Do you have to be certified to debride wounds in a hospital?

  1. Here's the situation... A Dr wrote an order Friday for a burn wound to be debrided on Monday and for PT and named the PTs he wanted to do it and to do it using instruments .. A nurse I work with has debrided a pt before and was told not to because she wasn't certified.. She got sick of waiting and used a surgical stub brush and did it herself .. This pt is a burn pt deep burns and it's been about 3 weeks sine the pt was burned... The RN said she knew how to do it and didn't feel the need to wait for the physical Therapists you need to be certified as a RN to do wound debridement? Was she okay to just do it on her own even if the dr who wrote the order told her not to do it? It did look good to me when she was done.. Is wound debridement in a RN's scope of practice? I've been a RN since 1986 and never debrided a wound ! I guess the RN who did it was in the army and did it there .. Ty all for listening ! Oh is there a special class you take for wound debridement ? Correction that's scrub brush !!
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    About ohmeowzer RN

    Joined: Mar '07; Posts: 2,399; Likes: 1,752
    RN; from US
    Specialty: ob/gyn med /surg


  3. by   nurseprnRN
    There's debridement and there's debridement. I've debrided lots of scummy wounds in my time but I'd never touch a burn wound because I have never been taught to do one properly. (Also I seriously cringe at the thought of working in a burn unit. I've seen them scrub them things and it's more than I can stand.)

    I would imagine the answer would lie in your hospital's policy and procedure manual. If they have a process for signing people off for burn care, that would control.
  4. by   txwildflower57
    I don't know about debriding a burn wound - have done other types before but to me the question here is "Did she break the rules and not follow Dr.'s orders?" I hope the patient is ok.
  5. by   katnurseswims
    Go to the Nurse Practice Act of your state & follow policy/procedures of the facility. It sounds like the nurse probably overstepped her boundaries. Its most definitely your responsibility to report it to appropriate individuals. Great catch!! Sounds like you are a good patient advocate
  6. by   yeoldrn
    I think the key here is the MD gave a SPECIFIC order that PT was to do the debridement. In this case it's not a matter of if the RN is covered to do it, it's a matter of following the MD order. I think that in most places burn debridement is in the realm of PT. At least in bigger cities where there is access to large hospitals. In Calif. I think you might need to be a wound specialist.
  7. by   Shawn4z
    I was in a wound clinic rotation last week and the RNs were debriding. My understanding is that most states Nurse practice acts allow RNs to debride as long as they have "taken a course or been shown how to properly do so" (how vague is that?)But there is no national certification that I could locate.
  8. by   sherdk
    I live in Canada and would have to look up Standards of Practice for each province and they may be different regarding this issue. Then each facility may approve or not approve nurses debriding burn wounds. And if there is no specific documentation as to whether this may or may not be done--it would be the nurses own respnsibility dependant upon knowledge , skill and ability of the induvidual nurse. Some nurses may have extensive experience in this area and others may have none and should not be taking this on without supervision/ guidance as in rural areas where actual supervision may not be possible.
  9. by   tamadrummer
    Isn't wet to dry dressing considered debridement? We do it all the time. That is the purpose of that particular dressing. I&D is a whole different deal but debridement is a regular occurrence for us.
  10. by   DSkelton711
    I agree with yeoldrn, sounds like she did not follow the doctor's order. I don't like to have to report other nurses unless I have to. I think this is a "have to". Be prepared, though. If she is bully enough to dismiss a physicians specific order then she may try to bully you. Don't let her. Good Luck.
  11. by   GrinchyRN
    Sharps debridement typically requires certification. The RN that did this AGAINST the physicians order foolishly put her license on the line. Hope the patient is ok.
  12. by   GrinchyRN
    Also, had this nurse nicked an artery or caused harm to the patient, she would have no leg to stand on in a court of law.
  13. by   dirtyhippiegirl
    Quote from GrinchyRN
    Sharps debridement typically requires certification. The RN that did this AGAINST the physicians order foolishly put her license on the line. Hope the patient is ok.
    It sounds like the doc might have wanted a sharps debridement from the way the order was written but what the actual nurse did certainly wouldn't be considered as such on the burn unit where I work. It was just a scrub brush.

    Agree with everyone that going against the order is the big problem here.
  14. by   nurseprnRN
    Not a wound specialist, but I thought wet-to-dry dressings (where when the dry dressing is pulled off, fresh bleeding results) had been soundly discredited in favor of a moist wound environment, to allow fibroblasts and all do their thing? If your facility is still doing them, suggest that you get a good WOCN (wound-ostomy-continence certification) nurse to come in and talk about all the different types of dressings for different types of wounds.

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