wound management dilemma

Sour Lemon · Oct 12, 2016

I had an interview lately and i was thrown a question that I was not prepared of and was not able to give a proper answer. I was quite a tricky one. until now i am still looking for an answer.. lol..
so the question goes:
You have a patient who had just a dressing done by another nurse. As a nurse who had experiences in wound management, you know at a glance that the dressing is not properly done. What would you do in this situation? How would you manage the patient and the nurse???
Need suggestions and comments guys.. thanks

I would verify that the dressing really was "wrong" (check the order, clarify if needed, etc.), take corrective action, then mention my adventure in learning to the other nurse the next time I saw her.

I would probably pull her aside and say something like, "Hey, Nurse X ...I noticed Mr. Smith's wound care order specified "no tape". The dressing had a little bit of tape on it last night, so I went ahead and changed it."

After I pointed out the mistake, I would try to minimize it so that the other nurse didn't feel belittled or accused or just bad. I might say something like, "I was a little confused, at first ....that's a really strange thing for Dr. Y to order. He usually puts tape all over everything!" Then I'd quickly move on to the next subject unless they want to discuss it further.

For 99% of people, that corrects the problem and preserves a good working relationship.

ms_cog86 · Oct 12, 2016

thanks for the comment.. the wound is NEWLY dressed but it was not done properly. what should be done? if i redo the dressing, the patient might wonder? and the nurse might get offended or embarassed? help...

Cat365 · Oct 12, 2016

I would never lie to a patient, but some won't question. I want to look at this. I just clarified the order with the dr. Ect. Only if confronted directly would I say. This order didn't call for tape. Previous. Nurse must have overlooked that ect. I would try to avoid using wrong or incorrect.

ms_cog86 · Oct 12, 2016

I would never lie to a patient, but some won't question. I want to look at this. I just clarified the order with the dr. Ect. Only if confronted directly would I say. This order didn't call for tape. Previous. Nurse must have overlooked that ect. I would try to avoid using wrong or incorrect.

then i think it will cause an issue with the other nurse. patient may question and think that the previous nurse does not have the skill and next time would not want to be handled by that nurse..

Sour Lemon · Oct 12, 2016

thanks for the comment.. the wound is NEWLY dressed but it was not done properly. what should be done? if i redo the dressing, the patient might wonder? and the nurse might get offended or embarassed? help...

I would never tell the patient that their dressing was "wrong". I would simply look for a reason to change it that the patient might be agreeable to. If there was some drainage, for example, I'd suggest that we change it for that reason. I might also say, "I'd really like to assess that wound, but we'll get it done quickly so that you can get back to ____."

This actually happens to me with some regularity. The biggest "wrongs" are dressings that are too tight after being ordered to be "loose" and dressings with tape on the skin (that are ordered otherwise). I also see products mixed up when patients have multiple wounds. ...iodine seeping through a sacral dressing, for example, when the iodine was supposed to go on a leg wound and the sacral wound called for hydrogel.

Cat365 · Oct 12, 2016

I would never tell the patient that their dressing was "wrong". I would simply look for a reason to change it that the patient might be agreeable to. If there was some drainage, for example, I'd suggest that we change it for that reason. I might also say, "I'd really like to assess that wound, but we'll get it done quickly so that you can get back to ____."
This actually happens to me with some regularity. The biggest "wrongs" are dressings that are too tight after being ordered to be "loose" and dressings with tape on the skin (that are ordered otherwise). I also see products mixed up when patients have multiple wounds. ...iodine seeping through a sacral dressing, for example, when the iodine was supposed to go on a leg wound and the sacral wound called for hydrogel.

See this is what I was trying to say. There are usually ways to get around saying its "wrong".

Esme12, ASN, BSN, RN · Oct 12, 2016

then i think it will cause an issue with the other nurse. patient may question and think that the previous nurse does not have the skill and next time would not want to be handled by that nurse..

We are all professionals (at least most of us I hope...LOL). If I noticed that the dressing was not as prescribed....I would smile at the patient and say that I need to get a good look at the wound or say it needs to be redressed as it seems to be loose, soiled...whatever. You avoid words like "error" "wrong" "mistake" Just like you never document that an incident report has been filled out...you do not use certain words.

I would ask the nurse to talk with me privately and just let her know that MD xzy is anal retentive about his/her dressings and I found the drsg DEF so I changed it before the MD could cause a scene. If it fixes the problem then fine. If it is a pattern that she does not follow what is prescribed I would go to the charge nurse for assistance.

tyvin, BSN, RN · Oct 13, 2016

You simply change it, document, and tell the nurse that changed it improperly that she/he did it incorrectly. Check the TAR and make sure it's written well, check to see if the previous nurse documented on it. We are all adults here. As for the patient questioning, just tell them it needs to be changed again...it's really that simple. Being brutally honest and implying that the other staff are doing things wrong only gets you gossip, chaos, and burnt bridges. You sound young. Communication is a large aspect of what we do.