What would you do?

[perc71, BSN, MSN, APRN, NP]

I work in a county hospital ICU. I arrived one night to start my shift in the hospital as usual. After getting the report from the day nurse. I started assessing my 2 patients and I noted one obtunded pt with 2 tourniquet to his arms. both arm were purplish/bluish. I struggled to make a decision whether to write an incident report that will involve the day nurse. After contemplating, I wrote up the nurse who forgot to release the tourniquet, I really felt bad knowing that there will be some serious consequences to the nurse involve i.e. suspension or perhaps termination. The nurse involved told me "you should just kept things quiet cause the pt was not harmed". I need a poll

a) Did I do the right thing?

b) should I just let it go?

Thanks

One confuse nurse

[mochamocha]

i think i would do the same b/c the pt's arm is purplish/blue... what if the next nurse saw the arm and thought that it was you who caused it? but then again, i don't have enough experience and I'm interested to know what others have to say! :)

[NRSKarenRN, BSN, RN]

Definitely need incident report to CYA and protect your license by reporting practice issue: nurses can be held liable for NOT reporting deviation from acceptable standards of care. Tourniquet left on one arm can see happening but TWO arms "both arm were purplish/bluish" ????

[brownbook]

Please remember, drill it into your head, an incident report is not punishment. You are stating the facts of what happened. No one in today's nursing/medical community should think incident reports are blaming. Incident reports are a critical tool to help hospitals focus on problem areas and make necessary changes. How can we improve if we won't admit mistakes are made and investigate why they happened and how to prevent them in the future?

[Scrubby]

The nurse who told you to keep it quiet is an idiot. There was potential for patient harm and if you did not notice it and the patient lost a limb over it then guess who would have been in the firing line? Yep you would have been. Mistakes happen but you don't cover them up because no one gets hurt.

[Up2nogood RN, RN]

You did the right thing. To put it in perspective ask yourself what if that pt had been YOUR family member? YOU are the patient's advocate.

[Penelope_Pitstop, BSN, RN]

Of COURSE the nurse involved wanted you to keep quiet!

Incident reports are just that...a report of an incident, not a "write up" like our bus drivers used to give us in elementary school.

[CNL2B]

I actually encountered this situation once. My patient was coherent, and complaining of numbness in one of his arms. I start assessing and, lo and behold, above the elbow (but under his gown) was a VERY tight tourniquet. Of course I released it immediately and he was fine. His arm wasn't blue that I recall. I have no idea how long the tourniquet was on, however.

I didn't write it up, in hindsight perhaps I should. If you were comfortable with your co-worker I think it would be worth it just to mention what happened to him/her. Sometimes the tail end of the shift gets hairy and you just don't do stuff you should, or miss stuff you shouldn't. If you are respectful and have a good rapport, sometime just talking about it with a co-worker is more appreciated than having it go to the nurse manager (which is potentially punitive). Maybe something like, "Hey, I really didn't want to write this up and have it go to the NM, but you really need to remember to take off your tourniquets after you start an IV. That guys arms were blue." If she/he takes that criticism well, that will probably be just as effective in changing his/her behavior without the involvement/threat of management. (And if it isn't received well -- you can always write it up anyway.) If the patient was actually harmed or if this is repetitive behavior -- then absolutely an incident report should be done, however.