Missed something in clinical

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Specializes in Cardiac, Acute/Subacute Rehab.

I had the same pt this Thursday and Friday that I had last week. Little old lady c R hip fx and gamma nail sx, hx of :redbeathe dz and DM. In the week I was in class, she developed ARF and was recovering from that.

I was told in report that she had already had a bath, so when I assessed her I just rolled back her TEDs to check pulses. They were weak, so I listened c the Doppler. No abnormalities there. Just weak pulses. Given a likely state of dehydration, I charted as such.

The thing is - When I rolled back her TEDs, I did everything BUT check her heels for signs of breakdown. The wound consult report described (and I later saw) eight areas of breakdown, the worst of which was a huge fluid filled blister on her R heel.

I feel like I should take it personally that I didn't check this. Did it happen overnight? No. Did I turn her like I was supposed to and when I was supposed to? Absolutely. True, dementia contributed to her inability to maintain position and she kept rolling back supine. She'd even move the pillows we propped her on and lie on her back. Still, I didn't pick up on these EIGHT areas of breakdown on her legs because I didn't take her TEDs off.

So, what have I learned, you ask? Never again will I make the same mistake. I'll assess everything down to nose hairs now.

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Specializes in CCU MICU Rapid Response.

Well, look at it like this... you will never forget to look at heels on anyone ever again! Always take off teds all the way so you can see all of both legs... you never know what you may find underneath!! :o Consider it a learning experience and take it in stride.

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Specializes in Critical care, tele, Medical-Surgical.

Good for you!

You will continue learning and be an expert nurse!

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Specializes in Cath Lab, OR, CPHN/SN, ER.

At least you consider it a learning experience and not just an "oops" moment!

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Specializes in Trauma, Teaching.

Its also why we work as teams, when one of us drops the ball, someone else can help pick it back up. Obviously somebody found the breakdown, and addressed it. Are you sure the breakdown had already shown up last week or did it become apparent during the week between your clinicals?

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Specializes in Cardiac, Acute/Subacute Rehab.

We have to give baths, meds...total care in clinicals...and I gave her a bath the week before as I was doing my assessment. She was 1 day post op last Thursday, and the surgeon had removed her dressings just after I got report. Great timing, actually. But, no, I didn't see any signs of breakdown last week.

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Specializes in LTC,Hospice/palliative care,acute care.
I had the same pt this Thursday and Friday that I had last week. Little old lady c R hip fx and gamma nail sx, hx of :redbeathe dz and DM. In the week I was in class, she developed ARF and was recovering from that. ....

. Did it happen overnight? No. Did I turn her like I was supposed to and when I was supposed to? Absolutely. True, dementia contributed to her inability to maintain position and she kept rolling back supine. She'd even move the pillows we propped her on and lie on her back. Still, I didn't pick up on these EIGHT areas of breakdown on her legs because I didn't take her TEDs off.

So, what have I learned, you ask? Never again will I make the same mistake. I'll assess everything down to nose hairs now.

This is why so many women over the age of 65 don't survive the year after a fx hip-this (and many other) complications are all too common. I worked in a hospital that required removal of ted stockings and insepction of LE's by a licensed nurse Q shift.It's good practice-especially since many patients went for days without having those ted's removed and re-applied.This type of thing CAN happen overnight-it can happen in a few hours in this type of patient. You learned how inportant it is for you to visualize every square inch of a patient you are responsible for-under teds and dressings,too.How many of us have removed a funky old dressing and found an obviously infected skin tear with no record in the chart of when or how it was sustained? It's doubtful that you caused this patient's problem. The good thing about all of this is maybe this incident will serve as a wake up call to the entire unit.
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Specializes in Med Surg, ER, OR.

there are things you miss and will inspect those areas much more the next time. I have missed areas before d/t not having strength/time/supplies/etc at the time of assessment in AM, but make sure I get to those areas throughout the day sometime (checking buttocks during peri care after a BM on an incontinent pt). the other day i had a pt with scd's but never removed them during both days i had taken care of her (definitely my mistake). at the end of my second day with her, one of the scd's were loose so i wanted to adjust it, i removed it completely and found 2 large white areas (black pt) on her shin/calf area what looked to be healed decubs. she told me there was nothing wrong with her skin, but that this was from a saphenous vein removal that got infected after a cabg in 1996. made me feel much better after that and made sure to document in the skin assessment what i had found.

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