Wednesday, February 17, 2010

Wound Dressing and Care Planning

Each day at least once practice the wound dressing from beginning to end. I sent an email to an Excelsior advisor 2 questions that came to mind were: (the answers from Dr. A are in the {})

1 -when is it appropriate to revise your plan of care if you find the one you have does not apply? {During Implementation.} Immediately after you initial assessment -first 20 minutes, or after you have performed all of your care? I would be inclined to do so as soon as possible so I could implement interventions and evaluate if the patient met the goal.

2 - during the sim lab for the wound, if you touch the skin with the gauze packing, is it acceptable to discard that gauze and get a new one {Yes} or do you have to re-apply sterile gloves {Only if you contaminated the gloves.}as well? (the gloves did not touch the skin). Are the gloves contaminated as well because they are in contact with the gauze? {No} - DO NOT FOLLOW THIS ADVICE!!!! I FAILED MY WOUND FOR THIS VERY SAME SCENARIO!!!! If I would have erred on the side of caution I would have changed my gloves, I questioned my instinct because there was a lot of discussion about saving money and wasting supplies in the hospitals. My appeal was denied even with this email and situation verified. - Live and Learn.

I went to a wonderful workshop - - I learned how unprepared I was. I know if I did not go to this workshop I would not pass. Sheri Taylor is the instructor and Greg Edwards assisted her. She is still helping me to understand how to write a care plan. I send one or two based on scenarios she passed out during the workshop and she critiques them and sends them back until I get it right. My husband helps me each night by playing the role of the CE during the wound station. He uses the step by step outline from the workshop. I forget small steps like asking where is the bio-hazard container and state washing hands after removing sterile gloves.

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