Wound Dressing

[agrj]

Does wound dressing requires a doctor's order? like ordinary wound and surgical wound..

[ZippyGBR, BSN, RN]

If a surgeon wants a wound dressing left then s/he needs to put this in the plan of care ...

The fact that RNs need ' permission' from a Doctor to do wound care outside of those scenarios is a joke ... even more fun when a dressing requires 'prescription' depending on which unit someone is on as some units are allowed to carry a wider range of dressings as stock ...

[tainted1972, ASN, RN]

Usually surgeons like to do the first dressing change and will then write an order for the nurses to do the other ones. Every once in a while you will get a surgeon who wants to change all the dressings while the patient is hospitalized.

If a dressing is saturated and the surgeon does not want you to change it, you can apply more 4x4's, abd's.. etc over the existing dressing.

The main reason is that the surgeon wants to see what is or isnt leaking out of the wound.

[Armygirl7]

In our hospital the surgeon always changes the first dressing post-op. Then they usually write an order - often discussing with the nurse what will work best.

In our ED the residents and docs usually ask us what kind of dressing we think will be best - we are expected to have an opinion/rationale. There will eventually be a written order by the MD but the RN is almost always consulted.

[chulada77, ADN, BSN, MSN, APRN]

Does wound dressing requires a doctor's order? like ordinary wound and surgical wound..

Yes. Some places have a standing order for minor lacerations/abrasions that don't serious attention though which is still an order. Surgical wounds definitely need an order and many times the order will say to change dressing "every day or prn" so that if the wound is draining you can use your nursing intuition and change it and assess area.

[miss81, BSN, RN]

Not in my hospital (except for VAC dressings or packing). That is a Registered Nurses order/intervention. We use our own judgement for type of dressing (i.e. mepitel, silvercel, aquacel, etc.). We also have a wound care RN that can be consulted for very difficult cases. She can also do debridement and order VAC application.

[kaliRN]

Please always follow the policy and procedure at your facility. What has been posted here are general "rules" and practices.

For RNs who function with autonomy in this regard, please do not take the pressure ulcer and application of dressings lightly. I have seen extensive trauma to a wound caused by overuse of hydrocolloids like Duoderm. The well-meaning RN did not wait for a consult or even ask the family what was being done at home. Nearly a month later, long after discharge from the hospital, the patient is still not recovered from this new damage to what was intact "healed" tissue.

Some MDs have little knowledge of such things. Just a reminder that nurses need to not take things for granted.

[sunshine1216]

depends on the wound. Surgical wound...yes. Skin tear...I would say no....I would apply caseline gauze and kerlex and write a note about it.

[sunshine1216]

i meant vaseline :)

[Lynx25, LPN]

I suppose it really depends on the facility. Here, LPN's write and perform their own wound care orders, and then give the doc the order to sign later.

It does result in some screwy dressings occasionally though...

[Daisy_08, BSN, RN]

I know usually surgical wounds come with orders at least standing ones.

To answer Do DOCTORS need to order would care i'd say no. If your pt bumped his knee in the middle of the night are you really going to let him bleed while you call the doc? Wound care nurses know a lot more then some doctors and are often the ones writing the order for chronic/complex wounds. I work PRN in LTC and I write my own orders for wound care. Now maybe there is some sort of standing order for nurse to do that, idk.

[Anna Flaxis, BSN, RN]

It depends upon the wound.

For skin tears we have a protocol for how they are to be dressed, and you do not need a doctor's order to initiate the protocol, but rather, are expected to initiate the protocol on identification of a skin tear.

For surgical wounds, the surgeon writes orders for wound care, i.e. "dressing change q shift".

For an assessment by a wound care nurse, a doctor's order needs to be in the chart. The wound care nurse then assesses the wound and writes wound care orders, which the doctor signs off on.

In the ED, most of our wound care is the infiltration (with anesthetic agent) and irrigation of wounds that need to be sutured (wounds to genitals, digits, or below the eyebrow are off limits.). Identifying wounds appropriate for I&I and performing the I&I are part of our nurse initiated protocols that are covered under the medical director's license. So, technically, we have a doctor's order to do it, in the form of a protocol order. Only RNs who have received training in I&I and had their competency verified are allowed to do this.