A Clinical Risk Case Study- The Importance of Wound Management in A&E from Injuries Involving Glass

A Clinical Risk Case Study- The Importance of Wound Management in A&E from Injuries Involving Glass

Setting the Scene

The Patient arrived at the Emergency Department with an open wound from an injury involving glass. The wound was closed using steri-strips and the Patient was subsequently discharged however, no x-ray was performed to rule out the prescence of a foregin body. Unfortunately upon discharge, glass remained in situ.

The main learning points from this review stem from the following events:

  • Not perfroming an x-ray to formally indentify the existence of a forgein body.

  • Closing the Patient’s wound without confirmation that the wound was clear of debris.

Recommendations to Prevent Incident Recurrence and Improve Patient Safety

The way that glass can break can vary upon the type of glass object, and can take on many shapes. It can either break off into cube-like structures, small pebbles, or and can splinter into large or small shard-like pieces. Depending upon the mechanism of the injury, small-shard like pieces can puncture the skin and travel into the tissues, and cannot always be felt by the patient or practitioner.

Incised or puncture wounds caused by glass shattering can be either deep or superficial and therefore, these wounds will need to be explored. In the absence of foreign body sensation in a glass-related injury with a high-risk mechanism injury pattern - such as falling from a great height -it is vital that an x-ray is performed so as to rule in or rule out, foreign bodies within the wound.

TMLEP’s recommendations to reduce recurrence and enhance patient safety are as follows:

  • A Standard Operating Procedure for penetrating injuries involving glass should be considered to aid practitioners when assessing patients who have sustained open, incised or puncture wounds with glass involvement, looking at various type of injuries and the mechanism of injuries.

  • It is recommended that there are regular teaching sessions on wound assessment and wound management.

  • Pracitioners should maintain a high suspicion of foreign bodies when seeing to injuries sustained from high risk mechanisms such as falling from great heights or going through a windscreen during a RTA.

To Summarise

The Patient was discharged with foreign bodies in their wound after sustaining an injury involving glass. It is important that healthcare providers educate their teams and provide a Standard Operative Procedure on this issue as part of their training so as to ensure there is constantly a high suspicion of foreign bodies when assessing and managing wounds sustained by glass, particularly in high risk mechanism of injury patterns.

References

  • Ingraham, C & Mannelli, L & Robinson, J & Linnau (2015) “radiology of foreign bodies: how do we image them?” Springer https://link.springer.com/article/10.1007/s10140-015-1294-9
  • Schaefer, N & Cappello, J & Daniele, L (2015) “punching glass; a 10 year consecutive series” Plastic and Reconstructive Surgery Global Open https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4494506/
  • Wardrobe, J & Edhouse, J (2004) The management of wounds and burns. Oxford University Press
  • Co-written by The TMLEP Clinical Risk and Patient Safety Publishing Group, Claire Sheen - Senior Emergency Nurse Practitioner DiP HE nursing & Midwifery and Ms Kathryn Pfeiffer LLB (Hons) TMLEP Analyst. (2019). A Clinical Risk Case Study- The Importance of Wound Management in A&E from Injuries Involving Glass. TMLEP Clinical Risk Case Studies. 2 (7), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.