[Tweety]

Originally Posted by jonear2

Umm, I never said anyone called me a perv, I was just making a joke, not getting defensive. Actually Im just as curious as you all about daily assessments. I hope that we will get alot of feedback on what assessments people are doing. I hope that this will serve as a learning tool for myself and others who, like me are still very very new.
My assessment includes
heart/lung/bowel sounds
When the pt rolls to the side for me to listen to lung sounds on their back thats when I check the skin- the gown is open anyway.
peripheral pulses radial and pedal
heels for breakdown wwhen checking the pedal
muscle strength and grasp (important for fall precautions)
And I do PERRLA because I have had a pt who was blind in one eye and I never would have known it had I not done that.

The whole assessment takes about 5-10 minutes at the most.

Good assessment skills. Skin assessment is part of a good head-to-toe assessment and I incorporate that into my overall assessment, without specially asking "may I see your butt".

We are required to do Braden scales on all our patients. Those with a BS of less than 18 should have their butts checked q assessment. Walkie talkies don't need a specific butt check, but just an overall skin asssessment during their routine assessment or throughout the day.

A good assessment focuses closely on the needs of the specific patient to be focused on.

[grinnurse]

Originally Posted by jonear2

The thing is, full skin checks are a part of our routine assessment. In fact our facility has dubbed wednesday "butt check" day. The nurse manager from each floor goes around to do a full head to toe skin assessment on each patient to see if the nurses missed anything. I think it has something to do with a big lawsuit a couple years ago that had to do with undocumented skin breakdown. I am following P&P on this issue. The flowsheets even have a skin assessment section complete with the diagram of the body so that the nurse is free to draw pictures if words cannot describe. Any skin impairment from a scrape to a boil and beyond must be referred to wound care nursing for follow up.
I do not "enjoy" doing skin checks particularly and I was under the impression that every facility had the same attitude as mine. Doctors in the ED do not do skin checks and in fact the Wound Care team (nurses) have held many time consuming inservices about how you are never supposed to trust anyone else's documentation even the doctor's. I would not go to the H&P on admission to check the patients lung sounds even if he were admitted for say finger pain. I also do not equate looking and blanching someone's buttock with performing a digital rectal exam. If the patient refused the exam I certainly woud not push it, I would document the refusal. But I cannot document "skin intact" if I dont know that it is. I hope this clarifies the situation in that it is not me personally who just throws back the covers to see whats to see, but actually a facility wide policy which I am trying to follow. The original point of the post was that I was having a hard time doing the skin checks that I am supposed to do. Maybe this info will help and not make me sound so much like a perv.

Amy-I agree with you on this subject. We have skin sheets for each patient and alot of the nurses that I work with will put down that the skin is intact on the walky talkies when in all actuality its not. As someone said in an earlier post, you can't see your back and the walkie talkies, are at risk for melanoma and your skin check may be the one time that something treatable is caught. Or God forbid, some kind of physical abuse. I also check my Peds skin too. There is a reason those skin sheets are being used. Of course if the patient refuses that is what I will chart but I also explain to the younger ones my reason for doing the skin check and then they understand why I am looking and haven't had one yet that has had a problem with it.

[anniev]

jonear2 come work LTC my DON would love you ! It is amazing the things not found on admisson usually a time situation.

[SeanSean]

We are required to do a full skin assessment on all patients, including the backside....but we don't unless the person appears at risk. But occasionally you get the walkie-talkie elderly person who ambulates on own fine to the bathroom but spends amost of the time when in bed on his/her back though reminded to turn or invited to allow a pillow to be placed under hip. Nurses get written up at my facility for such matters if they miss them.

So I always tell the aide, "Let me know when you are going to turn (as in TQ2H, or clean the patient, and I'll help," then I jump in to complete the skin exam. Occasionally one finds a red coccyx that hasn't been previously charted, esp in transfers from ICU. And the latter is important if ICU hasn't charted it properly so my med-surg floor doesn't get blamed for the Stage I.

