Wound Edges Overlapping/Postop Auditing?

RE: Wound Edges Overlapping/Postop Auditing?

Robyn — Tue, 31 Jan 2017 16:53:20 GMT

Fabulous, thank you!

RE: Wound Edges Overlapping/Postop Auditing?

PJ Zurawel — Fri, 27 Jan 2017 19:45:53 GMT

[quote user="Robyn "]Our system won't allow us to do anything fancy like Steph suggested as far as I can see, but it sounds like this might be super effective and easy. I'm the only nurse so I'm the one seeing all the postops anyway, it won't make a difference to me if I'm the only one filling it out ;) How did you find it was best to format it? [/quote]

We formatted it very basically with just columns for date, surname, animal name, surgery they had and then the post op outcome.

RE: Wound Edges Overlapping/Postop Auditing?

Robyn — Thu, 26 Jan 2017 15:05:50 GMT

That's a great point Sal. I rarely feel like the sutures are too tight, but it's maybe something I need to spend more time really considering during postops. Cheers for the tip!

RE: Wound Edges Overlapping/Postop Auditing?

Sal the 1st — Wed, 25 Jan 2017 19:32:13 GMT

[quote user="Robyn "]

[quote user="PJ Zurawel"]

We used a spreadsheet to monitor neutering post op infection. It does work well and makes it easy to see where improvement is needed, however what I found is that because I was put in charge of it I was the only one doing it! I tried to get the other members of staff to pitch in and fill it out at every pot op check, I even did 80% of the work for them but it still didn't get done.

[/quote]

Our system won't allow us to do anything fancy like Steph suggested as far as I can see, but it sounds like this might be super effective and easy. I'm the only nurse so I'm the one seeing all the postops anyway, it won't make a difference to me if I'm the only one filling it out ;) How did you find it was best to format it?

[/quote]

Cruciate sutures a wee bit tight? certainly I have seen this has become more common since the cruciate suture pattern has become more popular as the wound edges have quite a bit more movement, never (or very rarely) came across this with horizontal mattress and simple interrupted

RE: Wound Edges Overlapping/Postop Auditing?

Robyn — Wed, 25 Jan 2017 12:54:07 GMT

[quote user="PJ Zurawel"]

[/quote]

RE: Wound Edges Overlapping/Postop Auditing?

Robyn — Wed, 25 Jan 2017 12:51:49 GMT

[quote user="steph fursland"]

I find that when I do skin suture the apposition is never perfect. I think this is because I don't have the fine balance of even width and depth bites each side. I think also they can be well apposed when put in but then if there is some swelling, the stitches pull the wound edges over each other.

For this reason I put intradermals in everything possible - as you have to be in the dermis and exit at the wound edge, there should be no overlapping, also I think it looks less Frankenstein, and nothing to remove :-)

[/quote]

That's what we're finding tbh - the apposition looks great as the leave the practice, but at their 5 day post op things have slipped. The vest majority of our patient experience a little swelling or are super bouncy, so I'm assuming these are the major factors. It's a little frustrating!

I would love to see more intradermals used, but the vets we have here aren't keen on them. Our PM/head vet has had better results on the client side by using visible sutures - there's something visible to remind them to keep the pet quiet and the buster collar on, and to make sure they come back for postops. She sets the policy, so we only use intradermals in exceptional circumstances (aggressive animals for example).

RE: Wound Edges Overlapping/Postop Auditing?

PJ Zurawel — Tue, 24 Jan 2017 23:30:56 GMT

As a practice we use intradermals as mentioned above. Just because we think it looks a bit better but also it can be difficult removing stitches from wriggly patients.

RE: Wound Edges Overlapping/Postop Auditing?

steph fursland — Tue, 24 Jan 2017 21:00:05 GMT

If you are wanting to audit, some practice management systems allow you to add a billing item 'post op complication' to the animal record, which will allow you to do things like see the total complication rate per month, % of spays done that have complications etc.