Guest guest Posted December 2, 2008 Report Share Posted December 2, 2008 Hi ,  Not really good enough mate, should be more detailed.  Rgds, . From: peter mitchell <treetop_bay@...> Subject: Treatment Notes Date: Tuesday, 2 December, 2008, 4:16 PM Just a question here out of curiosity,  Along with name - age (68) - past Hx - Vital signs - weight - height - peak flow these were the daily treatment notes on an employee having bd dressings, would the group consider these as sufficient or inadequate, they continue in the same manner for 7 days as the dressings continue.  Thanks  P.  Date Time Reason for Visit Treatment 15-11-08 13:30 Wound on left ankle – moist – clean – oedema of ankle, not cellulitis . Wound toilet with dry dressing Review bd . 18-11-08 07:00 Wound on ankle – moist – clean . Not attending clinic - ? venous ulcer Wound toilet and dressing – add tubigrip – advise re bd . 18-11- 08 18:30 Venous ulcer . Wound toilet and dressing + tubigrip support bandage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 2, 2008 Report Share Posted December 2, 2008 I agree, should be much more detailed. I would hate to be the oncoming medic to follow this pts care. ________________________________ From: Sangster <justin_sangster@...> Sent: Tuesday, December 2, 2008 11:59:38 PM Subject: Re: Treatment Notes Hi , Not really good enough mate, should be more detailed. Rgds, . From: peter mitchell <treetop_bay@ .co. uk> Subject: [Remotemedics. co.uk] Treatment Notes @groups. com Date: Tuesday, 2 December, 2008, 4:16 PM Just a question here out of curiosity, Along with name - age (68) - past Hx - Vital signs - weight - height - peak flow these were the daily treatment notes on an employee having bd dressings, would the group consider these as sufficient or inadequate, they continue in the same manner for 7 days as the dressings continue. Thanks P. Date Time Reason for Visit Treatment 15-11-08 13:30 Wound on left ankle – moist – clean – oedema of ankle, not cellulitis . Wound toilet with dry dressing Review bd . 18-11-08 07:00 Wound on ankle – moist – clean . Not attending clinic - ? venous ulcer Wound toilet and dressing – add tubigrip – advise re bd . 18-11- 08 18:30 Venous ulcer . Wound toilet and dressing + tubigrip support bandage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2008 Report Share Posted December 4, 2008 Hi P, These are just off the top of my head. I am going to have to ask a question, what is " wound toilet " ? Now, on to the info I would like to see. Where at on the ankle? What caused it? Work boots, insect bite? I would ask about diabetes. 1)PMS 2)Cap refill 3)Measurement of wound 4)Initial measurement of both ankles, then periodic measurement of the swollen ankle. How far up does the edema go? Has the edema increased, decreased or stayed the same? 5)Continue working full duty, restricted duty? Bed rest? I am not trying to be picky, but I learned the hard way on a pt that resembles this. V/r ________________________________ From: peter mitchell <treetop_bay@...> Sent: Wednesday, December 3, 2008 8:01:05 AM Subject: Treatment Notes Thanks for the observation , what would you want to see ? P From: peter mitchell <treetop_bay@ .co. uk> Subject: [Remotemedics. co.uk] Treatment Notes @groups. com Date: Tuesday, 2 December, 2008, 4:16 PM Just a question here out of curiosity, Along with name - age (68) - past Hx - Vital signs - weight - height - peak flow these were the daily treatment notes on an employee having bd dressings, would the group consider these as sufficient or inadequate, they continue in the same manner for 7 days as the dressings continue. Thanks P. Date Time Reason for Visit Treatment 15-11-08 13:30 Wound on left ankle – moist – clean – oedema of ankle, not cellulitis . Wound toilet with dry dressing Review bd . 18-11-08 07:00 Wound on ankle – moist – clean . Not attending clinic - ? venous ulcer Wound toilet and dressing – add tubigrip – advise re bd . 18-11- 08 18:30 Venous ulcer . Wound toilet and dressing + tubigrip support bandage. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2008 Report Share Posted December 4, 2008 Thank you for the lesson. You have opened my eyes to an area I need to study a bit more. ________________________________ From: peter mitchell <treetop_bay@...