Skin assessment in the ED - page 2

by amarilla

4,700 Views | 15 Comments

Hi all, I am a surgical floor nurse visiting you all with a question about how skin assessments are done in the ED. The hospital where I work has initiated a protocol that a head to toe skin assessment should be done on all... Read More


  1. 3
    Quote from Altra
    If I had to quantify it, I would say that only half of ED patients who get admitted get completely undressed while in the ED.
    See, now *this* is what gets missed even though it seems like common sense. I had another nurse pass on in report that newly admitted patient 'had two small, closed sores - one in-between third and fourth toe and one on the bottom of second toe that the ED didn't catch." I remember thinking, 'who's looking at a AOx3, walky talky 38 year old appy's feet in the EMERGENCY department?!'

    UG!! This is exactly why I'm here to gather some info, because there are some who seem to be under the impression that you guys strip everyone naked and know and see all.

    Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.
    canoehead, ~*Stargazer*~, and Altra like this.
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    I'm not an ED nurse, so I really have little idea of what goes on there.

    But the very name implies it deals with stabilizing urgent issues, which as far as I'm concerned does not include a head to toe skin assessment.

    If I get sent a SNF pt with a stage 4 on their coccyx, I'll be a little irritated that I didn't get a heads up so I could have camera and supplies ready for when the pt rolled up. If it's a small open area that the walkie talkie 20-something got breaking in her new heels on the dance floor that night, I can totally understand it being missed.

    Our ED is supposed to do the pics and documentation if they find something. Honestly though I'd rather do it myself b/c they never get it right. Not their fault...barely any training, and we do WAY more wound photography and documentation on the floor, so we've had a lot more practice at it and all the little quirks in our charting system.
    amarilla likes this.
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    Ohh please tell me you are joking?! Sadly, I could see my ER forcing one more juggling act on the ER staff nurse. The ONLY time I note skin assessment is if there is reason. For instance, my patient comes in with altered mental status I will note the decub on his buttocks as he could be septic. But it he comes in with respiratory distress and gets himself a tube, then no I did not get past The "B" in my ABC's, his skin tear is besides the point. The ER should be a focused assessment and take care of the emergency at hand, not the besides the point diagnosis. When do the ER nurses perform these detailed assessments? In between intubating room 1, getting the MI in room 2 to the cath lab in <90 minutes, playing along with the "seizure" the drug seeker in room 7 is having, or assisting the Doc with the chest tube in room 8. Come on management your killin me
  4. 2
    Quote from amarilla
    Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.
    We actually did this where I used to work with one inpatient unit with which relations were becoming particularly strained. You could bring this up to your shared governance council as well.

    If you're really going to get a feel for it, though, you need to come at the predictably busiest times -- usually from 3pm to 11pm. Or ... at 7am on a day when we have held 15+ admissions overnight because there are no beds upstairs ... and you can see what it's like trying to provide inpatient care in an outpatient setting.

    Thanks for wanting to understand the whole problem!
    amarilla and GM2RN like this.
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    [quote=amarilla;511777I remember thinking, 'who's looking at a AOx3, walky talky 38 year old appy's feet in the EMERGENCY department?!'

    UG!! This is exactly why I'm here to gather some info, because there are some who seem to be under the impression that you guys strip everyone naked and know and see all.

    Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.[/quote]

    And you're welcome to come to the Dark Side anytime you wish, should you feel like you want a change of scenery. :heartbeat
    amarilla likes this.
  6. 3
    Quote from amarilla
    See, now *this* is what gets missed even though it seems like common sense. I had another nurse pass on in report that newly admitted patient 'had two small, closed sores - one in-between third and fourth toe and one on the bottom of second toe that the ED didn't catch." I remember thinking, 'who's looking at a AOx3, walky talky 38 year old appy's feet in the EMERGENCY department?!'

    UG!! This is exactly why I'm here to gather some info, because there are some who seem to be under the impression that you guys strip everyone naked and know and see all.

    Thank you again for all of your responses. Even for a few hours, I wish they'd let us come down and see how things operate. I'm sure it would eye opening and most helpful with things like this.

    I agree with everyone else on the topic, but what I really want to say is that, as an ED nurse, I really appreciate your insight and attitude in a difficult situation. You sound like a great nurse and I hope your co-workers appreciate you.
    amarilla, canoehead, and Altra like this.


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