reducing in-house acquired pressure ulcers the long-term care approach by: yolanda wingster
TRANSCRIPT
REDUCING IN-HOUSE ACQUIRED PRESSURE ULCERS The Long-Term Care Approach
By: Yolanda Wingster
THE FOCAL POINTS!!
PERFORMANCE “STAGING”
• Stage I Intact skin with non-blanchable redness of a localized area usually over a bony prominence.
• Stage II Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.
• