Skin Sweeps

[txdon]

Just curious as to how other DON's conduct skin sweep. We currently have a "treatment" nurse who has no wound care experience and is making a lot of mistakes. He misses wounds, only does head to toes on the wound in question - doesn't look at the entire body, doesn't address pain, etc. The nurses don't like it because they don't know what is going on with their residents and when he is gone treatments get missed because they are used to him doing them. Any suggestions on how to handle this situation?

[CapeCodMermaid, RN]

My nurses are supposed to do a head to toe skin assessment weekly on shower day and document in the treatment record. The nurses' aides check skin daily and if there are any new areas they document it in CareTracker.

[txdon]

We use caretracker as well. The reason why we hired a treatment nurse was because our facility has had problems with treatments not getting done, particularly wound treatments. At my previous facility the DON assigned one person to do the weekly measurements and assessment on all wounds. BTW, are you able to run a report on caretracker showing who had had showers for the week? The CNA's are not reporting residents who are refusing showers to their nurse, or they are changing their shower day w/o letting anyone know. As a result, showers are getting missed. Also, if a resident is in hospice and has a CNA, can the hospice CNA give the two showers per week or does it have to be my staff? I was told that the facility staff must give the first two showers, then any additional showers can be done by the hospice CNA.

[CapeCodMermaid, RN]

There is a way on CareTracker to differentiate between a bed bath and a shower.

You have to give 2 showers before the hospice aide can help? Never heard of such a thing.

Our shower days are what they are. If the resident refuses, the CNA tells the nurse who then tries to convince the resident that bathing is a good thing. If that doesn't work, we try again the next day. BUT the CNAs do not change the day by themselves.

[txdon]

I know, I never heard of such a thing either. The explanation I received was that we have to show that we provided atleast the first two showers before additional outside services (such as hospice CNA's giving additional showers) can be used. My thought is: Surveyors don't care who is giving the bath just as long as the baths are getting done. They stated we are obligated to give the first 2 showers because that is a service we say we provide each resident. Again, we are ensuring showers are being preformed - does it really matter "who" is performing it? How should I go about arguing this? I spoke with the hospice manager and she said that was her understanding from my facility, not from hospice. Furthermore, most of our resident's in hospice don't want more than two showers a week, so the hospice CNA's aren't giving baths at all.

[debRN0417]

The Surveyors I know do not care who gives the bath just as long as it is done, or the reason is documented (refused).

[CoffeeRTC, BSN, RN]

Why have a hospice CNA then? They are normally the ones who are able to give the TLC with the shower/ bath. I've never heard that before.

We use the same system as Capecod does.

As far as the measurements..we are a small place so our DON took it over and measures the wounds once a week. For years it would be the nurses measuring them once a week on a specific day and what ever shift did the dressing they did the measurements.

Sounds like your wound nurse needs more training. He should have a specific day for each unit and measure the wounds then. Also a schedule should be posted on each unit lettling them know what days he is off and that the nurses need to be doing the dressings on those days. The nurses should be cross trained in wound care too.