My mil was in the hospital around 1 month ago and had an emergency knee replacement. She was quite sick for awhile, as the plastic in her knee from the replacement 12 yrs ago caused a local then systemic infection.
This hospital she was in, has been consistently voted in the top 10 nationwide.
In this hospital, her buttocks and coccyx broke down; by the time she was transferred to a rehab hospital, it was stage III-IV and approx 10cm diameter.
This was totally from her not being repositioned.
When I spoke with the DON in this hospital, I told her how preventable this was.
That day they got her on an air mattress.
The rehab hosp discharged her home last week.
I've been doing the dsgs 1x/day and visiting nurse, 1x/day.
I told the visiting nurse that mil needs aggressive surgical debridement as the tissue is non-viable.
So now the visiting nurse is going to get a plastic surgeon involved.
GRRRRRRRRRRRRR. I am so freakin' upset.
My neighbor, who is a very sick and brittle diabetic, had bil aka because of heel ulcers he got in this very same hospital.
And my mil's roomate in the rehab hospital, also had decubs from this hospital.
How long does it take to reposition a patient??????
What the hell is it with these nurses that just don't get it?
Repositioning a patient has to be one of the easiest yet most effective interventions we can do to prevent skin breakdown, never mind STAGE III-IV DECUBS!!!!!!!
Now I am sure that my mil will be going back to the hospital for surgery to remove all of this necrotic tissue. And she's on oxycontin for pain with only moderate relief. :angryfire
Why does this ignorance exist?
There is no reason for something that takes 1-2 minutes q2-3 hours.
In an ICU setting, there are no aides to assist in turning pts. An ICU nurse must round up other busy ICU RN's for assistance in turning. While I know that this is no excuse for the higher incidence of decubs seen in the ICU setting, it is most definately a contributing factor, particularly when there are critical pts going bad all over the place. Never forget your ABC's. And sadly, in a busy ICU, Q2 re-positioning does have to take a backseat to critical care. That's just one more supporting reason that the sooner a pt is stable, the sooner the need for transfer. But a stage III-IV decub occuring in ANY hospital setting is deplorable. :angryfire
In an ICU setting, there are no aides to assist in turning pts. An ICU nurse must round up other busy ICU RN's for assistance in turning. While I know that this is no excuse for the higher incidence of decubs seen in the ICU setting, it is most definately a contributing factor, particularly when there are critical pts going bad all over the place. Never forget your ABC's. And sadly, in a busy ICU, Q2 re-positioning does have to take a backseat to critical care. That's just one more supporting reason that the sooner a pt is stable, the sooner the need for transfer. But a stage III-IV decub occuring in ANY hospital setting is deplorable. :angryfire
Some ICUs do have Aides in them... I know ours does.... I agree over a critical patient turning Q2 does take a backseat.. But ICU isn't the only place where people are busy and things are chaotic.. I think it happens on every floor... However I do understand your point.. Just like yesterday, I had 9 patients on day shift on an orthopedic floor.. That is way too much... 4 of them were fresh post-ops.. those patients take time.. especially your knees where you have to re-infuse the suretrans and all that good stuff... We had one get combative and trying to get out of bed.. It took 5 staff members to get this 80yr old lady back to bed.... I probably have more faith in my aides then I should, I wish I could go check EVERY patients skin, but I can't so I do trust them to tell me, and once they do, the problem is being corrected...
My mil was in the hospital around 1 month ago and had an emergency knee replacement. She was quite sick for awhile, as the plastic in her knee from the replacement 12 yrs ago caused a local then systemic infection.
This hospital she was in, has been consistently voted in the top 10 nationwide.
In this hospital, her buttocks and coccyx broke down; by the time she was transferred to a rehab hospital, it was stage III-IV and approx 10cm diameter.
Earle, while I totally understand your frustation and disappointment - I have to wonder whether or not there was family there with her most of the time. We all know that pts whose families are there and involved - asking questions, demanding quality care such as baths, repositioning, etc usually get more attention from staff. "the squeaky wheel gets the oil" I did wound care 9 yrs in home health. It doesnt take long for an immobile pt to start having tissue breakdown. However, stage III and IV wounds with necrotic tissue does not happen in a few days time. Also, you mentioned she had complications with knee hardware causing systemic infection. Im sure she was in a lot of pain/discomfort and it would only be natural for her to not want to move/turn. Elderly pt are especially vulnerable when they are taken out of their home to a hospital where people are poking and prodding at her day and night. Is she alone? I cant believe that anyone in healthcare would intentionally want to cause pain/discomfort to an elderly pt. It helps having family there to encourage pt cooperation. Also, the elderly dont always get the pain medicine they need because of the possible complications. There obviously was poor communication between md/nurse/and aides. This does not excuse them - someone wasnt bathing her, obviously werent changing dirty diapers, etc or they would have noticed the breakdown. This includes staff and family. It sounds like you are on the right track. She probably enjoys having a home nurse and you visiting her every day and doting on her. It makes older people feel loved, needed and appreciated. I do understand - Ive been in your shoes and I have learned that no one is going to take better care of our family than we do.
