Help out a student looking to learn more about the care surrounding pressure ulcers?

Editorial Team / Admin · Mar 22, 2020

Welcome to allnurses, @Zac! Your post has moved to our student assistance forum for more relevant replies.

Rosalie Blythe, BSN, RN · Mar 25, 2020

On 3/22/2020 at 6:02 PM, Zac said:
Hello everyone, I'm sure things for you guys are crazy at the moment and I appreciate everything you've been doing. You guys rock. That being said I need to speak with health professionals regarding the standard of care concerning pressure ulcers and at the moment I am having difficulty finding people to speak too as they're a little preoccupied with this virus that's going around. I was wondering if you could take a few minutes out of your day to help this desperate student get some answers so I can pass my class. Any little bit you can provide me would help and I'd be very appreciative if you could just take a few minutes to answer these questions. Doesn't even have to be all of them if you don’t want. Thanks again
1. How big of a problem are pressure ulcers within your institution? If you had to rank all problems you guys face, where do PUs fall?
2. How do you currently prevent/manage pressure ulcers? Do you feel these methods are effective? If not, how do you feel they could be improved?
3. Who makes decisions regarding what supplies are ordered in the facility? Are you involved with these decisions? If so, what do you take into consideration when considering a product to purchase?
4. I’ve read that PUs can have an impact on Medicare ratings as well as reimbursement rates. How much focus or attention do you give that?
5. Have you ever faced any litigation relating to PUs? If unsure, can you put me in contact with someone who may be willing to discuss that?
6. Is there anyone else you think would like to discuss this topic with me?
7. Is there anything I haven’t asked you that I should have asked you

I used to work in LTC and acute care of the elderly (ACE) when I was a student. Unfortunately, I can tell you that PU is especially common in the geriatric populations - PU is probably the top 5 imo.

In the LTC that I worked, the day shift and evening shift nurses would complete a thorough weekly skin assessment on 2-3 patients per his/her shift, mostly checking for possible impaired skin integrity and new PU. For existing PU, BID dressings is usually ordered. And PSWs are supposed to reposition the patient q 2 hours as recommended (but do they actually do that? questionable). I personally do not think its quite effective because especially my floor, 1/4 of the patient is total care and required a lot of time from both the nurse and the PSW. It's also especially challenging to do skin assessment who are confused (half of the residents on my floor has Alzheimer) and do not want to be touched or they will be physically aggressive towards you. I wish they can have a special wound nurse to conduct those skin assessment on a set schedule. In hospital and some LTC, they sometimes can put high risk patients (usually the one with high immobility) in an air mattress to prevent PU but again, resources are limited and these mattress are expensive. In my opinion, half of the residents on my floor should be on it but in real life only a few residents are using one

The director of care, my boss, is the one ordering supplies. In the nursing home I work in, I am the other RN after my boss. On weekends when my boss is away, I am the nursing manager supervising the RPNs who are working on a less heavy floors. I personally am very involved in advocating for the right wound supplies to be ordered, even though I know lack of funding is always an issue especially for LTC. I believe that only the right and correct dressing supplies can help with the healing process of a PU especially for the geriatric. I had found myself staying after work several times to email my boss about what supplies were short and asked her to restock them. I usually emphasized on ordering different size of "3M Tegaderm High Performance Foam Adhesive Dressings". They come in different shape like square, oval and heel/elbow design. I personally used a lot of the heel/elbow one and I always make sure I have them stocked up in my dressing cart. I also like the square one because I can cut them into smaller piece and secure it with either opsite or medipore (depending on the condition of the surrounding skin area of the wound) and use the remaining on the other patients (which is not recommend but due to lack of funding and resource, you have to work with what you have)

I know that in some hospital setting, if new PU is found in any patients, an incident report must fill out...not so much in LTC. But if a new PU is found in the residents, there is advanced directive/protocol to follow what type of dressings to apply...unless the PU is at a very late stage, then we have to call the M.D. for further instruction. However, for any type of PU, as a nurse I would record the new PU the Dr's book (a book that the Dr will read when he/she comes to see the resident once a week, it records all the concerns any nurse might have / family concerns that the family members want the Dr to address). On top of that, I would also complete a wound assessment charting and let the next shift nurse know this new PU. I will also write it on the today's worksheet; We have a worksheet with all the patient's name on it; its a sheet to record any new changes for the resident in any given shift you work.

I know that for any new wound being reported, family members of the resident must be notify too. I never got into trouble with PU *touch wood* so I cannot help you with the rest of the questions you have. Hope it helps.