Skin prep on open areas...

Nurses General Nursing

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Specializes in Med/Surg/vascular surg/Rehab/LTC.

Hello all!!

Im working as a supervisor for a LTC facility via an agency. I am contracted here for the next month and have been here for this last month.

I have a resident that has a very obvious stage 2 pressure ulcer which along with a mosture issue. It is located on her lower right buttocks near her peri area. She is 90 with poor nutrition and on hospice. She spends all of her time in bed or in a wheel chair.

Here is my issue. I assessed the area last night, developed a tx plan and called md and received orders for a tx to the area. Open skin to have tao with dsd and a tegaderm for protection with skin prep to surrounding area to hold dressing. The drainage last night was bloody, and continues to be. Now here is my issue, the RN and manager changed my TX (which is fine, if i thought their tx would help) changed it to skin prep to the area with no dressing and changed the stage 2 to "moisture related only". Now, im not a know it all by anymeans, but, skin prep weither it would be non sting or the regular formula per 3m and smith and nephew website states NOT TO BE USED ON OPEN SKIN. I am told that this rn manager has a tendency of changing stage 2 wounds to moisture related quite frequently. I spoke with the ID nurse and the nurse educator and they told me i need to speak with the DON when she returns. I have a passion for skin car4e and this is just eating at me. When i approched the rn manager she screamed and said "THIS IS wHAT we DO HERE" and stormed into the nurse ed's office. I feel like i should say something ( the don always asks me if i have any info about how things are going here" but m not sure if i should.

What do you all think??

Thanks,

gabs :)

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Specializes in Med/Surg, Geriatric, Hospice.

Oh my, you definitely need to bring this to the DON. Covering up what IS a pressure sore and calling it 'moisture related' and simply putting SKIN PREP on it is abusive. I know pressure sores are evil entities to facility's but denying and covering up their existence is totally unethical. Better to see how fast you can treat and heal the ulcer than not treat it.

If you don't get the reception you are looking for from the DON.. maybe it's not the place you would like to be working for.

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Specializes in Med/Surg, Geriatric, Hospice.

Oh my, you definitely need to bring this to the DON. Covering up what IS a pressure sore and calling it 'moisture related' and simply putting SKIN PREP on it is abusive. I know pressure sores are evil entities to facility's but denying and covering up their existence is totally unethical. Better to see how fast you can treat and heal the ulcer than not treat it.

If you don't get the reception you are looking for from the DON.. maybe it's not the place you would like to be working for.

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Carefully plan what you want to say in your conversation with the DON. My last DON treated certain nurses as though they were her best friends and these people were never reprimanded for very questionable acts similar to those you are talking about. Some people just don't care.

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Specializes in Hospice, LTC, Rehab, Home Health.

If they have a section on wound care and treatments in their P&P manual see if there is a facility accepted treatment more suitable to the patients needs and present that as an option when you speak to the DON.

If the patient came with the area from wherever they were prior to admission as opposed to a facility acquired Stage 2 you will probably be better received. If they are going to take a hit for a facility acquired decub, you probably won't get far. Sorry to say but that's the way it is in most LTC facilities. Especially if they are in the window for survey, because in house decubs are a major tag.

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Specializes in Med/Surg/vascular surg/Rehab/LTC.
If they have a section on wound care and treatments in their P&P manual see if there is a facility accepted treatment more suitable to the patients needs and present that as an option when you speak to the DON.

If the patient came with the area from wherever they were prior to admission as opposed to a facility acquired Stage 2 you will probably be better received. If they are going to take a hit for a facility acquired decub, you probably won't get far. Sorry to say but that's the way it is in most LTC facilities. Especially if they are in the window for survey, because in house decubs are a major tag.

i spoke with the two people in the facility that deal with p and p and both agreed with me. I will present to the DON what I have found, its all that i can do. I understand as a facility they do not want decubs, but what will happen when this wound ( which assessed tonight is now PURPLE) has gotten worse and then they find that I documented it a day prior and the next day it all of a sudden is "moisture" I think that is going to be a large issue also. I refuse to change my feelings. And skin prep on open wounds ( i tried it on my husband and didnt tell him it was gonna sting) to get his reaction and he jumped from his skin. NOW imagine a 90 yo hospice frail and not aware of her surroundings resident........UGH im so annoyed. And i verified by pharmacy they ordered reglar skin prep, alcohol based!!!

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Specializes in LTC, Subacute Rehab.

If it's purple and non-blanchable you might have a deep tissue injury on your hands - in which case the wound will just keep growing as the injured tissue dies off.

Stage II in my facility is generally tx'd with hydrogel and a foam dressing (nice for added padding over wound). Skin prep might be appropriate on the intact skin -around- the open area...

Poor patient :crying2:

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Specializes in hospice, home care, LTC.

Skin Prep never goes on an OA. Also, this is a hospice patient. Hospice should positively be called in on this wound. They have expertise in dealing with EOL wounds and treating them for comfort. This wound will never heal and putting Skin Prep on it is patient abuse!

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Specializes in Cardiac/Step-Down, MedSurg, LTC.

Good for you for sticking up for yourself, and more importantly- your patient! Is the open area truly a pressure area, or could it be a partial thickness injury? I learned this from my current hospital, that if moisture is a factor in the skin breakdown, it may not actually be a stage 2... just food for thought. If the patient is incontinent frequently, I would probably try something like a mepilex border or zinc oxide (Balmex) to the area. Sounds like it is an open deep tissue injury at this point though...

Best of luck!

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Despite your best efforts to speak with the DON, the facility is going to do what they want...what you need to do, to cover your own behind is to DOCUMENT like crazy...make sure that you document everything that you are assessing, and who (MD and nurse alike) that you are speaking with, and what orders you are getting and putting into place. Reference P&P in your notes if you have to. But make sure that your documentation displays the facts at hand and clearly demonstrates your efforts to save the patients skin.

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