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.
OP is not at fault. She is the only one who even tried to reach the damned surgeon who didn't bother to write a simple order. Family should take out their ire on surgeon, as should OP's bosses.
And no other nurses bothered to rectify the matter or even move the pt to the right floor. Everyone was lazy and shunted the problem to the fall guy, the conscientious OP.
OP, shake the dust off of your shoes and hold your head high. Are you really in trouble?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
OP is not at fault. She is the only one who even tried to reach the damned surgeon who didn't bother to write a simple order. Family should take out their ire on surgeon, as should OP's bosses.
And no other nurses bothered to rectify the matter or even move the pt to the right floor. Everyone was lazy and shunted the problem to the fall guy, the conscientious OP.
OP, shake the dust off of your shoes and hold your head high. Are you really in trouble?
OP is indeed at fault. We don't know that she's the only nurse who even tried to reach the surgeon, but we do know that she didn't actually reach the surgeon until Day 8. Why didn't she resolve the matter on Day 7? "He's notorious for not calling back" is not an excuse. OP's head should not be held high as she didn't go up the chain of command until getting a result, look up the policy and procedure for chest tubes in her facility's policy or procedure manuals or contact the ICU or the respiratory floor for advice. Family could have taken out their ire on any nurse up to Day 8, but since OP didn't take care of the situation on Day 7, they weren't wrong to blame OP.
The patient may have been on the right floor . . . or maybe the orthopedic floor would have been just as correct as the respiratory floor. The argument about "moving the patient to the right floor" is invalid. Most patients have more than one thing wrong with them, so it's not always clear where they "belong." Not being the "right floor" is no excuse for giving the patient substandard care.
During the entire stay an attending or hospitalist never visited this patient and asked about the dressing change? I mean if other nurses commented how it looked then I would think someone would have said something to the rounding physician for an order.
I mean it sounds like the physician is a major jerk, but still it falls back on basic patient care. When it comes time to take the hit trust me the physician isn't going to take the beating.
Specializes in Oncology; medical specialty website.
They're giving your unit education on chest tube dressing changes, and this is being thrown under the bus? I don't think "being thrown under the bus" means what you think it means.
It's true that the physician bears some culpability here, but the failure of the floor staff to implement P&P for over a week is not something that should be overlooked, and I think providing education in order to prevent this from happening in the future is quite generous. I would be thanking them.
Waiting for cries of being bullied and "NETY, NETY, NETY!"
I agree with some previous comments. Changing dressing is a basic thing and it doesn't need orders. It is a known fact that all dressings have to changed daily. And as a family member I would be upset with everybody in the hospital if my family member haven't had his/her dressing changed over a week. And then you say that being educated about that is throwing you under the bus? No way. If you don't know how and when to do it, it is correct that every nurse in your ward should be educated about it.
It is a known fact that all dressings have to changed daily.
No, it's not.
Not only do frequent dressing changes cost more in nursing time and in supplies used as well as causing skin stripping with tape removal, but each dressing change also increases the risk for wound contamination and subsequent infection.5
Taking all of this into consideration, the literature supports these recommendations:
• Do not routinely change dressings unless the dressing is compromised in some way or there is a significant need to visualize the tube insertion site based on changes in the patient's condition.
I agree with some previous comments. Changing dressing is a basic thing and it doesn't need orders. It is a known fact that all dressings have to changed daily. And as a family member I would be upset with everybody in the hospital if my family member haven't had his/her dressing changed over a week. And then you say that being educated about that is throwing you under the bus? No way. If you don't know how and when to do it, it is correct that every nurse in your ward should be educated about it.
If you are speaking specifically about chest tube dressings, the majority of literature states simply "change per facility policy". Some recommend changing every 48 hours, others say only if it is wet or soiled.
If you're making a broad generalization, no it isn't "a known fact that all dressings have to be changed daily." Some wound protocols call for every other day, every 3-5 days, even weekly, depending on what the treatment is.
Yes, they were remiss in not finding the policy or contacting the other unit. The buck was passed too often.
However, know what you're talking about before you criticize. You may need to learn a bit more yourself.
Specializes in OR, Nursing Professional Development.
It is a known fact that all dressings have to changed daily.
