Help!! New LVN and new to HH

[ybstressed, LVN]

Ok I need major help and guidance:

One of my patients had an order for wound care. The doctor wanted his bandages changed every day until his next visit. The problem.....the order was given to the patient with no information about the clinic (like doctors name, address, phone number, etc) and the order also instructed the patient to hold bp med until bp improved (bp was low at the clinic). I assessed the patient and his bp was low 94/56 and his wound and dressing looked GREAT.

So I decided not to dress the wound at the time due to the fact I felt as if I did not have a complete order, I did not have all the supplies needed, and the packing material given to the patient was opened and on the floor. I decided that I would call the wound care clinic, get an order faxed, obtain some sterile wound care supplies, and then change the dressing tomorrow. I also decided, although the wound care doc said hold bp meds, that I would call the pcp and inform him of the low bp.

When I called the pcp office the docs wife answered the phone and she was SOOOOOOO rude. I tried to get informed about the patient's referral to the wound clinic and she argued with me for about 30 minutes to tell me she did not know what I was talking about, then when I told her about his low BP she told me that she could give any treatment advice because she did not have complete information. I calmly told her that it was my job to inform the doc when the patients vitals are abnormal ...she then stated that I needed to have the patient call the office and she hung up on me.

So after all that I still went to the office and attempted to gather supplies for my wound patient so that I could do wound care the next day but some of the supplies were not available. So I decided to gather all my supplies tomorrow...get the orders....and head to the patient's house.

Well I guess this choice was not correct.........I was told by my employer that I did not handle the situation correctly and that I should not have left until I had orders from the wound care clinic......

Should I have waited:confused:? Even if I did wait I did not have the supplies needed to dress the wound.

I just feel so terrible. I feel like I let down my employer and my patient.

[ItsTheDude]

no real biggie, i would have had the patient call though after just a minute or two of the stalling. i'm sure you'll also be carrying a lot more supplies with you now.

live and learn

[nursel56]

Well, the sequence of events is somewhat confusing. . . but I'll just ask some questions for clarity in the situation.

1) What time of day did all this occur? Did the wound care doctor verbally inform the patient, or did he write something down for the patient? Are you saying the patient had no idea what the name of the clinic he went to was? No idea what the doctor's name was? The first thing to do would be to ascertain that information, call them and ask them specifically what kind of dressing he was supposed to have. There are tons of different ways to take care of wounds, and not all are sterile. You mention "the packing material was on the floor". That tells me that the wound care clinic gave the patient at least some of the supplies he needed.

Regardless, if for some reason you aren't able to carry out an order, don't just decide to wait. Call the doctor, call the clinic, call your nursing supervisor. His wound may have "looked great", but specific dressings for specific wounds for specific purposes are ordered for wound care, and the rationale might be something other than "looks great".

2) I'm not sure why the wound care doctor decided to manage the patient's BP, but "hold BP med until BP improved" isn't an order unless you are paraphrasing. An order for that should be "hold xxdrug-dose if BP lower than 90/50", for example.

Generally speaking a BP of 94/56 when his BP meds have only been held less than 1 day isn't something I would call the doctor about. If you had doubts about that, bounce it off your supervisor before calling the pcp. I would probably have taken it at 1-2 hour intervals with same or trending low BPs before calling the doctor.

3) (heh, not trying to drive you crazy, I promise) If the pcp doctor's wife is not a doctor, (unclear from your post) she is not authorized to, nor should you take orders from, the wife. 30 minutes talking/arguing to her is a waste of time, not to mention you are calling them to report abnormal findings, but they are unaware of the situation with the wound care doc.

Ideally the wound care doc probably should have said to the patient that his BP was low, perhaps hold x1 day, and contact the pcp to follow up.

Well, sorry to be so long winded, but these are guides you can use or not. The first and foremost consideration is to be persistent in obtaining the information you need until you get it. Make sure your communication loop is active. Those on-call supervisors should be called whenever something seems wonky or off. You will protect yourself and your patient when you stay in touch.

You are not a terrible nurse at all!!! You will be fine, and no harm has been done to anyone. Best wishes going forward!! :)

Oh, yeah one thing I forgot! Like what It's the Dude, said, load up on stuff to bring with you!

[caliotter3]

When the individual at the PCPs office hangs up on you after telling you to have the patient call, it is time to call the nursing supervisor, give a full report, and have her/him intervene. Make certain that you write a complete communication note in addition to your normal documentation and carry on, or follow whatever the nursing supervisor tells you to do.