Some ICUs do have Aides in them... I know ours does.... I agree over a critical patient turning Q2 does take a backseat.. But ICU isn't the only place where people are busy and things are chaotic.. I think it happens on every floor... However I do understand your point.. Just like yesterday, I had 9 patients on day shift on an orthopedic floor.. That is way too much... 4 of them were fresh post-ops.. those patients take time.. especially your knees where you have to re-infuse the suretrans and all that good stuff... We had one get combative and trying to get out of bed.. It took 5 staff members to get this 80yr old lady back to bed.... I probably have more faith in my aides then I should, I wish I could go check EVERY patients skin, but I can't so I do trust them to tell me, and once they do, the problem is being corrected...
NINE pts!!!!! That is just insanity. What is it going to take for the public to get a clue and demand safer nurse-pt ratios? And you ortho nurses have it worst! Ambulating post-ops!! YIKES! And not just one, but FOUR as you said! That is very time consuming, and then you have to chart on each and every one. I just don't know where you get the time!!! Does PT come and do the inital ambulation on your pts? I know some hospitals do have PT do it, and some don't. Mine doesn't. Yet all the ortho nurses I know there love their floor, and have the greatest camaraderie. Were it not for them, I would dread floating to that floor, simply because the workload is overwhelming. Yet these nurses manage to make a night there bareable, and dare I say it, even fun. I've never had that many pts, thank goodness, and as an ICU nurse I have serious doubts that I could do that. But I am also a fairly new RN, so my prioritizing skills are still in the developmental stage.
Leslie, SO sorry your mil has to be going through all this. Especially when it could have been so easily prevented.
You know what scares me - thinking of the future if things don't dramatically change in nursing care. Don't know what hospital she was in, but 30 years ago (ancient history, I realize) I worked at MGH, on a male medical ward in the old Bulfinch building. On a daily basis I never had more than two patients - and I'm not talking ICU here. We were encouraged to sit with our patients, and have "therapeutic conversations" - anyone remember those? To this day I still remember those patients. I remember very well having the interns and residents rush - yes, really - to empty bedpans. The first time I saw that I almost fainted! We had so much opportunity to learn, to attend lectures, to talk with the docs - and at the same time the patients got such excellent care. We did teaching, along with return demonstrations by the families. Daily backrubs were a given.
And to think nowadays the care has deteriorated to this extent! What would your mil have done without a nurse dil to look out for her interests? That is a disgrace.
She probably enjoys having a home nurse and you visiting her every day and doting on her. It makes older people feel loved, needed and appreciated. I do understand - Ive been in your shoes and I have learned that no one is going to take better care of our family than we do.
That is soo true. We should never forget Maslow's heirarchy of needs. Right after physiological and safety needs are met, LOVE and belonging comes into play. This sweet little lady just wants to feel love from her fellow man, and just by visiting her, you are providing it. As a nurse, I find that very gratifying. :)
Leslie, SO sorry your mil has to be going through all this. Especially when it could have been so easily prevented.
You know what scares me - thinking of the future if things don't dramatically change in nursing care. Don't know what hospital she was in, but 30 years ago (ancient history, I realize) I worked at MGH, on a male medical ward in the old Bulfinch building. On a daily basis I never had more than two patients - and I'm not talking ICU here. We were encouraged to sit with our patients, and have "therapeutic conversations" - anyone remember those? To this day I still remember those patients. I remember very well having the interns and residents rush - yes, really - to empty bedpans. The first time I saw that I almost fainted! We had so much opportunity to learn, to attend lectures, to talk with the docs - and at the same time the patients got such excellent care. We did teaching, along with return demonstrations by the families. Daily backrubs were a given.
And to think nowadays the care has deteriorated to this extent! What would your mil have done without a nurse dil to look out for her interests? That is a disgrace.
Wouldn't it be nice to be able to give care like that now? They spent time teaching us about "therapeutic communication" in nursing school, but in the real world, there just isn't TIME for what I KNOW needs to be done along these lines. I *wish* I could have been a nurse back then. Or better yet, that nursing was still that way now. Is it any wonder that some of our elderly pts who remember hospital care from 30 odd years ago expect this kind of individual attention? I admit, when I am very busy and someone sits on their call light and every time I come in they ask for "pillow adjustments," etc... I get aggrivated. But I think what they really are asking for is reassurance, comfort, and someone to talk to. It is really a travesty that we are expected to perform these tasks, would LIKE to perform these tasks, but simply cannot because we are so overburdoned.
