reporting skin alterations to NM, daily

[Diana,RN]

Here is another issue:

patients with pressure ulcers

Do you report these to your NM/OM daily?

My unit wants to do this, and yes, I am all for it!

What tool do you use to update your NM on a day to day basis about patients w/ pressure ulcers, their stage and treatment plan?

Another log book is totally undesired, as well as filling out Incident Reports.

Let me know what you do?

Diana

[JSB]

We do report skin alterations daily. I work in ICU, and we do grand rounds daily with the intensivist, respiratory, charge nurse, wound care, dietician, social work, infection control, etc. We report to them the Braden score for each patient, and if there are any pressure ulcers, what stage it is, and any other alterations in skin integrity. The physician and wound care nurse then can make any recommendations they have for the care of that patient.

We also use a turn audit tool twice daily, filled out by the charge nurse. We have a turn clock in the unit, and every two hours the patient must be turned either to their left side, right side, or back, usually corresponding to the correct position on the turn clock. The charge nurse writes the time of day she conducts her turn audit, what position the patients are in, and if not in the correct position according to the turn clock, the reason for that. If a patient turns themselves, s/he writes that on the tool, and also whether their skin is intact. This has to be checked by every nurse for every patient every day, and even better, with every turn. We also make sure to remove TEDs/SCDs to look at skin, and check behind ears if wearing a nasal cannula, monotherm cable contact areas, etc. The turn audit is done twice a day, and is turned in to our unit director. Each week, she places a compliance chart that graphically shows how well we turned our patients. If there was a good reason for not turning detailed in the tool, that still counts as compliance. We are just now instituting the practice of having patients sit up in chair position during their turns to their backs during the day if tolerated. This helps to redistribute the pressure off of their sacrum onto the ischium instead.

Hope that helps. Our unit acquired decubitus rates have dropped significantly after doing these things. We also make sure to assess and document on admission for decubiti so that if the patient comes in with one, we will know that we did not "give" it to him/her.

It sounds as though it would be time intensive, but it is really not too bad. The Grand Rounds take the longest, but the goal is to only give a quick rundown, and take about 5 minutes per patient. Of course, that doesn't always happen, and then everyone, including you, the staff nurse are stuck for a while longer. The turn audit tool takes hardly any time at all to do.

[Tweety, BSN, RN]

We used computerized Incident Reports, one of which is emailed to the manager and the Wound-Ostomy Nurse. This is when it is discovered, not on a daily basis. We follow protocols and are do updated wound care sheets weekly, but the manager doesn't get these. They are part of the patients records and the wound care nurse and a committee come look at them.

[classicdame, MSN, EdD]

We use the TLC program designed by Hill-Rom (same people we get specialty beds from). It consists of a pad with a person drawn on it. The CNA circles the area of interest when something is found and indicates name/room number or whatever then gives to nurse. The nurse has to document followup. The notes are then given to Director to followup on the next shift or next day or with skin care nurse, etc. to be sure the situation is not progressing.