Pressure ulcers urgh

mind_body_soul RN · Feb 1, 2014

If things are really that bad, you need to bring it up to the DON or administrator. I am sure it would pique their interest as pressure ulcers cost the facility money. Sounds as if some CNAs aren't doing their jobs. It is also the nurses' responsibility to ensure briefs are being changed and residents are turned. I was told by someone that state sees writing on briefs as a dignity issue for residents, so be careful if you choose to go that route. Look where the pressure ulcers are located. Sometimes they can be due to a poorly fitting brief or people yanking the brief out from under the resident when in a hurry. If I noticed any pink spots on my residents, I began aggressive management with the application of barrier cream and foam. Everyone at risk had pressure-relieving devices such as air mattress toppers and gel cushions to their wheelchairs. Maybe you can also coordinate inservices, like a prevention class for CNAs and a pressure ulcer management class for nurses. Surely they change dressings PRN when you are unavailable? Good luck.

PeacockMaiden · Feb 1, 2014

Is your facility staffed with enough CNAs to be able to deliver good care? If it's anything like the place I worked in, there was not enough staff to provide good care and so we had a lot of pressure sores too.

Sam J. · Feb 2, 2014

This was posted in another area in here also. It takes the whole place to prevent pressure ulcers, and they are considered so serious now (as in abuse allegations, incident reports, reports to corporate and the state and the physician and the family) I can't imagine any DON (or MDS Coordinator) not requiring swift, immediate corrective action, at any cost. A wound nurse is only one member of the team- is that wound nurse reporting the seriousness of what she/he finds to every member of the IDT? Has that nurse been trained, and are those wounds really acquired, are they really pressure ulcers, and really stage 2, or even 3? And blaming CNAs may be easy, but a pressure ulcer doesn't reflect badly on them alone- it reflects badly on everyone in that building. And in my opinion, having a single wound nurse to do all the treatments and wound assessments is not a great idea- it allows the other nursing staff to be kept out of the loop, 'as in out of sight/out of mind'. Might be better to rethink that, and have a med nurse, so the nurses have time for their own wound care, which would definitely make them more aware of the importance of wound prevention, as well as the consequences of acquired pressure ulcers? And don't sign briefs (or even dressings) unless your policy dictates that. It serves no real purpose, it doesn't solve anything, and it can lead to unintended consequences...

CapeCodMermaid, RN · Feb 2, 2014

I have one wound nurse for 152 bed facility. She is responsible for tracking the pressure ulcers and making sure weekly skin checks are being done. The nurses are responsible for following the care plans and ensuring their residents are turned. If I saw anyone writing on a brief in my building, they would be counseled...it's demeaning and unnecessary.

adh2530 · Jun 9, 2015

I myself am working as a new tx nurse in a LTC/rehab facility that has some acquired wounds. S/Ts and some PUs. The med cart nurses have a tag system. Each tag has a number and says "go see your nurse when you find this". These are meant for the CNAs. The nurses record tag# and time it was placed/taped on brief. That way we can ensure our residents are being taken care of. This doesnt happen on a daily basis. Just either as a "every-so-often" basis to make sure CNAs are doing good or when there are CNAs that we suspect not doing their job up to our standards.

ktwlpn, LPN · Jun 9, 2015

Quote=. The med cart nurses have a tag system. Each tag has a number and says "go see your nurse when you find this". These are meant for the CNAs. The nurses record tag# and time it was placed/taped on brief. That way we can ensure our residents are being taken care of.

Cape Cod,is this something you would implement?I agree with you about writing on the briefs,not a good idea...I like this tag idea.

adh2530 · Jun 9, 2015

Our CNAs also have shower reports to fill out after every shower to document condition of residents skin, wounds, rashes, etc that isnt normal for resident at that time; which gets turned in to us tx nurses. All residents have weekly skin assessments that are done by the med cart nurses; are assigned at least 2-4 residents per day to do for their units. If they find anything new, they notify us tx nurses. These are just some of the ways we try and head off wounds etc before they start or get any worse. Hope this helps.

CapeCodMermaid, RN · Jun 9, 2015

Quote=. The med cart nurses have a tag system. Each tag has a number and says "go see your nurse when you find this". These are meant for the CNAs. The nurses record tag# and time it was placed/taped on brief. That way we can ensure our residents are being taken care of.

Cape Cod,is this something you would implement?I agree with you about writing on the briefs,not a good idea...I like this tag idea.

I wouldn't implement this system. I find it demeaning and makes the CNAs feel like they're not trusted. We don't have issues with most people being changed. Our aides are really good about doing rounds and letting their nurse know if there is a skin issue. If there is a new pressure area, the team nurse is supposed to start a treatment and send a communication form to the Wound Nurse. We also to weekly skin checks on shower day.

ktwlpn, LPN · Jun 10, 2015

Our nurses are responsible for the weekly skin checks on shower day.Our facility is close to 300 beds.Retaining good staff is getting tougher every year.Sad to say there are more then a few who would get caught in this web...