Sig change for the same reason

[glm777, BSN, RN]

I did a sig change on a resident when he developed a stage 2 and a stage 3 area. He recently went into the hospital and returned with the same areas PLUS three additional areas - a stage 4 and 2 stage 2s. The treatments to the original areas remain the same.

The current care plan addresses wounds. This resident's condition is poor, his nutritional status is poor and it is likely that he will continue to break down. The family has been offered Hospice but they adamantly refuse.

Would you do another sig change because of the new areas? I feel that if I have to do a sig change every time this man develops another area, I will be doing COS after COS.

Thanks for the input!

[sallyrnrrt, ADN, RN]

I see your reasoning....and somewhat agree

[Talino]

When you first completed the SCSA, what was your expectation based on your goal and interventions? More than likely that the pressure injuries will decrease in size and the resident will not experience further breakdown, a combination of treatment and preventive measures.

Considering the resident's condition had turned to worse and is now even at risk for more injuries, another SCSA is warranted. However, this time the team will address the change in condition as an expected, well-defined part of the disease process and is being addressed as part of the overall plan of care for the resident. Hence, if further deterioration ensues, another SCSA will not be required.

But, if the resident's status improved and has returned to former status, a new SCSA will be necessary.