new cms guidelines on wound care

[panurse101]

I am starting to in service our nurses, then the cna's on the new cms guidelines, as well as basic wound issues, such as assessments, prevention, etc. I am wondering what kind of weekly body assessments for the first four weeks, after admission, is everyone doing to help "catch" those that are high risk for skin breakdown. Right now, our facility has a nice small abbreviated assessment for admissions. We are going back and forth on, continuing the weekly body audits with showers, ( which arent getting done properly), using the branden scale.. or one of our RNAC's told me about an article she read in one of her MDS/ RNAC magazines, to use the raps from the MDS for a prevention skin assessment. You can purchase extra skin rap assessments seperately. Any information as to what everyone is doing to help "prevent".. to catch those that dont have anything, but are still at a high risk for breakdown. Thanks, Tracy

[CoffeeRTC, BSN, RN]

We do weekly skin assessments on all of our residents . This ocurrs on bath day. After the bath the nurses will do a head to tow assesment

[debRN0417]

When prospective residents are screened for possible admission we review all labs and other pertinent information. We go ahead and put interventions in place such pressure reduction mattress or pressure relieving measures (low air loss mattress, gel cushions, ets). Once they are admitted the admitting nurse, of course does a full skin assessment. This is followed up by the wound nurse who insepcts every "nook and cranny". We then discuss the resident at our morning meeting and make sure we address abnormal labs, skin conditions and nutritional needs. Our dieticians are consulted. We then discuss the resident at our weekly RISK meeting and make sure that all our interventions are appropriate and in place. (We have corresponding assessments provided by our company that addresses certain "protocol" we use for abnormal labs, skin conditions and the like, addressing the use of suppliments and treatments). Weekly skin assessments are done by the nurses on the unit and the wound nurse does the 4 week assessments with corresponding documentation also. The DON does audits of all (skin sweeps) and signs off...that means she (that'sme) also looks at everybodys skin at least once per month, new admissions within the first week. Our company is in the process of adapting the guidelines to make this process compliant with the regulations. My consultant nurse is a God-send. Hope this helps. We also use the braden scale on all admissions and it is done again quarterly or with a change.

[donmomofnine]

Do you do the braden on admission, and then times four?

[CapeCodMermaid, RN]

In Massachusetts we have to do the Norton Plus (although I think the Braden is better). At my facility we do the Norton Plus on admission and then for 3 consecutive weeks, then quarterly, annually, and with change of status. It's an expanded Norton Plus taken right from the MDS RAPS.

DEB....how big is your facility? We would NEVER have time to do that with all new admissions. We average 6 or 7 a week and have has had as many as 8 in one weekend!

[panurse101]

In Massachusetts we have to do the Norton Plus (although I think the Braden is better). At my facility we do the Norton Plus on admission and then for 3 consecutive weeks, then quarterly, annually, and with change of status. It's an expanded Norton Plus taken right from the MDS RAPS.

DEB....how big is your facility? We would NEVER have time to do that with all new admissions. We average 6 or 7 a week and have has had as many as 8 in one weekend!

One of our RNAC's gave me an article from her ANAC magazine, which said, to use the MDS RAPS, for an assessment, instead of the Braden or any other assessment. What is your opinion to using that over the Braden scale? What would be the difference, besides the fact that the Braden will give you, High risk, Med Risk, Low to No risk. and the MDS RAPS just will flag anyone that is a risk?

[CapeCodMermaid, RN]

I think the surveyors will be looking for systems. We have no choice but to use the expanded Norton...it came from the corporate office. I think what's more important is more what you do with the information you gather from the tool than the tool itself. I can do the best assessment in the world, but if I don't then care plan it and carry out what I've said I'm going to do, I'll get cited. If your incidence of acquired pressure ulcers is low, then you'll be OK. But, if you miss a week or two of doing a skin check and that patient later developes a pressure ulcer!!!! YIKES! Luckily,or maybe it's not luck but diligence, we do a really good job preventing pressure ulcers. Last month in a 142 bed facility we had 2 acquired, both stage 2. One was healed in a week and one is at least 50% smaller than it was. I think that's what the surveyors will be looking for.

[donmomofnine]

I heartily agree!:)

[debRN0417]

In Massachusetts we have to do the Norton Plus (although I think the Braden is better). At my facility we do the Norton Plus on admission and then for 3 consecutive weeks, then quarterly, annually, and with change of status. It's an expanded Norton Plus taken right from the MDS RAPS.

DEB....how big is your facility? We would NEVER have time to do that with all new admissions. We average 6 or 7 a week and have has had as many as 8 in one weekend!

We have 109 beds. Fortunately our admission rate is relatively low because we stay full most of the time. We usually have only 2-3 admits per week. That makes it easier to do all the necessaries....uknowwhutimean...paperwork.