Geriatric bruising and what to do

I'm guessing that maybe the fact that your facility is so hyper-focused on bruising is that it may have been the subject of a DOH/Ombudsman investigation.

Your questions (except #6) all seem to focus more on the post-occurrence rather than prevention. There should be approaches that are care-planned and made known to all. And it should be an interdisciplinary approach probably best addressed thru some committee (a wound committee freq handles this).

What approaches have you already tried? I'm sure there is research out there to help.

We've got everything under the sun careplanned!

For the people that ambulate on their own we have restoritve and therapy working with them on gait and balance. For those in wheelchairs we have restoritve and therapy working with them on w/c mobility.

We even have postures careplanned! (Mr. Smith sits with his hands under the table and has been observed bumping the edge of the table when when raising hands above table to eat: staff to encourage resident not to rest hands in lap while at dining room table)

It feels like the higher ups are making new rules whenever the mood strikes them. We were just told that careplans require a doctors order.... I've never heard that ever before..so, do they require a Dr order and I just missed that somehow?

We've done transfer check offs, and in services, and I've told staff to come get ME if they need assistance with a resident and can't find help.

Care plans do NOT need an MD order. However, the doc is supposed to be in agreement with the plan of care. As the DON, I expected the nurses to investigate every bruise. If there was an abdominal bruise and the resident gets Lovenox, that's what we write on the event report. I've had to investigate nasty bruises...It's distressing to think someone is being abused. We use geriarms and gerilegs. Old people bruise and old people fall.

I'm guessing that maybe the fact that your facility is so hyper-focused on bruising is that it may have been the subject of a DOH/Ombudsman investigation.

Your questions (except #6) all seem to focus more on the post-occurrence rather than prevention. There should be approaches that are care-planned and made known to all. And it should be an interdisciplinary approach probably best addressed thru some committee (a wound committee freq handles this).

What approaches have you already tried? I'm sure there is research out there to help.

I agree with the likelihood of there being POC in place.

I worked in a building that every single fall was an automatic Xray of the pelvis and bilat hips regardless of clinical findings. Was a pain but a POC is a POC so we complied.

Facilities have wacky policies. I worked for a large company which wanted us to do a UA C&S after every fall. I argued against it. Sure, if they had other symptoms grab a urine, but many times the falls were observed...one lady tripped over another lady's wheelchair leg. It wasn't a UTI, it was an activities department who tried to cram people in the room. At least things should be based in reality. We had people who fell 5-10 times a year. If they had an x-ray every time they'd be glowing in the dark.

Thank you all for your comments.

I have discovered that it IS corporate just making things up as they go. During a meeting one of the higher ups actually said to disregard what the state surveyer said (we had a surveyer in to clarify) and continue doing things like we've doing them. I want my residents safe but this is overkill and its actually hindering the care they receive. It may be time for a new job.

The sad thing is that despite all your facility's high-stepping, their bruise rate MAY NOT go down, but instead will remain unusually elevated.

I had a really wise instructor in my BSN Nsg Issues class. She pointed out that some statistics may not be really be unusually high compared to others in the facility. It was that some units just practiced better REPORTING all their occurrences, whereas some other units were less stringent with reporting/documenting.

At my very first job, every unit received statistical monthly/quarterly Falls/Safety reports. My unit ALWAYS ALWAYS had the highest falls rate. But I knew we reported EVERYTHING & ANYTHING resembling a fall. (When I floated, I learned some occurrences were just DEALT with - no Incident Reports.)

Sadly, your facility's aggressive reporting may be biting them in the butt when the Sate looks at the rate.