Generally, all or nothing statements don't have a place in healthcare. No, not all dressings need to be changed daily, for many reasons. For a select few of my patient population, we use a special vac dressing on a closed incision. It is not to be changed for 7 full days. Protocol for regular vac dressings in non-closed wounds at my facility is that the dressing is changed every 3 days or as needed if it is saturated/not maintaining vac seal/leaking.
Perhaps things are different in your country (your info lists you as being from Estonia) but just because it's a "common fact" doesn't make it best practice nor policy and procedure everywhere.
Well, where I am from we change dressings every day. It is even required by the fact that every day you have to evaluate the wound. If doctor wants a longer period, then it will be written into the documents but otherwise, you change dressings every day. All our patient documents and papers have a line for describing the wound and stating you have changed dressings.
Plus, if you don't know something, you ask. For example, if we have a patient in ICU who has had face trauma and her upper and lower jaw are hold together (I really dont remember that diagnose even in Estonian but believe you get the picture), teeth have some kind of elastic bands on them and no one of the nurses knows or dares to remove those bands by themselves. Every time we call that wards doctor and nurse to do it.
Today I injected Adenosine to a patient. My partner didn't know how it is done because he hadn't done it before. He told me that and asked me about it.
The point is that if there is something you don't know you ask about it. Well done for that nurse, she asked.
Everybody has to take care of the patient. If that would have been in our hospital, every nurse and every doctor who were assigned to that patient would be held accountable. And if the only thing that follows is educational, then that is real good. You can learn from the mistake. That is not throwing under the bus.
I can't understand why the physician had not looked at the chest tubes and noticed that the dressings needed to be changed. Everywhere I have worked the physician will look at the site when he/she makes rounds. Sounds like everyone involved from nursing, physician, bed management etc should be educated. Bed management should have never sent the patient to an ortho floor. I recently moved from an ortho/neuro floor to the MSICU and before the move I was clueless on the proper care of a chest tube. If it was bed managemets best option to send that pt there then priority should have been to move that pt to the proper floor when a bed became available. I also don't understand why the nursing staff did not advocate for themselves and let it be known to management that this pt needed to be transferred to the appropriate floor. Also, the nursing staff should have called the resp floor and asked for guidance in proper care of the chest tube/dressings. When I worked ortho/neuro other floors would sometimes call us when they had questions about things they do not see very often and we did.
Just because the doc was negligent doesn't mean that nursing wasn't ALSO derelict. It doesn't have to be one or the other.
Trust me, in a personal injury lawsuit involving something of this nature, EVERY SINGLE PERSON who is on record as caring for this patient would be named in the suit. As culpability becomes more clear with discovery, some names will be dropped from the suit. But really, who wants to deal with that? This is an example of failure at almost every juncture.
I agree that being required to receive education is the farthest thing possible from being thrown under the bus. Education is ALWAYS a good thing.
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I can't understand why the physician had not looked at the chest tubes and noticed that the dressings needed to be changed. Everywhere I have worked the physician will look at the site when he/she makes rounds. Sounds like everyone involved from nursing, physician, bed management etc should be educated. Bed management should have never sent the patient to an ortho floor. I recently moved from an ortho/neuro floor to the MSICU and before the move I was clueless on the proper care of a chest tube. If it was bed managemets best option to send that pt there then priority should have been to move that pt to the proper floor when a bed became available. I also don't understand why the nursing staff did not advocate for themselves and let it be known to management that this pt needed to be transferred to the appropriate floor. Also, the nursing staff should have called the resp floor and asked for guidance in proper care of the chest tube/dressings. When I worked ortho/neuro other floors would sometimes call us when they had questions about things they do not see very often and we did.
I don't understand why everyone is so convinced that the patient didn't belong on the ortho floor because he had chest tubes. If he had an orthopedic problem and needed care for that, ortho might have been the best place for him. The Med Surg floor might know how to take care of the chest tubes but might not understand how to rehabilitate the orthopedic problem so the patient regains full function. I would think regaining full function would take precedence over a chest tube.
Kooky Korky, BSN, RN
5,216 Posts
OP is not at fault. She is the only one who even tried to reach the damned surgeon who didn't bother to write a simple order. Family should take out their ire on surgeon, as should OP's bosses.
And no other nurses bothered to rectify the matter or even move the pt to the right floor. Everyone was lazy and shunted the problem to the fall guy, the conscientious OP.
OP, shake the dust off of your shoes and hold your head high. Are you really in trouble?