Pressure area Assessment

Although this may only be a local phenomena I am posting this to see what nurses in other countries think about the situation.

Traditionally in Australia pressure area assessement and management has been a purely nursing field, Recently I have noticed that occupational therapists have been encroaching on this role.

In ICU if an occupational therapist is called in to fit the patient for splints, they will then take it upon themselves to perform a "complete pressure area assessment" often utilising the nursing notes to assess inaccessable areas such as the sacral area - i.e. "noted in nursing notes patient has small break on coccyx". As if this was not bad enough they then will go on to state "Suggest nurses continue to reposition patient 2nd hourly".

The last facility I worked ( a major metropolitan hospital) this was accepted. To make matters worse, pressure relief devices such as "pig fat" pads were only available through the occupational therapists who would then argue your decision with you offering instead interventions such as hard rubber rings for the heels.

When told that it is no longer correct to use hard rings under heels - would act affronted but the next time you saw them they would be sprouting the "latest research" about how hard rubber rings "should not be used" ( Grrrrr I suppose. at least. they LISTENED to me!)

Unfortunately by taking the ability to order relief devices out of the nurses hands a cycle of relying on the occupational therapist to assess and order the devices was rapidly becoming entrenched.

Since THEY are the experts why should WE bother? I even noticed a slow decline in interest in keeping this area under the nursing umberella.

I am looking forward to your opinions on this matter.

Don't get me wrong, I love OT's - but - are they going to come in & assess the pt q2h to make sure the interventions are effective? Or if the pts condition changes over a public holiday period, will the OT take responsibility for a developing PA?? I DON'T THINK SO......really bad trend, as far as I'm concerned......

I can understand PT having interest in pressue ulcers, but not OT. At the LTC where I worked we would get PT to give us their opinion r/t to pressure ulcers and we worked very closely in the plan of care to get them cleared up, but not the OT. OTs have a habit, I have noticed of encroaching in areas they did not need to.

[P_RN, ADN, RN]

I can understand an OT would want an idea of the general skin condition so as to fabricate a splint that wouldn't put undue pressure somewhere.

We had an excellent rapport w/ PT. In fact the satellite gym was right on our unit. OT one the other hand was based in th emain department downstairs. I can honestly say I don't believe I ever saw the same OT more than twice. There must have been a couple of dozen who only stayed a very short time and then moved on. Has anyone else seen this?

That is bizarre gwenith...

We never ever see the OTs unless we call them in on a consult. And even then, they will refuse to come unless it's on an MD order. The MDs are not there that frequently to notice things like footdrop etc....it's usually up to us to bring it to their attention and then we wait forever for them to fill out the referral form. So usually I say that yes, I have an MD order and then hope that I can wave it in front of an unsuspecting resident MO and get it signed off before the OT gets there.

As far as PA assessment goes, the OTs here don't give a rats so long as it's not affecting the limb that they're treating. And yeah, I never see the same OT twice either.

[ceecel.dee, MSN, RN]

To me, this accentuates the fact that we have little, if any, practice of our own.

I recently heard a speech therapist say "Well... I'M THE SPEECH "PATHOLOGIST", SO I SHOULD KNOW" when a nurse just told her what the patient's wife vervalized regarding her husband's reactin to the new communication board.

The nurse was just trying to inform the ST about possible problems she may encounter!

Everyone is an expert giving us ORDERS! About things we have recommended consult on! Where do we stand...without a practice...diagnosing the problems, offering suggestions for others to write orders about for us to be written up about?

This is a very serious topic. (Perhaps I am off topic altogether! Sorry.)

[gwenith, BSN, RN]

No Ceecel

You are not off topic this is exactly the point I was trying to make. I know we have all heard the old wheeze about "role erosion" so much that we are sick of it but it is a real phenomena and ongoing.

To this day I am not sure what exactly disturbs me the most about this scenario. The fact that OT's who have less knowledge of physiology and certailnly less hands on experience were telling me how to do my job or that this was accepted by my fellow nurses as correct and proper. After all it saved them from having to it themselves. The fact that this was and is happening in a major metropolitan hosptial, one that is supposed to be a "leader" in the field of health care bodes ill for the future of our profession.

[renerian, BSN, RN]

What is a pig fat pad?

renerian

It feels really soft and squishy and moulds to the shape of the body. Think along the lines of more shock absorbent jelly (sorry, jello for US folk). It's supposed to be made from pig fat, hence the name.

Sorry if that is a lame explanation but I have no idea how else to describe it.

[renerian, BSN, RN]

Interesting. Thank you for explaining it.

renerian

Check the following:

http://www.nelh.nhs.uk/guidelinesdb/html/PrUlcer-ft.htm#II

[Nurse Ratched, RN]

We had a wonderful OT who always brought things to staff attention just in case it had been overlooked. For instance, she would assist in showers to determine the patient's level of independence and what modifications or special tools might tbe needed for home. If she happened to notice a bruise, pressure area, etc., she would be sure to seek out the nurse to ensure she was aware of it. But never was the responsibility or authority for treatment/prevention of same placed in her hands.

Wound care involving major dressing changes up to and including debridement is handled by PT or the wound care nurse with standing orders. Took me a while to get used to that, but I like that they always have just the right materials for whatever they run into.

Prevention of bedsores and the like remains in nursing's hands.

We have a skin care team (nurses) who assess pt at risk for PU or with skin breakdown who write orders on skin care. It works really well at our facility. It stays with the nursing staff, not PT or OT, but it is still someone who does nothing but skin care and just assists with the other nurses on the unit.

Hey ladies and gents,

I'm still in school, just done my first clinical rotation, but I thought I'd pitch my 2 cents in (that's canadian currency, so approx .5 cents US).

But at the last hospital that I worked at, we had a special "Wound and Skin Care Team" whom would take responsibility for ordering special surface bedding (airbeds etc) for patients if needed. But, the nurses on that ward were responsible for completing a Braden Risk Assessment Scale (I assume it's something like the pressure area assessment that you're referring to) every tuesday, and could call in the skin care team at any time if the score was above a certain value, but it was the nurses who were responsible for initiating it and turning etc.

This seemed to work well-ish...I can't believe that some places you have to have an OT come in to do this!! craziness...

Lys