How's your pressure ulcer prevention care on your residents like?

  1. We get an average of one ulcer occurance per month. Not bad, but could be better. I've seen worse in other LTC homes.
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  2. 12 Comments

  3. by   fluffwad
    Some of this depends on what kind of patients you have. Some homes cater to younger disabled, a few places take only the walkie-talkies.

    The average age at my facility is about 87 and we have several patients between 95-101. We get a lot of people who have pressure sores on admission.
    We have several hospice patients.

    The bottom line is how much preventable breakdown is happening.
  4. by   Nikki69
    Every resident who is at risk for breakdown must lay down after breakfast and lunch. They must be clean and dry with extra protective cream applied at all times. The residents who already have ulcers, and are bedridden should be turned every hour on the hour, and a good skin nurse should be on top of things by doing everything possible to clear them up. I have a resident who is very large and keeps breaking down on the backs of her legs. Our treatment nurse (I love her!) got an order for a very thin clear ointment that cleared the open sores up in three days. I can't remember what the name of it is, but I'll ask her tomorrow.
  5. by   CapeCodMermaid
    I work in a 142 bed facility. Last month we had 2 acquired pressure areas. One woman is on hospice and the other is 96. My corporation said we'd better improve because it looks like we're "growing" pressure ulcers. They never mention the woman who came in with a stage 4....7cm high X 7cm wide X4 cm deep. Her wound is now 2cm high x 1.4 cm wide x 0.4 cm deep!!
  6. by   Antikigirl
    I am so very happy to say we DON'T have any of these probelms AT ALL! Our caregivers are well educated on pressure ulcers and know they are very preventable with just a bit of effort! They have also seen the horrors of pressure ulcers and the effort it takes to cure them for our residents that come back with them from hospitals (no offence towards hospital nurses...but most of ours come from our local hospital, and we have reported them often!) or rehab facilities!

    The old addage of turning every 1-2 hours is so very true, and our caregivers do it!!! I mean, it makes sense...a ounce of prevention for the sake of the resident and staff as well..is worth it! Lucky for me they know this, and follow it!

    We also have a nurse totally into skin care and skin breakdown prevention. Most of the time I feel it is OVERBOARD the charting and implementations we do (we report all skin issues, and fill out incident reports for ALL issues..even 1cm ecchymosis or tears...followed up weekly in the care notes and a skin assessement/treatment sheet in the MAR's)...but since we haven't had a single decube in the 3+ years I have been there...well...heck, I can chart a bit more for that!!!!!

    The trick is careful assessment by all staff..and reporting every skin issue...from hangnails to bruises no matter the size! Tedious...YES, worth it...YES YES YES!
  7. by   lovingtheunloved
    Quote from Nikki69
    Every resident who is at risk for breakdown must lay down after breakfast and lunch. They must be clean and dry with extra protective cream applied at all times. The residents who already have ulcers, and are bedridden should be turned every hour on the hour, and a good skin nurse should be on top of things by doing everything possible to clear them up. I have a resident who is very large and keeps breaking down on the backs of her legs. Our treatment nurse (I love her!) got an order for a very thin clear ointment that cleared the open sores up in three days. I can't remember what the name of it is, but I'll ask her tomorrow.
    Thank you! I keep trying to get the other CNAs I work with to understand that. It doesn't matter how much "ointment" or cream you put on someone. There is a reason it's called a pressure sore. Their skin must be kept clean and dry and they need to be off of it. Period.
  8. by   dawnb70
    Just curious...I was wondering how many nurses are being educated about Terminal/Kennedy ulcers. We've had state in the building recently over a wound that was clearly a terminal ulcer, and now the family is sueing. How do you document when you are certain that that's what the wound is? And how do you prevent legal action in that type of situation?
  9. by   gwenith
    Are none of you doing risk assessments on patients?
  10. by   Bird2
    Quote from gwenith
    Are none of you doing risk assessments on patients?
    We use the BRADEN SCALE. It helps zero in on the main risk factors. These are done on admission, weekly for one monthe then quarterly. Preventive skin protocols are in place for all at risk residents.
  11. by   doodlemom
    Quote from dawnb70
    Just curious...I was wondering how many nurses are being educated about Terminal/Kennedy ulcers. We've had state in the building recently over a wound that was clearly a terminal ulcer, and now the family is sueing. How do you document when you are certain that that's what the wound is? And how do you prevent legal action in that type of situation?
    I am a hospice nurse and I recently had to give a whole bunch of information on this subject to a facility because the DON was all upset and scolding the staff for not having noticed it before it "popped up." I did not have any official information - just what I pulled off the internet.
  12. by   CapeCodMermaid
    Quote from gwenith
    Are none of you doing risk assessments on patients?
    You can do all the risk assessments you want...Braden...Norton ..neither of them are very good indicators. I have a man with a Norton of 1 whose skin is beautiful. It takes good nursing care, good nutrition and a never ending watchful eye. (PS. The aforementioned huge stage 4 which had shrunk significantly...it's now RESOLVED 100%!!!!!!!!!!!!:hatparty: :hatparty: )
  13. by   silverpilot03
    Quote from CapeCodMermaid
    You can do all the risk assessments you want...Braden...Norton ..neither of them are very good indicators. I have a man with a Norton of 1 whose skin is beautiful. It takes good nursing care, good nutrition and a never ending watchful eye. (PS. The aforementioned huge stage 4 which had shrunk significantly...it's now RESOLVED 100%!!!!!!!!!!!!:hatparty: :hatparty: )
    No tool is perfect. The Braden, Norton and Waterlow have limitations but they are clinically validated. WE ALL KNOW that an assessment if done timely and accurately is the first step towards proper care. Nursing 101: "ADPIE".
  14. by   dawnb70
    We use the Norton Scale at our facility. Those at high risk are care planned to address the issue. We also have a program called TAPS (Turn and Position & Sips-offer hydration)that is announced at odd hours over the intercom. For example, "Attention staff it is 9:00 o'clock, TAPS to the window". It seems to be working well. I haven't worked anywhere else, so I wonder if other facilities use similar programs? We also hand out barrier cream at the beginning of the shift, and the CNAs are reminded to "grease" everyone when TAPS is done. We have really cut back on our skin issues.

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