admission assessments

Nurses General Nursing

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I am a med/surg RN who is trying to figure out how to improve our wound documentation on admissions and during hospital stay. I am trying to find information on how other hospitals handle their admission/discharges and wound care. During admission assessments there are about 75% of the nurses that don't visually do an assessment. They ask the pts "do you have any skin issues like bruising, rashes, sores, cuts, etc. that I need to know about?" Obviously if a pt. states "no" but two days later is found to have a Stage II pressure ulcer on his coccyx the hospital is now liable for that ulcer.

Currently we have 3 RNs that split a 24 bed floor in half. They each have 1-2 LPNs with occasional SNT/CNAs. If we are lucky we have a fourth RN who charges but mostly one of the three RNs charge. The RNs responsibilities are notes on patients or passing meds and taking orders off. We have a GREAT deal of new grads so very little experience.

We know the reasons as to why they are not always a FULL assessment (staff shortage, lack of time, inexperience, etc). I realize it is crucial to do a FULL assessment but meeting some resistance from other nurses. If I come up with a better solution that WORKS at other facilities then maybe I can change their views. It is either we decide or management will. ANY help would be EXTREMELY helpful! Thanks

Photographs, photographs, photographs.

Really does not matter what they want to do or have time to do, the issue is that documentation needs to be done. As of October 1, 2008, the US government will no longer be paying for any care for patients that develop pressure ulcers that they receive while they are patients, so if there is no documentation that the patient arrived with it, then the hospital is going to be eating thousands of dollars in charges. And they are not going to be happy with it.

Asking a patient is not a good enough answer, and it could turn and bite them on the butt and make them subject to being questioned by all of management.

It is going to be out of their hands and it is actually a requirement that a head to toe assessment be done on all new admits to any unit. Violations of this can be costly for all.

It comes down to if they do not do it, and there are repercussions because of it, they are the ones that are going to suffer and they can actually lose their job over it, as it would be the same as falsifying a document. If they never saw it, but recorded that they did, then that can get them into trouble with the state as well.

Suggest that you just show them a copy of this thread.

Policy is that pictures are taken on admission and weekly for any decubs. Skin problems that develope while pt is an inpatient usually is found on assessments or aides call attention to the problem.

Do you have an admission nurse on floor or even a skin resource nurse? I would like to suggest to hire another staff member to due the admissions and discharges M-F but also provide education to ALL RNs on how to do a PROPER assessment! I totally agree with photographs. Are all nurses trained in how to use the camera or is there someone else in charge of that?

The committee meets next wed. and I want to take some suggestions. Thank you again!

Photographs, photographs, photographs.

Really does not matter what they want to do or have time to do, the issue is that documentation needs to be done. As of October 1, 2008, the US government will no longer be paying for any care for patients that develop pressure ulcers that they receive while they are patients, so if there is no documentation that the patient arrived with it, then the hospital is going to be eating thousands of dollars in charges. And they are not going to be happy with it.

Asking a patient is not a good enough answer, and it could turn and bite them on the butt and make them subject to being questioned by all of management.

It is going to be out of their hands and it is actually a requirement that a head to toe assessment be done on all new admits to any unit. Violations of this can be costly for all.

It comes down to if they do not do it, and there are repercussions because of it, they are the ones that are going to suffer and they can actually lose their job over it, as it would be the same as falsifying a document. If they never saw it, but recorded that they did, then that can get them into trouble with the state as well.

Suggest that you just show them a copy of this thread.

So should we photograph every at risk patient's hind end and pressure points? I look all of my patients carefully on admission, and while they may not have had a sore when they come in, their skin is so fragile and their mobility and nutrition are so poor that they are a decub waiting to happen. If that is the case, I document that the patient has very poor and fragile skin.

it is a requirement that skin assessment is done. if someone comes in with a dressing then the dressing has to be removed unless md orders not to. The nurses are accountable for thier own assessments. they have to be. there is not enough time for the charge nurse or manager to go check all the pts.

I am on a team of nurses/physical therapist who spent about the last 3 months rewriting our policies. We decided that a Braden scale will be done on admission and daily during bath time. The nurse will have to sign that she/he has done this so if anything happens, that nurse will be responsible. The policies go in great detail as to what is to be done on a daily basis and who is responsible. Medical Staff approved it Thursday and now the hard part starts.

Specializes in med surg.

grammyr, we are in the process of reviewing our policy and requireing the braden be done daily also, any info you could share would be appreciated. also do you have skin care teams, again looking at implementation of this.

Specializes in RN- Med/surg.

Our wound expert says photographs are not reliable. Unless you have exact distance, angle, and lighting it won't look the same if taken twice within a minute.

Also- quite honestly....wound or not- if you came at my bottom with a camera- I'd be sueing for something- and I'm an intelligent alert individual. I think the practice of taking pics is horrible and demeaning.

Also- quite honestly....wound or not- if you came at my bottom with a camera- I'd be sueing for something- and I'm an intelligent alert individual. I think the practice of taking pics is horrible and demeaning.

You aren't coming at my heinie or anything private with a camera either.

Our wound expert says photographs are not reliable. Unless you have exact distance, angle, and lighting it won't look the same if taken twice within a minute.

Also- quite honestly....wound or not- if you came at my bottom with a camera- I'd be sueing for something- and I'm an intelligent alert individual. I think the practice of taking pics is horrible and demeaning.

Ya, I would not like by butt being taken a picture of just because it got a sore on it.

I would use the government making changes as to what will be covered and what won't be as reasoning to hire more staff. 3 RNs for 24 patients in M/S is a horrible ratio. Let the hospital know it will cost them more to cover charges than to hire additional staff in the long run.

They will of course say the 3 nurses have to find the time to do it and really assessments should always be done, but when they do them other care will suffer due to being short staffed. Either way your hospital is opening themselves up to violations and possible lawsuits. Hopefully appealing to their greed will get them to do the right thing.

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