Worried and feel bad...

[melissa_rn]

About 2 weeks ago I put a fiberglass long-arm cast on a hispanic man who did not speak english, per dr's order. The man had an interpreter with him. The fracture was at the radial head. He worked at a restaurant and slipped/fell in the kitchen. While I was casting, the man asked through the interpreter why I was doing a long-arm cast, and that he had broken his arm in the past at the wrist and only had to have a short-arm cast. His body language showed that he was upset that he had to have the long-arm cast. I explained, through the interpreter, that the doctor wanted to have his arm very still while we were waiting to have an MRI authorized through L&I. When I was done with the cast I could stick 2 fingers under it, I explained cast care instructions and gave a paper copy of the instructions (in english, its all we have) to the interpreter. These instructions include to not stick anything down the cast, to not cut it off yourself, that if there is any increase in pain, numbness/tingling in the fingers, discoloration of the fingers to call us immediately to have it cut off.

Two days ago I got the authorization for the MRI, so I called the pt's home to let him know he could schedule it. A gal answered who spoke very little english, but said he was not home, he was at work, and she could not take a message because her english was not good. I had his work number in the chart so I called there, and the guy who answered said he was not there "he broke his arm" but he could take a message for him, since the pt. did not speak english. I said I was calling from Dr. soandso's office, and gave the number to call back. He asked if this was the doctor in another city, and I said no, we were in Seattle. He told me "he is seeing a doctor in (other city) because the cast that you put on was too tight and his fingers were purple, so he went to the ER and they put on a short one, and now he's seeing that doctor".

I immediately feel bad, because I know I put the cast on the pt., but I also know that I gave instructions to call us if that would happen (through the interpreter). My chart note says something like "Long-arm fiberglass cast applied to right arm per dr's order, cast care instructions verbalized and written copy given to pt. and friend/interpreter".

Then about an hour later the receptionist in the phys. therapy office across the waiting room came over and said she was just on the phone with this pt's daughter, (the receptionist speaks spanish) who was very upset "he could have lost his arm" and basically saying she/they did not like the care they were given by the doc and our office.

I still feel really bad and I worry that I will somehow be in trouble. Should I be worried?? I often get anxious about things when I shouldn't....let me know what you think.

[sirI, MSN, APRN, NP]

About 2 weeks ago I put a fiberglass long-arm cast on a hispanic man who did not speak english, per dr's order. The man had an interpreter with him. The fracture was at the radial head. He worked at a restaurant and slipped/fell in the kitchen. While I was casting, the man asked through the interpreter why I was doing a long-arm cast, and that he had broken his arm in the past at the wrist and only had to have a short-arm cast. His body language showed that he was upset that he had to have the long-arm cast. I explained, through the interpreter, that the doctor wanted to have his arm very still while we were waiting to have an MRI authorized through L&I. When I was done with the cast I could stick 2 fingers under it, I explained cast care instructions and gave a paper copy of the instructions (in english, its all we have) to the interpreter. These instructions include to not stick anything down the cast, to not cut it off yourself, that if there is any increase in pain, numbness/tingling in the fingers, discoloration of the fingers to call us immediately to have it cut off.

Two days ago I got the authorization for the MRI, so I called the pt's home to let him know he could schedule it. A gal answered who spoke very little english, but said he was not home, he was at work, and she could not take a message because her english was not good. I had his work number in the chart so I called there, and the guy who answered said he was not there "he broke his arm" but he could take a message for him, since the pt. did not speak english. I said I was calling from Dr. soandso's office, and gave the number to call back. He asked if this was the doctor in another city, and I said no, we were in Seattle. He told me "he is seeing a doctor in (other city) because the cast that you put on was too tight and his fingers were purple, so he went to the ER and they put on a short one, and now he's seeing that doctor".

I immediately feel bad, because I know I put the cast on the pt., but I also know that I gave instructions to call us if that would happen (through the interpreter). My chart note says something like "Long-arm fiberglass cast applied to right arm per dr's order, cast care instructions verbalized and written copy given to pt. and friend/interpreter".

Then about an hour later the receptionist in the phys. therapy office across the waiting room came over and said she was just on the phone with this pt's daughter, (the receptionist speaks spanish) who was very upset "he could have lost his arm" and basically saying she/they did not like the care they were given by the doc and our office.

I still feel really bad and I worry that I will somehow be in trouble. Should I be worried?? I often get anxious about things when I shouldn't....let me know what you think.

Hello, melissa,

I understand your being uncomfortable with this. And, it is normal to feel badly. But, does not appear you did anything negligent.

I know you have brought this to the attention of your physician and clinic administrator. They must be made aware of all that has happened since the cast was applied. And, since it is rather obvious from your post your area has a significant number of Spanish-speaking individuals, I suggest you have your instructions printed in that language.

As you know the application of a cast is not without complications as you just described. It does happen. And, as you are also aware, any individual can sue over anything. If this is a concern of yours, please seek legal advice for we at Allnurses.com are unable to do give you legal advice.

Try not to blame yourself. I believe you acted appropriately.

[Tweety, BSN, RN]

I'm not in legal nursing, so take my thoughts with a grain of salt.

The patient experienced a complication. It was documented that the patient was aware of the potential complications.

They are trying to blame someone for the complication which is very common in our society. But just because someone has a complication, he is going to have to prove the care negligent.

I'm not an ortho nurse, but I doubt the fact it was a long-arm cast vs. a short arm cast had anything to do with the post procedure swelling.

It goes without saying your should write an incident report of this conversation with the receptionist so risk management is aware, or whomever in your place of employment needs to be notified. Which I'm sure you've done already.

I wouldn't worry too much. Good luck.