2 Nurse Skin ✔ q Shift ❓

[Emergent, RN]

I was talking to a gal who told me that the latest and greatest at her hospital is that 2 nurses have to document a head to toe skin check on every single patient,  every shift, no matter what their risk factors. Real awkward on a 14 year old, ambulatory pediatric patient. Every crack and crevice, she said.

Sounds like more regulatory and desk jockey overkill to me. What happened to nursing judgment and preserving patient dignity? I would flatly refuse if they tried that on me.

[heron, ASN, RN]

If true (and, frankly, I doubt it), sounds like a gross overreaction to a malpractice judgement or regulatory penalties. 

[Davey Do]

Yeah, that was part of Wrongway's knee-jerk computer charting, Emergent.

Unless there was a bed ridden geriatric patient or an acute condition, we just behaved like professional button pushers.

[JBMmom, MSN, NP]

That's crazy. We have a two RN skin check on admission and let's face it, on busy days/nights we all have our go-to friend that we say "hey I'm charting you as the 2 person check on my admission, okay?" We recently got a brand new contraption that looks like a radar gun and we have to thermal scan EVERY person admitted, their butt and heels, to look for skin breakdown that isn't visible to the eye. I guess it's helpful for some, but overkill for most. 

Ahh, to sit behind a desk and get paid more money to institute clinically questionable policies that just take up the time and resources of staff. Sounds fun, (not).

[Emergent, RN]

heron said:

If true (and, frankly, I doubt it), sounds like a gross overreaction to a malpractice judgement or regulatory penalties. 

Oh, it's true. 

[Rose_Queen, BSN, MSN, RN]

heron said:

If true (and, frankly, I doubt it), sounds like a gross overreaction to a malpractice judgement or regulatory penalties. 

Can confirm- my previous employer required this. My guess is that it's to have more preexisting pressure issues caught so the hospital isn't on the hook for them (and the cost of their treatment)

[LibraSunCNM, BSN, MSN, CNM]

JBMmom said:

We recently got a brand new contraption that looks like a radar gun and we have to thermal scan EVERY person admitted, their butt and heels, to look for skin breakdown that isn't visible to the eye. I guess it's helpful for some, but overkill for most. 

Not to derail, but--what?!? What is this device that can thermally scan for hidden skin breakdown?

[JBMmom, MSN, NP]

LibraSunCNM said:

What is this device that can thermally scan for hidden skin breakdown?

I think it's called a Scout. It's kind of cool technology, but another thing that takes time and is of questionable use to patients. It's really just so the hospital doesn't get dinged for pressure injuries, so no actual benefit to patients since we take all the same precautions anyway. 

[NRSKarenRN, BSN, RN]

Internet sleuthing found

Advances in Skin and Wound Care July 2019

Use of Thermal Imaging to Identify Deep-Tissue Pressure Injury on Admission Reduces Clinical and Financial Burdens of Hospital-Acquired Pressure Injuries
 

Quote

A deep-tissue pressure injury (DTPI) is a serious type of pressure injury that begins in tissue over bony prominences and can lead to the development of hospital-acquired pressure injuries (HAPIs). Using a commercially available thermal imaging system, study authors documented a total of 12 thermal anomalies in 9 of 114 patients at the time of admission to one of the study institution's ICUs over a 2-month period. An intensive, proven wound prevention protocol was immediately implemented for each of these patients. Of these 12 anomalies, 2 ultimately manifested as visually identifiable DTPIs. This represented a 60% reduction in the authors' institution's historical DTPIs/HAPI rate. Because these DTPIs were documented as present on admission using the thermal imaging tool, researchers avoided a revenue loss associated with nonreimbursed costs of care and also estimated financial benefits associated with litigation expenses known to be generated with HAPIs.

Using thermal imaging to document DTPIs when patients present has the potential to significantly reduce expenses associated with pressure injury litigation. The clinical and financial benefits of early documentation of skin surface thermal anomalies in anatomical areas of interest are significant.

,,,, 114 consecutive patients admitted to ICUs within the institution during the 60-day period from June 27, 2016, and August 25, 2016 (inclusive) received a thermal and clinical assessment of areas at risk of DTPIs (bilateral heels, sacrum, coccyx) by trained study staff. Thermal assessments were performed with an FDA-approved long-wave infrared thermography scanning device (the Scout device ; WoundVision, Indianapolis, Indiana).,,,

...Revenue Implications

The revenue loss from DTPIs not documented as present on admission (and therefore not reimbursable) is $43,180 per case. Therefore, the two DTPIs in the present study that manifested in skin where a thermal anomaly was noted and documented as present upon admission represent $86,360 in preserved revenue for the institution, because the costs of care for these DTPIs are considered reimbursable....

CONCLUSIONS

In this study, researchers reported a significant decline in the incidence of DTPIs compared with historical incidence in the study institution. This is attributed to the use of a commercially available long-wave infrared thermal imaging system to identify thermal anomalies in anatomical areas predisposed to the development of DTPIs and to implement clinical interventions to mitigate or reduce the severity of emergent DTPIs. By documenting DTPIs as present on admission, the institution's HAPI rate was reduced to zero, preserving significant revenue related to both payor reimbursements and legal liability. Most importantly, this study significantly improved the quality of patient care by identifying and managing DTPIs upon admission to the ICU.

 

[JKL33]

It is nothing short of blissful to not work in a hospital any more.

[hppygr8ful, ASN, RN, EMT-I]

Well we have always had a second person sign off on Body Check. Maagement knows if we don't because we are under the watchful eye of "Big Brother." Still psych is a different animal than most settings and the 2nd is mostley to pre allegations of abuse. 

Hppy

[Emergent, RN]

hppygr8ful said:

Well we have always had a second person sign off on Body Check. Maagement knows if we don't because we are under the watchful eye of "Big Brother." Still psych is a different animal than most settings and the 2nd is mostley to pre allegations of abuse. 

Interesting. There are plenty of unbalanced and/or litigious patients in acute care. Maybe the second nurse is more of an escort, in case of false accusations. 

Eventually they're probably going to go to bodycam. It's been a life saver for law enforcement.