Earle, while I totally understand your frustation and disappointment - I have to wonder whether or not there was family there with her most of the time. We all know that pts whose families are there and involved - asking questions, demanding quality care such as baths, repositioning, etc usually get more attention from staff. "the squeaky wheel gets the oil" I did wound care 9 yrs in home health. It doesnt take long for an immobile pt to start having tissue breakdown. However, stage III and IV wounds with necrotic tissue does not happen in a few days time. Also, you mentioned she had complications with knee hardware causing systemic infection. Im sure she was in a lot of pain/discomfort and it would only be natural for her to not want to move/turn. Elderly pt are especially vulnerable when they are taken out of their home to a hospital where people are poking and prodding at her day and night. Is she alone? I cant believe that anyone in healthcare would intentionally want to cause pain/discomfort to an elderly pt. It helps having family there to encourage pt cooperation. Also, the elderly dont always get the pain medicine they need because of the possible complications. There obviously was poor communication between md/nurse/and aides. This does not excuse them - someone wasnt bathing her, obviously werent changing dirty diapers, etc or they would have noticed the breakdown. This includes staff and family. It sounds like you are on the right track. She probably enjoys having a home nurse and you visiting her every day and doting on her. It makes older people feel loved, needed and appreciated. I do understand - Ive been in your shoes and I have learned that no one is going to take better care of our family than we do.
actually er, mil has 9 kids. and the icu had to severely limit family visits.
and yes, some of my inlaws were quite vocal with their concerns.
yet they do not understand the implications of not having a patient turned.
one nurse told my husband that they could not turn her because the operative knee couldn't be moved.
and that's when i intervened and had a 'chat' with the don saying that was a crock of bunk.
i understand fully, family dynamics, patient pain, fear, knowledge deficits...the whole gammit.
once i had this 'chat' with the don, she was transferred out of the icu and into the stepdown unit and got an air mattress the same day.
not only is her buttocks all yellow, brown with copious amt. of yellow foul drainage, it is also extremely indurated and painful. and that doesn't even include the hole. for the life of me, i don't understand how it got to where it was.
and i also told the np in the rehab hospital that it was indurated and infected.
i work in ltc facility we have received residents back from hospitals in area with decubs we have three hospital in immediate area two private hospitals and one chairity....all are remiss in pt care...
The cycle is humorous. Decub in hosp... admit to LTC... heal decub... hosp for pneu... new decub.
OR reverse it. Decub from LTC...etc...
Funny part is talking to ER at the very hosp where they received a decub... To talk to ER.. never happens in a hosp!!
NINE pts!!!!! That is just insanity. What is it going to take for the public to get a clue and demand safer nurse-pt ratios? And you ortho nurses have it worst! Ambulating post-ops!! YIKES! And not just one, but FOUR as you said! That is very time consuming, and then you have to chart on each and every one. I just don't know where you get the time!!! Does PT come and do the inital ambulation on your pts? I know some hospitals do have PT do it, and some don't. Mine doesn't. Yet all the ortho nurses I know there love their floor, and have the greatest camaraderie. Were it not for them, I would dread floating to that floor, simply because the workload is overwhelming. Yet these nurses manage to make a night there bareable, and dare I say it, even fun. I've never had that many pts, thank goodness, and as an ICU nurse I have serious doubts that I could do that. But I am also a fairly new RN, so my prioritizing skills are still in the developmental stage.
During the week PT comes on the floor twice a day and ambulates patients and place them in a wheelchair/geri-chair, but we are the ones who put them back to bed, and they always seem to want to go back at the same time.. We all work well together, but we are all tired of getting dumped on... I'm also a new RN, I do what I can, but I am only one person and I can't be expected to get it all done, especially with that kind of patient load..
Perhaps you should be talking to a lawyer. Compensation can be had for preventable pressure ulcers. But that wasn't your point. The point being -- preventable.
Good luck with her, sorry she's suffering like that.
Some ICUs do have Aides in them... I know ours does.... I agree over a critical patient turning Q2 does take a backseat.. But ICU isn't the only place where people are busy and things are chaotic.. I think it happens on every floor... However I do understand your point.. Just like yesterday, I had 9 patients on day shift on an orthopedic floor.. That is way too much... 4 of them were fresh post-ops.. those patients take time.. especially your knees where you have to re-infuse the suretrans and all that good stuff... We had one get combative and trying to get out of bed.. It took 5 staff members to get this 80yr old lady back to bed.... I probably have more faith in my aides then I should, I wish I could go check EVERY patients skin, but I can't so I do trust them to tell me, and once they do, the problem is being corrected...
Well it's been quit a while since I last posted, but I figure this is a good one to return to. So would you like to mail your license to your BRN via USPS or hand delivery? At least this way, no patient has to suffer, because taking responsibility for that many acutely ill pts is eventually going to lead to some unfortunate situation for your pt and/or possibly you. In fact, I read one study which states going from 4 to 8 pts per nurse increases the risk of dying by 31%. Do with the information as you wish.
Surely there is some sort of way you can legally refuse such an assignment, or take the assignment with the provision that your license isn't hanging on a noose. That way you can promptly spend your next day looking for a new job. I know in TX such protection is called Safe Harbor.
CarolineRn
263 Posts
In an ICU setting, there are no aides to assist in turning pts. An ICU nurse must round up other busy ICU RN's for assistance in turning. While I know that this is no excuse for the higher incidence of decubs seen in the ICU setting, it is most definately a contributing factor, particularly when there are critical pts going bad all over the place. Never forget your ABC's. And sadly, in a busy ICU, Q2 re-positioning does have to take a backseat to critical care. That's just one more supporting reason that the sooner a pt is stable, the sooner the need for transfer. But a stage III-IV decub occuring in ANY hospital setting is deplorable. :angryfire