20 February 2025
Yesterday the morning rain kept me from waiting for a bus so I didn't get to Golden Heights until after Joyce had not eaten lunch. She was still in bed, so I was about to get her up when Janet the CNA popped in to say she was just about to change her.
Fine, then I'll get her up.
Well, no, then Eric the RN who dispenses medications all day was coming in to do the wound dressing change. It would be, at 1 p.m., the first of the day. Her second would be done by the night shift.
And this would be his first time doing it.
Anne the RN and Binita the RN had been the two wound care specialists at the nursing home. But Anne has just been promoted to an administrative function so it fell to the nearest RN to fill in for her.
He had no idea what to do. Apparently reading the physician's order is not allowed.
So I sat in as Eric, with Janet's help holding Joyce on her side, went at it. Janet, Eric told me, had been an RN in the Philippines. And she did seem to know more about wound dressings than he did but she hadn't read the order either so she was advising him to use saline solution on the Kerlix rather than Vashe.
No, Vashe. Blue bottle. And soak it. I told them how to open the Kerlix package so it could function as a bowl for the excess Vashe.
Before that I explained how to apply the Santyl to the slough. There's a lot more slough and the discharge on the old dressing was green not yellow. I took a photo of the wound so when I got home I could update Jennifer the RN at the Wound Care Clinic. Joyce sees her next week for a debridement and she has her work cut out for her.
Once the Santyl covered the wound, I explained how to pack the Vashe-soaked Kerlix into the wound, cover that with a dry abdominal pad and hold everything in with bandages. They were out of the larger size and had to use three.
And they were down to the last thimble of Vashe, I noticed.
After four years of dressing this wound, Golden Heights care of it is very distressing to me. Yes, RNs do the change but they don't read the order and they are constantly short of supplies. I help them do the best they can under the circumstances but I don't see everything.
Anne and Binita handled the one-a-day dressing changes fine. But I'm afraid doing the change twice a day has only made things worse for Joyce, introducing people not familiar with the order using the wrong supplies.
After the wound was dressed, I got Joyce up and to the gym and Daisy the RNA and a helper had her walk 120 feet. I took her back to the room to sit up a while.
And she had a bowel movement just half an hour before Janet's shift ended.