Embarrassed. That’s how I felt. One of our patients, Bertie, saw the neurologist, Dr. S, today. He picked up a possible cellulitis in her left arm. We nurses should have caught that problem, not a doctor who just happened to see Bertie for something else today. Has this ever happened to you? Here’s 3 ways you can prevent missing critical changes in your patients.
1. Follow and reevaluate the care plan until the problem is resolved
A few weeks ago, Bertie, on Coumadin for chronic atrial fibrillation, hit her forearm on a chair. Within hours her entire arm was edematous and ecchymotic. We suspected the bleeding was from her Coumadin dose being high. The PT/INR results proved we were right. Bertie’s Coumadin dose was reduced. So far, so good. After completing our nursing assessment, we wrote a nursing care plan stating the nurses needed to watch Bertie’s forearm for edema, ecchymosis, pain, numbness or tingling or infection. Because the edema and ecchymosis were improving, did the nurses stop looking at Bertie’s arm daily? Were we so focused on the current problem that we overlooked the new problem, a skin infection?
2. Set priorities
Did the nurses get so busy that checking Bertie’s arm was no longer a high priority? There are so many pressing tasks that must be done and so little time to do them. The interruptions seem endless at times. But do nurses always focus on what’s most important? Do we delegate some things to other members of the nursing team so that we have time to perform the most important nursing assessments of our patients?
3. Fine tune your nursing assessment skills
If you saw Bertie’s forearm with a 10 cm by 6 cm area of erythema and edema, would you know to check for increased warmth? Would you call the NP, PA or physician to describe your findings? When you talked to the health care professional, would you mention Bertie’s allergies and that she was on Coumadin so if an antibiotic was prescribed, the PT/INR could be checked more frequently? (Many antibiotics affect the blood levels of Coumadin.) Or would you just continue to “monitor” the site and pass this information on to the next shift?
By following these three steps, you can lessen the chance that you will miss changes in your patients’ conditions. Do a nursing assessment. Read and follow your nursing care plans. Don’t let yourself get so busy that the highest priorities get missed. Delegate tasks that other members of the nursing team can do. If you see an abnormality, don’t just pass on the information, take action.