in need of greative ideas

[zuchRN]

I am in need of creative ideas for preventative skin care. I am a DON in a long term care facility. We are looking at developing a creative, fun and motivational way to involve staff in preventative skin care.

I am looking for things that people do from the time of admission, through their stay at the facility. We are so good at identifying people at risk for breakdown--but it usually gets dropped after that point. I want any ideas that are reasonable and work. Even things that we can reward staff with for correct positioning.

I would also like to know if anyone uses a scale for predicting risk of skin breakdown other than the braden scale. The Braden scale does not seem sensitive enough for our long term care residents. I am looking for a more sensitive scale. If any one can help...I would appreciate it!!!!

:roll

[VivaLasViejas, ASN, RN]

I used to be an RCM in a long-term care facility, and I agree with you about the Braden scale. At my facility, we used one generated by the corporation's nurse consultants that was much more comprehensive, and it focused on lesser-known risks for skin breakdown, such as low albumin levels and depression.

As far as preventative skin care goes, my experience is that the most important factor is nutrition, nutrition, nutrition! One of the first things I did when I assessed a new admission to be at risk for skin problems was to request an order from his/her MD for a good multivitamin w/ minerals QD and Vitamin C, 500 mg BID. If they came in with pressure ulcers, I added 220 mg of elemental zinc QD X 6 weeks plus Promod, 1 scoop TID to my request. If you work for an independent facility, you could even ask your house medical director to add these to your standing admission orders, along with the bowel care and acetaminophen protocols.

I know incontinence care and repositioning are also important, but I also know the realities of LTC and one of them is, these things are often not done correctly, or not done at all. You will still want to encourage your staff to do them, and one way is to put a slip of paper under randomly chosen residents with the date, time, and a note requesting that the slip be returned to you (or the RCM, or charge nurse) when found. This isn't foolproof, but it reminds the staff to change and reposition residents and lets them know that this is being monitored. You *could* use a turn schedule and make them sign off every 2 hrs., but this is not as effective, the aides tend to resent every new thing they have to document, and you're in deep doo-doo with the state if there's a schedule posted and that resident is not in the correct position (e.g. facing the door @ 10 AM, on his back @ noon & so on).

Hope these ideas help.