Archive March 2014 XV, No. 3

Cutting Remarks: Don't You Just Hate Confusing Post-Op Orders?

The clearer that I can make my discharge instructions, the better.

John Kelly, IV

John Kelly, IV, MD


post-op orders DID I MUMBLE? What part of my post-op orders don't you understand?

I'm blessed with very thorough PACU nurses, but not even the most conscientious nurse can overcome my confusing post-op orders. Here are 4 examples that clearly illustrate my point.

  • Can I put weight on this leg? After speaking to families and delineating post-op care, invariably I'll be in a case and receive a call to my OR from the PACU inquiring whether Mrs. Jones is "toe touch" or "non-weight bearing." Yikes! Whether someone is non-weight bearing or toe touching has no clinical relevance. The same stress is realized on the joint. It may appear important, but it is not. My bad for not making this clear. I have amended my orders now to say: "Under no circumstance can you put any weight on that leg for fear of incarceration!"
  • When can I remove the dressing? There's no real hard science regarding dressing duration and its effects on infection rate. Yet, I receive scores of phone calls from nurses and patients alike about when they can remove bandages. There's no magical formula for this. Thankfully, since I perform most of my surgeries with the arthroscope, Band-Aids usually suffice. Some patients feel that if they don't change the dressing soon after surgery, flesh-eating bacteria will attack. Others take the dressings off and replace them with everything from masking tape to peat moss. Better safe than sorry: Leave the dressing on until I see you!
  • When can I toss this sling? I'm a shoulder surgeon, so my patients leave the OR in a sling. The duration of wear depends on the procedure. Here is where the confusion arises. Massive cuff repairs are to leave the sling on for at least 6 weeks. A release of adhesions for a stiff shoulder should dispense with the sling ASAP. When we give the wrong instruction sheet or inadvertently administer another doctor's protocol, my gastric juice secretion escalates. Several weeks ago a patient with a massive rotator cuff tear was told to "move his arm right away." Three Hail Marys and 2 Xanax after I discovered this, I told the patient to chill and stay in the sling.
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