I have seen many different sets of cast care instructions in use and they range from four A4 sides of paper down to a tiny credit card-sized fold up piece of card. These last information cards are usually printed for free in exchange for a large advertisement on the card from a law company.
It can be a vexed question as to how much information we should give to the patient but I am never happy unless I can give them something in writing as well as my verbal cast instructions.
I favour the single sided sheet of A4 paper so that the paper is large enough not to get lost and text can be printed at a size that can be easily read if one is visually impaired. A lot of dense text or large words that use medical terminology exclusively are usually inappropriate. Simple instructions and clear and easy to follow directions are more productive, in my experience.
There are several things which are essential, in my view. I don't wish to teach other technicians how to do their work but the number of technical, difficult to read and almost illegible sets of plaster instructions which I have seen used suggest that we could aim towards a standard format without compromising patient care. The patient should be made aware that they have open access to the plaster room while they are wearing a cast.
Patients should be encouraged to contact the plaster room staff whenever they have a problem related to wearing the cast. An A&E phone number should be given as well; for when there are no plaster room services or staff available. What follows is a suggested set of Cast Care Instructions...
Cast Care Instructions
A plaster/synthetic cast was applied to rest your injured limb and prevent any further injury. Your cast will hold your damaged bones and soft tissues in their best position for healing. This position may feel a bit awkward to you but it ensures rapid healing and your early return to full and normal function.
Please do this if your arm or leg has been placed into a cast
- DO raise your hand above the level of your heart. (elbow resting on tables or chair arms)
- DO raise you foot above the level of your heart. (toes should be level with your nose)
- DO move any arm or leg part for 5 minutes every hour where they are not inside the cast.
- DO take your arm out of a sling - move your shoulder and elbow joints regularly.
- DO stand for 5 minutes an hour in a leg cast - move the hip and knee joints if not in cast.
Never do any of the things listed below
- NEVER get your cast wet by placing the limb in a cast in water or under a shower.
- NEVER stick any objects under the cast to scratch an itch.
- NEVER put cotton wool or similar padding under the cast if it is uncomfortable.
- NEVER heat the cast by any means whatsoever.
- NEVER attempt to cut, trim or adjust the cast in any way.
- NEVER wear any jewellery on the affected fingers until the cast has been removed.
- NEVER put any talcum powder or creams inside the cast.
- NEVER walk on a leg cast if you are told it is strictly non-weight bearing.
- NEVER lift anything heavy while your arm is in a cast.
- NEVER wear any nail polish on the toes or fingers of an injured arm or leg
Please watch carefully for any of the following signs and report them immediately
- ANY increased pain (more than when your limb was first placed in a cast).
- ANY burning sensation under the cast.
- ANY increase in swelling of the parts in a cast which are furthest away from you.
- ANY change in the skin colour of the affected limb part.
- ANY numbness or change in sensation of the injured limb.
- ANY smells or leakage from under the cast or any staining of the cast (with blood).
- ANY difficulty in moving the fingers or toes which are not inside the cast.
- ANY damage to the cast.
You MUST contact your plaster room or local A&E department immediately if you have experienced any of the above symptoms or signs. Do not sit at home trying to be brave and not wishing to bother anyone. We are all here to help you recover from your injury.
What to do if you feel any itching sensations under the cast
When the skin underneath a cast itches it is because your skin cannot be washed while it is under the cast. You can reduce the itching by cooling the cast with cold air from a hair dryer directed onto the cast where the itching is most noticeable. You can also use a packet of frozen peas laid on the cast to cool it where it itches the most. Usually a five to ten minute cooling period is all that is required to reduce the sensation of itching.
The skin is very fragile after a cast has been removed. Do not scratch it but wash the skin gently and dab it dry without rubbing it. A little moisturising cream will help the skin to recover its normal elastic character. It may take up to two weeks of applying moisturising cream and regular washing before the skin looks and feels normal to you.
One excellent idea which I saw being used is one that I feel could easily be copied and used nationally. It is the use of Google Translate. We are used to seeing patients from many different cultural backgrounds and it is undoubtedly helpful to present them with the cast care instructions in their own language.
Each time a language translation request is made to the service then a copy should be saved locally under a file name reflecting that language. It can then be printed on any other occasion when a patient requires the instructions in their own language.
It is accepted that the translations will sometimes be less than ideal, especially in any of the languages which are considered to be uncommonly used or heard in the UK. Many of the plaster rooms in which I have worked have never had any easy or rapid access to interpreting services.
The written cast care instructions have relied on the patient being able to understand English or being able to find a friend or relative who can translate the written cast care instructions for them.
This use of current technology is a step forward in ensuring that your patients are aware of the way to care for a cast before they leave your plaster room. It represents a major improvement in patient care for foreign nationals and I highly recommend its widespread adoption.