[Spidey's mom]

Originally Posted by Tweety

Good assessment skills. Skin assessment is part of a good head-to-toe assessment and I incorporate that into my overall assessment, without specially asking "may I see your butt".

We are required to do Braden scales on all our patients. Those with a BS of less than 18 should have their butts checked q assessment. Walkie talkies don't need a specific butt check, but just an overall skin asssessment during their routine assessment or throughout the day.

A good assessment focuses closely on the needs of the specific patient to be focused on.

Good post, as was jonear2's . . . . you don't need to say "let me look at your bum" . .. to do a skin check.

When we go in at 4 a.m. for first vitals, I check the back as I do lung sounds and then the patient gets up oob to the stand-up scale and I am able to check the rest of the skin. Obviously I'm not doing pelvic checks but I do ask if they have any problems.

We can do alot by not even telling the patient we are doing it during routine care in the morning. It is like counting respirations when they don't realize you are counting them because when they realize it, they breath differently.

I check pedal pulses and heels too for skin breakdown or mushiness.

steph

[ginampls]

Good for you for checking bums on everyone! I work on an oncology med/surg floor and even the walkie-talkies are at risk due to their compromised sytems! And thank you for taking the time to assess your patients!

[Chaya]

We have to fill out preprinted assessment forms that have a section for skin assessment. Woe betide you if you leave a section blank! I'm diligent about a detailed check on initial admission assessment; at this time I ask the pt how active they were before being hospitalized and explain the need for the check. It's a quick visual check if they were ambulatory and if they are alert/ oriented I'll ask if they have any skin issues before I look. If they've been immobile I check back of head, elbows, heels, again explaining why.
Our daily assessment form also has a skin assessment section. I do refer to assessments from previous shifts/ days; if no skin issues noted and the pt is ambulatory and continent I will kind of limit it to what I can see while listening to lung sound on their back.

[PhoenixGirl]

Do you have aides that help with pts bathing and ADLs? I had a walkie talkie the other day, out of 7 pts she was the only one. So no, I didn't turn her to check her backside. And she changes positions herself as needed, so she wasn't ordered as a q2turn. But I work with great techs/CNAs who I ask "if you see anything unusual, such as breakdown or skin tears during showering, pls let me know." Then I'll go in to assess it. Other than that, with a walkie talkie that's not at risk for breakdown, and not ordered any creams or xenaderm for their bottom, I don't check. If they have their own BRPs I just ask them "did you have a bowel movement today? Let me know if you need any assistance during this time." Then if they do, I can go in and assess without letting them know exactly what I'm looking for.

HTH
Rebecca

[CRNAorBust]

In my mind and on my floor we are told we have to assess the WHOLE patient especially if they're new to the floor. If the nurse who took the patient initially didn't find anything then we're cleared to not to have to look. But if YOU"RE the one taking the transfer or new admit. You better look or it something may come back to bite you later. What happens if they had a fall and decided not to say anything till they get out and home? Did anyone look when that patient came in to see if they had any bruising etc? And how often do you have a patient who has psych issues but that's isn't on the chart or new admit report?

I think some of this is an issue when you LOOK young as a nurse. You may not inspire confidence in the patient. People often see me as a doctor so they tend to go with the flow when i ask them to do something. If that's the real issue you'll have to make sure you're following protocol on your floor. Then if the patient refuses you can either just document they refused OR ask them if they would like another nurse (or even the charge nurse) to come and look for you. I had a mentally altered elderly man refuse meds because he thought i was going to feed him green horse poison. I asked him if wanted to speak to someone about that. He did. So i got my mentor there and she and i made sure he understood i was there to help. He then took the meds. So you have to handle it according to the rules of your hospital and when necessary you get a more experienced nurse to come in and help.

[JustaPatient]

Originally Posted by jonear2

.....The nurse manager from each floor goes around to do a full head to toe skin assessment on each patient to see if the nurses missed anything. .....

I am not sure how, as a patient I would feel with this. Someone who is NOT my nurse examining me so intimately to check if they are doing their job. You at least have a bit of a relationship with your nurse. You have none with the nurse manager.