question about pressure ulcer..

[Mommyof3Boys]

So I have a pt who is over 300 pounds.she also has loose stools several times a week (we keep it loose d/t past hx of mega colon and bowel obstr) and she is incont of urine. with that being said, she will only stay in semi fowlers refuses to be repos q 2 h and will not lay on her side either. she is a 3A for check and changes.

OK, so i went in to look at her coccyx cuz my LNA said it didnt look her base line. it was blanch erythema. about 48 hrs later it was non blanch. she cont to refuse repositioning despite several education sessions. we implemented changing her more often but even then she would refuse if it was in the middle of her tv show etc. so a week later it was a linear slit well approx but did have some depth to it, shallow crater like. and our policy is to email our wound care specialist and write a TO for a dressing. I initiated a hydrocolloid w/ a tegaderm type of dressing over that to reinforce it d/t the loose stools. w/in a few days the area was now no longer linear rather denuded mascerated non approx edges with non blanch peri wound yellow wound bed and deeper. I get an e-mail from the wound nurse telling me this is absolutely not a pressure ulcer because it is not over a boney promin. so this is actually a wound r/t spreading her buttock cheeks during check and changes and that my lnas need education and i am to do an incident report for an injury caused by staff and she took her off her list of pts to follow so i am kinda on my own as far as monitoring this issue now. I thought you could have a pressure ulcer on the coccyx d/t the constant pressure??!! I am so confused. my lnas feel insulted sense they were made to be the blame and I feel like we are not following this o/a correctly. so now in my notes i must refer to it as o/a instead of pressure ulcer and i had to D/C all prior notes where it was stated as such and correct it as error 'o/a' so i look like an idiot in my notes. what do yall think? have you ever run into this before? is it really not a pressure ulcer??

[nurseprnRN, BSN, RN]

Of course it's a pressure ulcer. Your wound care nurse should be following it as a nonhealing wound if she doesn't think so.

Write your incident report but be sure to include copies of the documentation of all the times you taught the patient about the consequences of not allowing repositioning.

I have no idea what an "o/a" is. If you aren't allowed to call it a pressure ulcer for whatever reason, call it an open wound and continue to document the hell out of its progression (because it WILL progress if it doesn't get better care).

Document that you have continued to ask the physician and the wound care specialist for wound care consult, daily if you can stand it. This is not the sort of thing that they should ignore, and it is not the sort of thing you should be dinged for.

[Swellz]

So I have a pt who is over 300 pounds.she also has loose stools several times a week (we keep it loose d/t past hx of mega colon and bowel obstr) and she is incont of urine. with that being said, she will only stay in semi fowlers refuses to be repos q 2 h and will not lay on her side either. she is a 3A for check and changes.

OK, so i went in to look at her coccyx cuz my LNA said it didnt look her base line. it was blanch erythema. about 48 hrs later it was non blanch. she cont to refuse repositioning despite several education sessions. we implemented changing her more often but even then she would refuse if it was in the middle of her tv show etc. so a week later it was a linear slit well approx but did have some depth to it, shallow crater like. and our policy is to email our wound care specialist and write a TO for a dressing. I initiated a hydrocolloid w/ a tegaderm type of dressing over that to reinforce it d/t the loose stools. w/in a few days the area was now no longer linear rather denuded mascerated non approx edges with non blanch peri wound yellow wound bed and deeper. I get an e-mail from the wound nurse telling me this is absolutely not a pressure ulcer because it is not over a boney promin. so this is actually a wound r/t spreading her buttock cheeks during check and changes and that my lnas need education and i am to do an incident report for an injury caused by staff and she took her off her list of pts to follow so i am kinda on my own as far as monitoring this issue now. I thought you could have a pressure ulcer on the coccyx d/t the constant pressure??!! I am so confused. my lnas feel insulted sense they were made to be the blame and I feel like we are not following this o/a correctly. so now in my notes i must refer to it as o/a instead of pressure ulcer and i had to D/C all prior notes where it was stated as such and correct it as error 'o/a' so i look like an idiot in my notes. what do yall think? have you ever run into this before? is it really not a pressure ulcer??

Is it over the bony prominence? I've been told by my wocrns that what I thought was pressure related breakdown was moisture related, and the reasoning they had was that the wound was not over a bony prominence. Both are a huge issue with your patient regardless. It certainly doesn't sound right for you to alter any documentation. You should definitely reconsult woundcare and keep the MDs in the loop.