Casting 2011 Derrick Howells Clinical Lead Plaster Room & Staff Governor Yeovil District Hospital

A cast that is applied incorrectly can create complications A cast that is applied incorrectly can create complications. The person who applies the cast is responsible for that patient until that cast is removed. Who ever applies a cast should document clearly what cast has been applied and sign for the work they have done and document any abnormalities The patient needs to be educated as to how to look after the cast and be made aware of any complications that may arise. The patient needs to understand the importance of reporting any complications and the reason for reporting the complications, and who to report the complication to. They must have a contact telephone number and information about what to do out of hours Documentation is essential to provide clear evidence of care planned, the decisions made, the care delivered and information shared and a written record of care undertaken must always be recorded within the patients documents. (UKCC1998). Verbal information has to be given before any treatment is given to the patient, and both verbal and written advice once treatment is complete.

Fits well- a loosely applied cast does not provide adequate splintage and can cause soreness by rubbing the skin. Does not cause constriction- a applied cast too tightly could restrict the blood supply and possibly nerve supply to the limb. Is smooth inside- the bandages are applied with an even pressure and without any creases or ridges. Is lightweight- use only sufficient casting materials as necessary, thereby keeping the cast lightweight. Is one whole- fully laminated cast, not a succession of layers. This is achieved by speed of application and constant moulding to bond the layers.

A Selection of Casts All pictures were taken with patients consent for training purposes only.

Distal Radius #. Covering the MCPJ. Patient was in great pain

The thumb could not move the fingers were squashed and unable to move.

Patient has only 4 toes. Restricting the little toe prevents the patient being able to move the toes to reduce swelling. Also it can compress the toes together increasing the chance off a circulation problem.

Once the back slab was removed the patient was pain free and the swelling reduced immediately

All fingers are compressed can only see tip of thumb

This patient had a distal radial fracture.

Another distal radial fracture

Pressure sore under cast due to poor back slab

Patient had a distal radial fracture Patient had a distal radial fracture. This was after we removed the back slab.

Wanted to show this one again.

Summary Casting is a skill like any other. It is our responsibility to apply all casts correctly providing the best care possible for the patient. The risk of iatrogenic complications is high. Each practitioner must take responsibility for their own learning needs and acknowledge any personal training needs. Training is always available via request from Clinical Lead Plaster room. Any treatment given to a patient should be documented and signed to say who carried out the treatment. Would you accept any of the casts seen today? I wouldn't. I would be thinking of compensation. Derrick Howells Clinical lead Plaster Room YDH 2011

Thank you!