounds and come up with some type of tx until the tx nurse could check everything out on Monday.

And then what if the coccyx dressing was a hydrocolloid or other type dressing that normally isn't changed q day? Wouldn't it be possible to assume the drsg had been replaced on admission as it should have been? Oy.

Please don't feel bad. You deserve a pat on the back for taking the time to dress all those wounds that went "unnoticed" for how many shifts. The tx nurse got mad at you because you were the most convenient target. Classic case of kill the messenger.

[SuesquatchRN, BSN, RN]

I guess I don't understand why, with two nurses in the room, there was no time to look at a decub. I can't imagine what would take precedence over wound care, unless you had a code.