Can nurses do more for patients coming from ECFs with stage III pressure ulcers?

[Axmann, RN, BSN, NREMT-B]

We see it time and time again. Patient is admitted from an ECF with a stage III sacral ulcer, and likely additional ulcers on the heel.

What can nurses do to advocate for these patients aside from just caring for them in the hospital and sending them back to be neglected?

[Here.I.Stand, BSN, RN]

See if case management can arrange for a WOCN consult? When I worked in SNF we had a WOCN who visited, assessed the wounds, and made recommendations. The MD/NP would sign off on any "order" the WOCN made, and the floor nurses would then implement the treatments.

[AJJKRN]

How bout rallying for better staffing ratios...for all of us

[KatieMI, BSN, MSN, RN]

If family is there and involved: teach them the proper care (turning, etc) and encourage to demand it after discharge. They may want to go to the LTC and have a talk with DON. If the talk proves to be fruitless, get case management onboard for transfer.

If family is not there/doesn't care, options are limited. Case management can be involved in most severe cases, and in two especially bad ones (which I know of, that is) our Powers reported the facility to State.

[Tenebrae, BSN, RN]

What is an ECF? something like a long term care facility

Anyhow, find out what the people who are normally caring for this person know and start educating them on the basics eg regular turning, best way to dress the wounds?

If you prescribe a specific wound dressing regime, make sure the patient will have access to the same dressings when they are discharged

[KatieMI, BSN, MSN, RN]

What is an ECF? something like a long term care facility

Anyhow, find out what the people who are normally caring for this person know and start educating them on the basics eg regular turning, best way to dress the wounds?

If you prescribe a specific wound dressing regime, make sure the patient will have access to the same dressings when they are discharged

ECF = Extended Care Facility (most commonly long term care but sometimes also rehab and others). Nurses there usually know perfectly well how to prevent and treat pressure ulcers. But when you have 30+ clients to care for with one aide (second one called off, as also did your LPN) and not a soul more to help, alone with inane number of sign-offs, checks and marks that only an RN can touch, as well as crazy families and dismissive doctors, then you only do what you can do.

[luvsltcrn]

Really??? Because you are sending them back to a SNF they are automatically going to be neglected?? Patients develop pressure ulcers with the best care regardless of where they are - SNF, hospital or home. I have gotten many patients from hospitals with pressure ulcers that developed in the hospital and never once considered they were all being neglected.

[KatieMI, BSN, MSN, RN]

Really??? Because you are sending them back to a SNF they are automatically going to be neglected?? Patients develop pressure ulcers with the best care regardless of where they are - SNF, hospital or home. I have gotten many patients from hospitals with pressure ulcers that developed in the hospital and never once considered they were all being neglected.

Unfortunately, that's the truth. Sometimes, especially in population of patients with high risk of trophic changes (malnourished, CHF/CRF, morbidly obese, paraplegic/quads, etc) pressure ulcers develop spontaneously, despite of excellent care. III degree (not Kennedy type) ulcers developing within 24 hours are not that rare in this population and they can be provoked by, for one example, ECG electrodes. Yet, understaffing and lack of all or any types of care, are most common reasons for getting them in long-term. In LTAC our poor case managers have literally fight families who want to place their loved ones in any LTC nearest to their own place of living so that the Mother Dear could be "close to the family and attend her church". Those are important things, but not as important as chronic staffing problems, absense of PT/OT and WOC nurse in staff, horrible reviews, inability of the facility to provide the correct type of diet (which was painstakingly worked out for weeks), etc. Clients there are not neglected per se, but things tend to fall through cracks there and case management knows it. Still going to that church on Sundays seems to be more important for a while.

[luvsltcrn]

Not all SFNs are equal in care. There are good SNFs and bad SNFs just as there are good hospitals and bad hospitals. I get really frustrated when the assumption is made that all SNFs are bad. I have been with the same company for 20 years and DON for the last 6 years. We are a 5 star facility and have had 4 deficiency free surveys. We have a large number of patients that receive excellent PT/OT from our therapists. Myself and my ADON are both wound care certified.

The patients in my facility receive excellent care and I'm very proud of that fact. Again I realize that all SNFs are not run the same way. I just feel the need to speak up and defend the nurses who work in LTC. The majority of LTC nurses provide great care to their patients and should be proud of the work that they do and not made to feel that they are inferior to hospital nurses. I think the majority of nurses regardless of setting provide the best care they can. I have the utmost respect for hospital nurses I just wish that respect was reciprocated.

[Double Dunker]

Not all SFNs are equal in care. There are good SNFs and bad SNFs just as there are good hospitals and bad hospitals.

This is absolutely true. Some SNFs I'd recommend in a heartbeat based on how their patients present upon admission. Others, as soon as you hear a patient is coming from them, you know their skin is going to be a hot mess.

[NRSKarenRN, BSN, RN]

Most ECF = Extended Care Facility receive that patient with a decubitus ulcer already developed or identified from inpatient stay at a hospital.

Case #1: Family member had cardiac arrest post anaphylatic reaction to IV Vancomycin, spent 6weeks intubated in ICU went into rapid A fib anytime turned or BP plumeted. Had redness R buttocks pinpoint opening when finally stabalized sent to telemetry. Upon getting to SNF, wound had opened to stage 3; rehospitaled another facility, now stage 4 with severe protein calorie malnutrition. Discharged to Home care where we used wound vac and decub closed after 6 months including 2 further short hospitalizations.

Case#2: Healthy father with dementia had 2 episodes diarrhea 1 week apart: sudden onset high temp, confusion, inability walk shows up in ER with Stage 2 gluteal fold decub as unable to properly clean backside. Healed with home care intervention. Stage 2 reoccured as health deteriorated, on Hospice as only wanted to sit, unable to ambulate.

[annabanana2]

I've asked myself the same thing, OP, except that it was "can home health nurses do more for patients coming from hospitals with stage 3 pressure ulcers that they definitely didn't have before admission?" Often they get referred to us for something completely unrelated like medication management and the large draining wound on their left buttock just goes quietly unmentioned in the referral materials (or they say something euphemistic like "skin breakdown to L buttock"), or we had them before their hospital admission and we're going to review. We have a province-wide reporting system for things like these as well as medication errors, falls, and other incidents that should be monitored and kept track of. It helps that the government is in charge of health care up here, so I'd imagine that's harder to do in the US, but do you guys have anything similar?