what are your policies on pressure areas? @ my facility, all the time and effort put in to the documenting of areas, treatment orders, skin sheets, calling doc and familiy, you come in the next day and it has all been changed to a "non-pressure area" stg. 2 and 3's called "hardened area". i know pressure spots are caused by "neglect" , but i don't agree with hiding the fact that it is there. despite knowing it will be changed the next day , i continue to document what i find.
Jun 5, '01
One can not always say prssure areas are caused by negelect. that's why we have Braden scales to tell us who is at risk. Even the quality indicators take risk into consideration. One of the greatest challenges is the variety of documentaation of the staging. We use the same coding as is on the MDS. some use the CDC coding. but what ever is used it needs to be universal in your facility.
Jun 5, '01
Too many tools are often confused with good documentation. Bottom line is always good assessment and documenting problem areas and potentials. For example, some patients have a really sharp, almost vestigial coccyx. What scale is that on? What works best for me personally are the pictures that have the problems areas shaded in. When I'm in a hurry, I can see at a glance what areas I need to focus on immediately.
Jun 5, '01
I use the most recent US government publication regarding skin wounds and treatment. I ordered this booklet less than six months ago. It is called "Treatment of Pressure Ulcers", by the U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Publication No. 95-0652, December 1994. (You would think there would be a more recent publication). From what I remember, eschar can not be staged, but from MDS/PPS standpoint it should be listed as stage 4.
Jun 6, '01
OK, goldennurse, I see what you mean. Just document what you see and take pictures if you can. The facility I used to work in never had the film to put in the cameras to take pictures of the wounds or residents. I wasn't sure if it was from lack of money or poor management. In this day and time, there needs to be pictures (updated) of wounds and residents in nursing homes. Especially with all the prn/agency/temporary nurses working now in nursing homes. But my guess, is that most CEO's of nursing homes don't want any evidence of anything. Just a strong guess, since I have been doing legal nurse reviewing for nursing homes recently. My advice is to buy your own camera - $4.50 at Wal-Mart for a disposable camera and take your own pictures. You might need them someday.
Jun 6, '01
Just a warning: In Oregon you need written consent to take pictures! To my knowledge, a "hardened" area is not an accepted term.
Jun 7, '01
i think i was misunderstood regarding the pressure areas,what i was trying to say was that the pressure areas are there, but management "covers" them up by calling them "skin tears" or "hardened areas" . to me that's wrong! it's a pressure area and they don't want to acknowledge it. they say that it shows bad nursing care.
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