> Sent: Thursday, December 4, 2008 11:20:17 AM Subject: Treatment Notes Dear , Thank you for your reply which is helpful to see what you would want in treatment continuation notes. A/ 'Wound Toilet' is the cleaning of the wound area prior to applying the dry dressing, main purpose for a Venous Ulcer is to keep it moist and clean. B/ Venous Ulcers are most frequently located on the lateral aspect of the ankle, as a result of the mechanism causing them. C/ The cause is age - venous wear & tear - varicose veins - gravity, as a gradual process. D/ Size of ulcer will take time to change once treatment starts with healing it generally gets bigger first - in ideal circumstances a specialised dressing is done once a week - in remote location with circumstances of work bd is OK - can take a month to change - so daily there is no need for measurements. E/ Venous ulcers would rarely be bilateral - the oedema is venous fluid under pressure from gravity so stays in lower region of ankle around the laterall malleous - part of the treatment is periods of foot elevation during the day and at night - while the principle healing comes from compression of the venous system - tubi-grip - reinforcing natural venous return, which will encourage a reduction in the oedema. F/ As this is a long term treatment then bed rest and restricted duties for a cook are excluded and as this is not a debilitating problem, when treated, so full duty is OK. It is an interesting condition and as mentioned the treatment is long term and quite specific unless infection gets in then anti-biotics are included, sometimes NSAIDs for pain from exposed nerve endings. The points you raised are appreciated but being now familar with the situation would you require that degree of information, twice daily, to have an appreciation of the progress, or could you be comfortable with - ' Varicose Ulcer - clean - moist', treatment, 'Wound toilet - dressing - tubigrip', considering that usually you would have a verbal hand over to your relief as well. There has been a discussion re this and we are interested in other points of veiw. Brgds P. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2008 Report Share Posted December 4, 2008 While a verbal report to your relief is fine for continuation of care, it can't replace proper documentation on a number of levels. One of the primary concerns (or what SHOULD be one of the primary concerns) for 'medics on the U.S. side is the legal impact of their actions, and the key to any defense is great documentation. At the very least, I would have documented a detailed initial exam, with at least weekly notes of similar depth to the initial exam, in addition to noting each clinic visit with the treatment provided, which I would also probably add as a list to my treatment notes as well. I would also write up a similar exam for the day of or day before I made crew-change. The turnover can then be 'Joe Blow is having a venous ulcer, the notes are on the computer.' Of course, I don't believe in the concept of a 'verbal handover,' either. I always have written notes that I at least print out, if not email to my relief and supervisor. In the U.S., offshore 'medics are already operating well outside the accepted lines, so it's important to maintain copious detailed notes to protect oneself for later on. Will they ever be needed? Will your relief even review most of them? Probably not. Will they save your ass if one of the ambulance chasing lawyers in Louisiana decides to sue you, your company, their client, the oil company, etc, in an attempt for a payday? Hopefully so. My rule of thumb is 'if it's worth writing about at all, it's worth writing a lot about.' I am a documentation nazi, though, so take it for what it's worth. Austin On Dec 4, 2008, at 11:20 AM, peter mitchell wrote: > Dear , > > Thank you for your reply which is helpful to see what you would want > in treatment continuation notes. > > A/ 'Wound Toilet' is the cleaning of the wound area prior to > applying the dry dressing, main purpose for a Venous Ulcer is to > keep it moist and clean. > > B/ Venous Ulcers are most frequently located on the lateral aspect > of the ankle, as a result of the mechanism causing them. > > C/ The cause is age - venous wear & tear - varicose veins - gravity, > as a gradual process. > > D/ Size of ulcer will take time to change once treatment starts with > healing it generally gets bigger first - in ideal circumstances a > specialised dressing is done once a week - in remote location with > circumstances of work bd is OK - can take a month to change - so > daily there is no need for measurements. > > E/ Venous ulcers would rarely be bilateral - the oedema is venous > fluid under pressure from gravity so stays in lower region of ankle > around the laterall malleous - part of the treatment is periods of > foot elevation during the day and at night - while the principle > healing comes from compression of the venous system - tubi-grip - > reinforcing natural venous return, which will encourage a reduction > in the oedema. > > F/ As this is a long term treatment then bed rest and restricted > duties for a cook are excluded and as this is not a debilitating > problem, when treated, so full duty is OK. > > It is an interesting condition and as mentioned the treatment is > long term and quite specific unless infection gets in then anti- > biotics are included, sometimes NSAIDs for pain from exposed nerve > endings. > > The points you raised are appreciated but being now familar with the > situation would you require that degree of information, twice daily, > to have an appreciation of the progress, or could you be comfortable > with - ' Varicose Ulcer - clean - moist', treatment, 'Wound toilet - > dressing - tubigrip', considering that usually you would have a > verbal hand over to your relief as well. > > There has been a discussion re this and we are interested in other > points of veiw. > > Brgds > > P. