Wound care

[Melinurse]

Ok, so I went to my first wound care today. It was a stage 4 ulcer on a pts coccyx. I was told to go wash with NS, apply isosorbide and pack and place occlusive dressing. The problem is when I get there, there are no supplies. ( I was told the supplies are there ) The patient does not want the treatment done but I talk him into it. He then states it has not been changed since at the hospital. ( when I look it is the origional dressing ) The Nurse Practioner documented she did it Friday which was the first " dressing change " . ( supposed to be done Mon, Wed, and Friday ) I volunteered to take Wed. They divided him up because he's a bit of a pain. So I call the origional nurse to ask and she says it's all there. So I look and look ( no correct supplies there ) and improvise with what's available. Problem is this patient is very particular and I don't want to go back and look like some incompetent nurse because I used what was available. Job still got done within the " criteria ", but not as neat and clean as I would have liked. Any advise on what to say next time I go there, just in case?

Or am I gonna be in trouble for the improvising?

[jnette, ASN, EMT-I]

hmmmmmm... sometimes we have to improvise when on the road all day. But, depending on the situation, and how far from the office I was.. I'd have either gone back and gathered up the proper and needed supplies, or called the office and insisted they send someone to deliver them to you.

I made a point of having extras of just about everything in my trunk.. and if you're doing a wound care, it wouldn't hurt to take what you know you will need, even if they say it's in the home already. This way you KNOW you will have everything you need.

I hate depending on someone else.. I like to be prepared at all times.

And again, there are times, when you have no choice but to improvise... HH nurses have tried it all !

As long as the care is safe and effective, (and within scope of practice and MD orders), you're ok.

[Melinurse]

It was an hour and 15 minutes from the office. Lesson learned though about keeping supplies in the car. Thanks for that reminder. I'm a new grad and this was my first home wound treatment. I did call the regular case manager for the patient who said everything was there and told me which occlusive dressing to use but I never was able to find the MD order. Did not help that the patient angrily refused to let me look around his room and at first refused to ally me to look for the needed supplies. I truly appreciate your advise about keeping supplies in the car. Thinking back though, I was told we were supposed to pack the wound and when I removed the old one it was not packed and had tape around the edges? I'm wondering if his mother had been doing some wound care too? I did document everything and if I was in the wrong well, I was wrong. Any advise on what to tell the patient next week? Pt is really not nice and very particular. ( polite way of saying it ) In other words the other nurses refused to do this pts treatment unless it was divided so each only have to go in once a week.

[Melinurse]

] Update. Spoke with the NP and she said I did a great job with the wound and loved that I improvised. She appologized for not having all the supplies there and said the next day she made a special tote box specially for the treatments and took it to the house. Yeah. She said she also put a copy of the orders taped to the inside lid of the tote. No more worries there. But I wanted to thank you again for the reminder about keeping some supplies in the car anyways.

[jnette, ASN, EMT-I]

Great ! Thanx for the update! Sounds like you did a super job.. good for you!

All's well that ends well.

Yes, it's really a good idea to carry extras.. I have a large plastic "tub" in the back of my car, and it is filled with extras of just about everything.. including sign-up packets, so I don't have to drive back to the office if I need to do an unexpected sign-up somewhere.

And always have enough lab tubes.. of every color.. extra syringes, butterflys.. foleys, straight caths.. you name it.

Don't get ridiculous about it, but do have extras... oh.. and keep plenty of telfa, hypafix, adaptic gauze, and DUODERM !!! You go through that like crazy.

Of course, once a month you'll need to go through everything and check expiration dates.. but it's worth it. Hate to be so far from the office and not have what you might need.. that's a real bummer... and embarrassing, too!

Glad it all turned out well for you.. and I hope your other patients are more pleasant !!! :chuckle