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 foreign body. Unfortunately upon discharge, glass remained in situ.
The main learning points from this review stem from the following events:
Not performing an x-ray to formally identify the existence of a foreign 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 or small pebbles 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. If the wound is deep or visualisation of the base of the wound is difficult due to bleeding then an x-ray must be performed. This is particularly important with a high-risk mechanism injury pattern - such as falling from a great height - 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, looking at various types and mechanisms of injury
It is recommended that there are regular teaching sessions on wound assessment and wound management
- Practitioners should maintain a high suspicion of foreign bodies when seeing any glass wound but particularly with injuries sustained from high-risk mechanisms such as falling from great heights or going through a windscreen during a RTA
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 Operating Procedure on this issue as part of their training, 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.