Reportable?

[GonnaBSN]

I cared for a pt this week who had stage III wound ( it was 4cm deep, MRSA positive, and horribly painful!). This pt was documented as "MR" and lived in a group home. According to my pt, the cause of this wound becoming so bad was that a nurse (LPN) who worked at the home "popped" it like a pimple, spreading the infection to the proximal area. Then they delayed treatment for two days -- a doctor advised them to take her to the hospital, but they waited.

Is this something that should have been reported as abuse?

[merlee]

Reportable? As in abuse? Maybe he should have been seen to the doc a bit earlier, but we really don't know the entire story.

What has the treating physician said?

This is a hard one. Thanks for the post!

[JDZ344]

.

.

.

[Nascar nurse, ASN, RN]

If you are staging it as a "stage III" that would indicate a pressure ulcer. A pressure ulcer does not start out as something that can be "popped". So my gut instinct is is that this guy has his stories mixed up as to what happened.

No, I would not report it. There is more to this than they guy knows (or understands) and would appear to be a clinical issue rather than an abuse issue.

[JZ_RN]

Neglect, yes. Abuse, no.

[mariebailey, MSN, RN]

It seems appropriate to file a complaint with the state board of nursing if harm resulted to the patient and the nurse acted outside of her/his scope and was without authorization from the doctor to perform the duties you described.

[redmielita]

If it happened as the pt states, then reportable. However, he would not be the first DD pt to get confused/not understand what had happened/out and out falsely report, so it's hard to say. Is there any way you can get more info?

[Elladora]

If the patient is a reliable historian and this is what happened, then yes. However as others have said, patients are not always the most reliable historians (non DD patients as well as DD patients) so the information regarding incorrect treatment/delay of treatment should be verified).

[classicdame, MSN, EdD]

reprotable??? Absolutely.

[Candinse]

I cared for a pt this week who had stage III wound ( it was 4cm deep, MRSA positive, and horribly painful!). This pt was documented as "MR" and lived in a group home. According to my pt, the cause of this wound becoming so bad was that a nurse (LPN) who worked at the home "popped" it like a pimple, spreading the infection to the proximal area. Then they delayed treatment for two days -- a doctor advised them to take her to the hospital, but they waited.

Is this something that should have been reported as abuse?

Pressure ulcer? Nope...Boil or to those just out of school...carbuncle (haven't heard THAT in a while)...They come to a head and can POP just being touched. Reportable? Doubtful...probably was started on po antibiotics. I have seen them a lot worse than what you are describing. Especially with MRSA.

[rn/writer, RN]

I see this confusion come up over many incidents that raise questions in a practitioner's mind. The running theme seems to be that you shouldn't report things unless you know for sure what is happening. This is backwards. While most people appear to have good intentions and don't want to get anyone in trouble without just cause, the entire concept of reporting possible abuse and neglect is based on the premise that the reporter is passing along the information so that objective parties who are trained to investigate will step in and pin down what is or isn't going on. THEY will be the ones who determine what is happening.

For a nurse to say, "I'm not sure if this is a reliable reporter," or "We don't really know what happened," and use such thoughts as reasons not to report is to abdicate the responsibility to protect the vulnerable. If we don't know what happened, it's our job to either find out directly or, if that isn't feasable, to alert those who have the authority to pursue that information further.

As nurses, we don't have to have all the answers. That's a job for the investigators. But they can't do their part if we don't raise--and share--the questions.

That's all we need in order to start the ball rolling--questions that do not have satisfactory answers. If the patient is an unreliable reporter, it's all the more important that someone throw a flag on the play and ask for further review.

We don't have to prove anything. We have to ask questions for those who may not be able to inquire on their own behalf. If we're wrong, that's okay. We still did right by the patient. But if something seems fishy and we keep quiet because we don't have proof, we may well be perpetuating a bad situation.

Of course, we can try to gather simple information on our own. If answers are forthcoming and they seem logical, consistent and correct, problem solved. But if the responses seem hinky or there are gaps or conflicts from one person to the next, that shouldn't be the end of the story. It could be that policy wasn't followed. Or there is no policy and there needs to be one. Caregiver training may need beefing up. The agency or facility might be lacking in supplies, equipment or adequate staffing.

The bottom line is that, beyond the basic checking of facts, WE don't have to investigate matters. WE don't have to decide whether there was ineptitude or intentional wrongdoing. WE don't need to take action to address whatever gaps or faults exist.

Our role is to call attention to things that don't add up, patients who seem to be suffering unnecessarily, and situations that expose the vulnerable to undue danger and distress, and let the powers that be take it from there.

[june2009]

I agree with the top poster on this page. It's not our job to decide whether abuse/neglect occurred. If you suspect, report it and let the actual investigaters decide.