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2008 Report Share Posted December 4, 2008 Dear Austin,  Thanks for the highlights of matters in the USA and you do mention good points, however you may have misread or misunderstood the situation...  A/  There is no mention of a verbal handover replacing documentation as it is supplemental and highlights documented cases of note which require extra attention ie; Joe Blow's Venous Ulcer .  B/ The intial exam was documented on an Initial Patient Attendance record not the daily attendance record....which is the documentation in question.  B/  Your mention of a weekly update is well taken...however the notes in question had not gone onto a week yet...you will observe they were of daily care which could note changes as they occur, though noting no change is also an option.  C/ These notes are in fact the daily clinic visits and treatment notes that you mention you would want done and after; Wound toilet - Dressing & Tubigrip application, there may not be much more to add.  D/ It was intriguing to read you do not give verbal handovers - though you then say that your copious notes may never be needed nor be reveiwed by your relief(?).....perhaps if you gave him/her a verbal handover then both would happen and if you wrote daily notes on a diagnosed Venous Ulcer which is kept Clean & Moist with treatment by - 'Wound Toilets - Dressings & Tubigrip' - then the Louisiana lawyer could end up whistling 'Dixie' while standing in the unemployment queue, copious notes are helpful when copious matters need addressing otherwise the heart of the matter could get lost in the telling.  It is sad that in USA the law, as manipulated by lawyers, rules, but for a medic the main matter should be, 'to do no harm' by correct diagnosis - correct treatment - follow up - documentation and resolution of the problem so a satisfied client may not want to sue you for curing him and if he does then for what ?  But your remarks are appreciated as you know how you want things done so thanks again.  P   Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 4, 2008 Report Share Posted December 4, 2008 rule one. if it ain't written down,it didn't happen. rule two. if it happened,its written down. rule three if it can go wrong,it will. rule four people lie(and the producers of house,owe us all royalties for that one). Fraser > Dear , > > Thank you for your reply which is helpful to see what you would want > in treatment continuation notes. > > A/ 'Wound Toilet' is the cleaning of the wound area prior to > applying the dry dressing, main purpose for a Venous Ulcer is to > keep it moist and clean. > > B/ Venous Ulcers are most frequently located on the lateral aspect > of the ankle, as a result of the mechanism causing them. > > C/ The cause is age - venous wear & tear - varicose veins - gravity, > as a gradual process. > > D/ Size of ulcer will take time to change once treatment starts with > healing it generally gets bigger first - in ideal circumstances a > specialised dressing is done once a week - in remote location with > circumstances of work bd is OK - can take a month to change - so > daily there is no need for measurements. > > E/ Venous ulcers would rarely be bilateral - the oedema is venous > fluid under pressure from gravity so stays in lower region of ankle > around the laterall malleous - part of the treatment is periods of > foot elevation during the day and at night - while the principle > healing comes from compression of the venous system - tubi-grip - > reinforcing natural venous return, which will encourage a reduction > in the oedema. > > F/ As this is a long term treatment then bed rest and restricted > duties for a cook are excluded and as this is not a debilitating > problem, when treated, so full duty is OK. > > It is an interesting condition and as mentioned the treatment is > long term and quite specific unless infection gets in then anti- > biotics are included, sometimes NSAIDs for pain from exposed nerve > endings. > > The points you raised are appreciated but being now familar with the > situation would you require that degree of information, twice daily, > to have an appreciation of the progress, or could you be comfortable > with - ' Varicose Ulcer - clean - moist', treatment, 'Wound toilet - > dressing - tubigrip', considering that usually you would have a > verbal hand over to your relief as well. > > There has been a discussion re this and we are interested in other > points of veiw. > > Brgds > > P. Quote Link to comment Share on other sites More sharing options...
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