Pressure injury

[Em K]

I work on a medsurg unit midnights 1900-0730. I’m currently suspended pending investigation and due to a pressure injury on a patient I was assigned to. The pt is immobile, has aphasia and is confused and he is Q2H turning and repositioning. I got report on the pt and we went in, double checked a heparin drip and assessed the patient for comfort  and he was sleeping. Shortly after the daughter (who is also happens to be a RN) came in to see him and she asked me to boost the patient. We boosted him in bed and she asked him a couple of times if he was comfortable and he said yeah. 15 minutes after it was now around 2030 she comes out and tells me her father said there’s something hard under him and she believes it’s a bedpan, she then states she believes it’s a bedpan he’s been on since “1400 before she left”. Regardless of how she knew it was a bedpan and how she assumed it was the same bedpan since 1400 without asking any staff if they had recently put him on bedpan, we turned the pt over and there was a bedpan under, she took out the bedpan, the area under was very reddened due to the prolonged pressure and she said she was going to make some noise and was going to house manager right there and then which I totally understood and would have done the same. I had just come on my shift and hour and 30 minutes prior, it was even time for me to do my Q2 turns and we had boosted him once and assessed for comfort and I had no way of knowing he had a bedpan under him. They are currently investigating the situation and I alongside the day nurse and NAs who took care of the patient have been suspended pending investigation at this moment. Any thought on if I’m gonna be in trouble? I’ve been losing sleep thinking about it. Thanks 

[Chickenlady]

Sounds like you are in the best position in this.  They may say you should have found it on your shift change assessment, but if the day staff put him on it, didn't remove it or advise you, then it is going to be them who are in the crosshairs.  Regardless, this doesn't seem like a fireable offense to me.  A write up, sure. 

[JKL33]

It's impossible to tell what route they will take with you specifically. It's unlikely they will actually do anything helpful overall to prevent this situation from happening the next time other than telling the staff that it was all their fault and they are responsible to make sure it doesn't happen.

There is nothing you can do here. In the future I guess making sure that your total care patients aren't lying on a piece of hard plastic will need to become part of the assessment you make as soon as you take over their care.

I hope you are shown some leniency for the idea that a full assessment cannot be done on all patients within 1.5 hours of hitting the floor, circumstances being what they are. But I wouldn't be surprised if they react harshly because this is a big deal and patients have been known to require extensive wound management due to errors and oversights like this.

Let us know how it goes...

[Em K]

I got the call today from HR and both my manager and assistant manager and HR stated that based on their investigation I did not violate or break any policies or protocols and I will be reimbursed for my missed shifts. However, corrective actions will be taken with the day nurse. 

[amoLucia]

TY for the comeback. And VERY glad to hear that you've been absolved of any wrongdoing in this unfortunate episode. My compliments to your Management & HR for doing a thorough investigation and then 'doing the RIGHT thing' by you.

And FTR, bedpans CAN leave a tell-tale 'ring-around-the-hynie' with prolonged placement pressure.