Just following the Dr's orders?

[DutchgirlRN, ASN, RN]

Yesterday I had a patient who is 10 days post-op a ruptured duodenal ulcer. He is still on TPN, Lipids, and NGT to low intermittant suction.

His kardex clearly says "daily dressing change, cleanse with H2O2, apply neosporin and redress with abd's".

I said to the patient I'm going to change your dressing now. He said why? I said because your doctor has ordered a dressing change everyday. He said they change it once in a while when it leaks but no one has ever cleaned it with peroxide or put neosporin on it, it hasn't been changed every day, are you sure you're supposed to do this? I said yes "I'm following the orders your doctor has written for you". He was fine with it then.

This patient is totally orientated. I know the nurses I work with and I know we get really busy but I find it hard to believe that not one followed the doctors order regarding the daily dressing change?

This patient struck me as the type to ask the doctor why no one was following his orders? I really don't care about that because my conscious is clean and his wound looked fine but I'm really puzzled? His surgeon is new to our hospital so I don't have any idea how he would react. At the end of the shift the patient thanked me for taking such excellent care of him. Any thoughts?

[Gail-Anne]

What has been charted re: drsg changes? Often people, though compus mentus, loose track of time especially with tubing changes, N/G emptyings etc. The first few days with analgesics esp. I'd go by that first. It is possible that staff are following what they usually do, not what was ordered. Of course, if a nurse thinks the drainage doesn't warrent changing or neosporin, they should question it, not ignore it!

[Tweety, BSN, RN]

I hate when I do things like flush IVs, do trach care, dressing changes and the patient says "no one else does that". Ugh..........don't get me started.

[DutchgirlRN, ASN, RN]

I hate when I do things like flush IVs, do trach care, dressing changes and the patient says "no one else does that". Ugh..........don't get me started.

I hear you tweety and know what you mean but.....no neosporin was found in this patients room and when I called the pharmacy it was the first time it had been pulled for this patient. Pharmacist replied, "whoops I guess we forgot to put that on his profile, it is ordered". I know the dressing has been changed and probably numerous times in 10 days but not one dressing change was charted.

[fergus51]

OT, but I thought peroxide was bad for wound changes?

[DutchgirlRN, ASN, RN]

OT, but I thought peroxide was bad for wound changes?

I've been told that too by the our infection doctor. Seems it also destroys the healthy cells? I still treat my own minor wounds with H2O2 and neosporin. Old habits are hard to break. Does any one have information on this subject?

[Spidey's mom, ADN, BSN, RN]

I've been told that too by the our infection doctor. Seems it also destroys the healthy cells? I still treat my own minor wounds with H2O2 and neosporin. Old habits are hard to break. Does any one have information on this subject?

Yep, H202 definitely out for this.

steph

[VivaLasViejas, ASN, RN]

I agree, peroxide actually contributes to skin breakdown, particularly at the edges of the wound where it's most fragile. I don't think I've seen H202 used since the late '90s........I'd definitely question that order and see if it can be changed to sterile water or NS and neosporin.

I also would write an incident report.......it's inexcusable to let wound care go like this, no matter what was ordered it should have been done. :stone

[Tweety, BSN, RN]

Maybe I'm old school but I thought if you rinse off the peroxide, it's a good anticeptic? Full strength peroxide isn't ordered much, but 1/2 strength for cleaning things like incisions and peg tube sites I still see. I don't see it for big wounds of course. Always, always follow any peroxide with a ns rinse.

[RN-PA, RN]

Something I was taught to do after doing a dressing change was to write somewhere on the dressing the date, time and my initials. We do that on tegasorbs and dressings like those that are to be changed every 3-5 days so nurses can keep track of when they're due to be changed. It's a good way to see when the daily, bid, or tid dressings were last changed-- OR to see if they ARE being changed.

[DutchgirlRN, ASN, RN]

Something I was taught to do after doing a dressing change was to write somewhere on the dressing the date, time and my initials. We do that on tegasorbs and dressings like those that are to be changed every 3-5 days so nurses can keep track of when they're due to be changed. It's a good way to see when the daily, bid, or tid dressings were last changed-- OR to see if they ARE being changed.

I always do that with med patches and IV's, never thought about it on dressings. Great idea. Thanks!

[kaseysmom, LPN]

We were taught to do the same as the previous post. If we didn't have an appropriate place to date, time and initial the drsng..then we put a piece of tape across the dressing. Tegaderms and some of the other dressing kits come with specific labels for those sorts of things.