Have you ever missed a pressure ulcer during assessment?

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Several days ago I admitted a post-op lady from surgery (I work in med-surg). She was relatively young and looked in good health. I got no report of a pressure ulcer. So during my assesssment, I very quickly looked at her backside but not thoroughly. Anyway, several days later a nurse pulls me aside and says "You missed a pressure ulcer on your admission! Be careful!" I guess fortunately, another nurse found it a few shifts later. It was a Stage II and her entire bottom area was red. Today it looks much better. I feel like a moron for not catching it... and also because I just assumed. They all pointed their fingers back at me. (But of course the pre-op and surgery people get off). Have you ever missed one?? I'll feel better if you share your similar stories. =-)

Specializes in LTC, Med-SURG,STICU.

I have seen people develope stage II pressure ulcers in less than an eight hour shift. I have to agree with the other poster that stated that you may not have missed anything. If there was several shifts inbetween yours and the one that the ulcer was found on everyone needs to take the blame. Personally I feel that it is too easy for nurses to miss a pressure ulcer especially if it is in a skin fold and that is why all of the nurses need to be doing a head to toe assessment. Granted I work in LTC and this would not be very practical in my case, but I still wish I could do a head to toe on all of my res. everyday. That would help to head off a lot of problems before they get out of hand.

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I always thought it took quite a while for a stage II to develop? This one was big and looked like it had been there for a while. As for those of you who said that you always check all of your patients: what about "the young crowd" - they techincally aren't at risk if they're mobile and they do not want you looking at their backsides. Do you still check them?

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Specializes in psych. rehab nursing, float pool.

In the hospital, yes we check everyone who spends any amount of time in bed, or has had a recent lengthy surgery. Look at some of the orthopedic patients their heels are so vulnerable.

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Specializes in LTC, Med-SURG,STICU.
I always thought it took quite a while for a stage II to develop? This one was big and looked like it had been there for a while. As for those of you who said that you always check all of your patients: what about "the young crowd" - they techincally aren't at risk if they're mobile and they do not want you looking at their backsides. Do you still check them?

I know that a stage IV pressure ulcer can develope in less than 24 hours. I know for a fact that a stage two can develope over the course of an 8 hour shift and in many cases less time than that.

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Specializes in Certified Wound, Ostomy & Continence Nurse.

It is very likely that the pressure ulcer developed between the time you did your assessment and the time it was discovered. The condition of a patient can change rapidly. Always stand by your assessment. You did not see a pressure ulcer on admission. Also, always assess your patients carefully on admission. It could be that blaming you for missing a pressure ulcer on admission is easier than admitting that the patient developed a pressure ulcer under the care of your facility.

Diana

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Oh my! 8 hours? I had no idea. I always thought it was something that took much longer. Anyway, I walk into the break room and there on our board is a big announcement that says, "effective Oct 1st 2008, any pressure ulcers that develop while in our care, the hospital is NOT reimbursed and must absord the costs." My thoughts: Oh crap, we're in trouble!

I walk into the patient's room a few days after all of this, and she and her husband admit that she developed that ulcer during her prior hospitalization, at a different hospital. My immediate thoughts: Hooray! So it's not our fault!

My thoughts a few minutes later: Wait a minute, then that means I really DID miss the pressure ulcer on assessment. :( lol

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Specializes in critical care.

yep-couple of weeks ago. Guy from NH on O2. Had pressure ulcers behind both ears from nasal cannula. Found it the next day. Felt like a moron. Never thought about them there though. CAT

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Oh my! 8 hours? I had no idea. I always thought it was something that took much longer. Anyway, I walk into the break room and there on our board is a big announcement that says, "effective Oct 1st 2008, any pressure ulcers that develop while in our care, the hospital is NOT reimbursed and must absord the costs." My thoughts: Oh crap, we're in trouble!

I walk into the patient's room a few days after all of this, and she and her husband admit that she developed that ulcer during her prior hospitalization, at a different hospital. My immediate thoughts: Hooray! So it's not our fault!

My thoughts a few minutes later: Wait a minute, then that means I really DID miss the pressure ulcer on assessment. :( lol

if you admitted her post op, where was she preop? why was it not seen ?

pardon me, but this just has a little "smell" to it, do you think the patient could have been ...suggested to say this was already there? so now the other hospital will have to foot the bill? that is going to go over like a lead balloon with them......good luck

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Her husband said that he saw it while at the other hospital too. Which, by the way, is a huge county hospital in the middle of Downtown L.A.

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Specializes in psych. rehab nursing, float pool.

It may very well have been that while in the hospital that patient did have a pressure ulcer which resolved. A resolved pressure ulcer will always remain an area of skin which will be more prone to future breakdown. In which case it is possible while she had an ulcer before, which healed. Then you admit her and if on the 3008 form no one documented a resolved pressure ulcer and where it was. You saw them, and saw no issue. Days later , pressure ulcer is now evident.

this is all conjecture on my part. Can happen though. In which case who would take the hit for the ulcer? I do not have the answer, any ideas?

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if it redeveloped at our hospital, then i assume it's my hospital's fault. however, since my assessment wasn't thorough enough, who is to say it was not there when i admitted her, only to be discovered later on by someone who did a thorough assessment.

this is totally random, but they should have RNs that do assessments and discharges ONLY. I always get an admission when everyone is in pain and I have little time - same thing with a discharge. They're too stressful! And while I'd love to get to know an new admit and go through the laundry list of things to ask and write down every single surgery and hospitalization that you've had, i really rather not.

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Specializes in psych. rehab nursing, float pool.
if it redeveloped at our hospital, then i assume it's my hospital's fault. however, since my assessment wasn't thorough enough, who is to say it was not there when i admitted her, only to be discovered later on by someone who did a thorough assessment.

this is totally random, but they should have RNs that do assessments and discharges ONLY. I always get an admission when everyone is in pain and I have little time - same thing with a discharge. They're too stressful! And while I'd love to get to know an new admit and go through the laundry list of things to ask and write down every single surgery and hospitalization that you've had, i really rather not.

I do not feel you were remiss in your original assessment of the patient at all. Take is as a lesson. When looking at someone skin we all need to be aware of area of skin which appear to be unusal in any way as it may indicate a necessity to be diligent in prevention of breakdown.:loveya:

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