We’ve Always Done It This Way: Flagyl Crushing & Other Wound Care Bad Habits

Published on June 23, 2017 by Keisha Smith, MA, CWCMS

Off-label drug use and questionable documentation are just two wound care bad habits that can get clinicians into trouble. Don’t just accept it because “We’ve Always Done It This Way” .

As clinicians, we use our knowledge, training and experience to find solutions and take care of patients in the best way possible. We learn about standards of care, scope of practice, and facility policies and procedures to guide our actions and care-giving.

There are several outdated common practices and treatments, however, that continue to surprise us. While there are plenty examples to talk about, let’s cover some of the issues most often brought to our attention.

Off-Label Drug Use

Even though Off-Label Drug Use (OLDU) is a legal liability, it is unfortunately a usual and customary practice in many facilities. For instance, it is common in hospice and home care to crush an oral Flagyl tablet and sprinkle it in the patient’s wound for odor control. For nurses, scope of practice does not directly state that you cannot crush Flagyl and apply it, but it does state that you cannot compound medications. Since nurses often crush pills that patients cannot swallow and administer by mouth, why is this an issue?

Flagyl tablets are approved by the FDA for oral use and utilization by the body. They are not approved for topical use in a wound bed. When it is used as a wound bed application, the usual 250 mg tablet is 100 times more concentrated than the FDA-approved topical Metrogel 0.75%. The safe, legal practice is to use the gel. If application is difficult or painful, apply the gel onto a contact layer (like peanut butter on bread). Then apply the contact layer with gel directly onto the wound bed.

Anti-Embolism Stockings

Another example of, “We’ve always done it this way,” is using white anti-embolism stockings on patients that are up and about. These types of stockings provide very light compression, useful only for preventing lower extremity blood clots in inactive bedrest patients. In other words, when it comes to anti-embolism stockings, do not use them on ambulatory patients. Follow the manufacturer’s instructions and use them where they are effective – in bed!

Wound Packing Documentation

If you ever document that you “packed a wound” requiring a wound filler, consider using different wording the next time. Why? Because if you pack a wound and it deteriorates and becomes larger, it could be said that you packed the dead space with too much vigor and products – and made it larger.

Even though you may have been taught to use those very words, instead choose terms that do not imply that you used too much internal pressure. For instance, “wound filler” sounds more moderate. If reviewed in a courtroom, you want the record to say, “… wound was filled with XYZ,” rather than, “…wound was packed with XYZ.” It sounds less harsh as a procedure.

Know Standards of Care

Always know your facility’s wound care policies, and initiate change when one is obsolete or a legal liability. When it’s one of those “We’ve Always Done It This Way” practices, arm yourself with the up-to-date knowledge and speak up. Keeping current with standards of care is important. One way to do this is to view or enroll in one of WCEI® webinars, seminars and certification courses.

Do You Have More to Share?

Do you observe any other bad wound care habits that fall under the “We’ve Always Done It This Way” category? We’d love your feedback. Please share any stories or examples by leaving your comments below.


Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Eligible clinicians may sit for the prestigious WCC®, DWC® and OMS national board certification exam through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

Keisha Smith, MA, CWCMS
Keisha Smith, MA, CWCMS

Keisha Smith, MA, CWCMS, is a freelance digital marketing consultant who works with clients in healthcare, law and behavioral health. Her specialties include content creation, social media and brand clarity. As an eight-time Wild On Wounds conference staff member and an alumna of WCEI's training program for wound care marketing professionals, she loves the exceptional passion of clinicians who treat wounds. She frequently finds herself advising friends and family to keep their minor wounds warm and moist.

  • Don’t miss the latest wound care news! Subscribe to receive our newsletter to your inbox.

    *By submitting this form you consent to receive communication via email from the Wound Care Education Institute®. Check out our privacy policy for more information. You can unsubscribe at any time.