I feel your pain. I know how those 15 page incident reports can be. I have some information that may actually help. Remember that the concern is that the bruise may have resulted from mistreatment, however I have found that many people refer to every purple spot on someone's skin a bruise. There is a difference. A bruise
is a layman term often used for contusion
which is swelling, discoloration, and pain that results from an injury. The edges of a contusions are usually smooth. Contusions can result from mistreatement and should be investigated. Ecchymoises
is a blue/purple discoloration on the skin that is caused by extravasation of blood into the SQ tissue that occurs when vessel walls are fragile. Ecchymoises usually has irregular edges. Ecchymoises is common in the elderly because of thin skin, especially when they are taking anticoagulants or steroids and occurs with minimal trauma to the skin. Sometimes just a little bump will cause this. Purpura
is a small blue/purple spot that occurs when there is a hemorrhage into the tissues. Older adults often have purpura (sometimes called senile purpura) due to fragile blood vessel walls that rupture without trauma. Differentiate between the three and tell the staff to avoid using the term bruise as it can be misleading. Investigate bruises but just document ecchymoises and purpura. If you have a patient who gets a lot of either of these, get a derm consult to confirm that it is a skin disorder and not from trauma. Hope this cuts down on the paper work.