I'm an RN on an ortho unit at a large hospital. We recently admitted a patient with a chest tube. Several days went by without the dressing being changed. I cared for the patient on the 7th and 8th days after admission. The general surgeon, who was the admitting, did not include any orders for dressing changes. Pt's family got very upset, especially after I paged the MD for change orders, and he didn't call back. Because we're an ortho unit, we don't see a lot of chest tubes, but apparently on the respiratory unit, it is common knowledge that this MD likes daily dressing changes on chest tube pts, so he never puts in orders for changes. Family contacted the director of med/surg for the hospital about this, and the director contacted shift supervisor, who then contacted me. I did page the MD, and I also left a note in the electronic chart for him indicating that the family wanted to speak with him about care, and included a phone number. He didn't contact them until he found out that they were upset. He didn't respond to my page (he's notorious for this). I feel like I did my best, but this matter has gone all the way to the chief medical officer, my unit supervisor, and the med/surg director. In an email, it was stated that our ortho staff needs education on chest tube dressing changes. I feel like we're being thrown under the bus. The MD should have put in dressing change orders. The MD should have responded to my page. The patient shouldn't have been on an ortho unit for over a week when he could have been transferred to the respiratory floor. As I said, I cared for him on the 7th and 8th days after admission. Maybe one of our nurses who cared for him much earlier in the week should have asked the MD about change orders. As it turns out, the MD is pissed off at me, the family is pissed off at me, and administration is pissed off too. Sometimes, you do your best and it still doesn't work out.
