Admission Skin Assessments

[NurseQT]

Wondering when other facilities do an admission skin assessment. At my facility the majority of our admissions are short term rehab patients and are admitted to our rehab wing. Most of our admissions usually arrive on the day shift. Our current admission process really sucks to be completely honest. On the day of the admission there is a 10-12 step process which we are expected to complete in one shift, this includes an admission skin assessment! Trying to do a thorough skin assessment on a fully clothed person while fighting off therapy, who will wisk that New admit away to do their own assessments the moment the nurse turns her/his back, is next to impossible. Not to mention the fact that most of these admissions are A&Ox3 and have absolutely no interest in taking their clothes off at 1:00pm! All too often we day shift nurses have asked the PM nurse to please do the skin assessment at bedtime, well one of the PM nurses complained and the day shift nurses scolded. Every facility I have ever worked in the initial skin assessment was done at hs. Not to mention the fact that so have never worked anywhere that required almost an entire admission to be done in one shift. Then nothing until the following day shift when there are more assessments and various tasks, most of them being assigned to days, only a couple on PMs, and none on nocs. Days also has the heaviest med pass, all the care conferences, all the discharges, and doctor rounds, and inter-disciplinary meetings. No one in management would dream of helping and our charge nurse is also a floor nurse. The process is just ridiculous I think..

[CapeCodMermaid, RN]

Welcome to the world of unreasonable expectations. We get most of our admits on 3-11 so the taking the clothes off thing isn't a big deal. I've worked in many places and no one has expected the whole admission to be done on one shift. Some of the assessments can't be completed on day one....how do you know if the person is continent? They most likely aren't going to tell you the truth. I have no advice except to keep trying to get people to be reasonable and spread the workload around.

[NurseQT]

Besides the 10-12 step process on the shift of admission there are additional assessments and tasks that are done over a 6 day period. For example, a 3 day toileting assessment is started on the morning after admission and then a bowel and bladder assessment and toileting plan are completed on day 6.

Every facility that I've worked at the admission skin assessment was always done at hs. Every so often there would be talk of changing the skin assessment to be done within 2 hours of admission but it wouldn't ever go through.

The other thing I'm finding is that when almost a full admission is being done on the shift that they arrive on and then there are no further tasks until the following day shift the nurses are barely looking at these people!! I had an admission come in this past Friday, on Sat I asked her if I could take a peek at her hip incision/bandage, her response? "I was wondering about that, you're the only person whose even asked to look at my hip!" What??!!! The woman was admitted with a 2 day old incision on her hip and the previous two nurses didn't think to look at it?! That's a problem.

[Mistyrose123]

nurse QT at my facility the skin assessment is done within one hour of admission. Per state surveyor guideline "a stage one pressure ulcer can develop in one hour". If you wait longer how can you prove to a surveyor that the pressure ulcer was admitted or acquired? Or if bruises are present, did they occur there or were they admitted. I do understand all the paper work, assessments, medication list, etc. At my facility, we have a med nurse and a unit manager and they both work on the admission. we have had up to 10 in one day. the other nurses come and help and the other unit managers come to help. we also have a treatment nurse that will come and do the skin assessment and advise on treatments. maybe you need to meet with your DON so she can let other available nurses know that they need to come help. I hope this helps you some.

[LPN9200]

I too work on a skilled/rehab unit and Our skin assessment is supposed to be done by the RN charge nurse assigned to the unit when the admission gets there. It's part of their initial assessment. Although, depending on the RN, the LPNs will do the skin assessment and note any concerns for the RN and then they usually follow up on them or depending on the LPN will just trust our judgment and go from there. I also work 3-11 though and we have a pretty good team that works well together to make the admission as smooth as possible. Most of our admissions come already from the hospital setting in a gown which makes the process 10x easier because we will usually wash them up, change their gown and do the skin assessment all at once.

[snow22]

Holy crap I feel your pain!!

I just started working day shift at my facility because I was attempting to avoid the admission process but they are starting to throw admissions on us ON DAY SHIFT!

Working 8 hours on days, with managers and therapists throwing you five different ways and hospital-grade patients plus an admission?? I haven't left on time since the holidays started...thank goodness those are done too!

Most the time I do a full skin assessment with a therapist or a CNA while they are working on getting through their day because I know if my shift doesn't get it done, the next shift will not be willing to do it.

The therapists want to throw a hundred things on me? I'll just bite back haha! (kidding love my therapists)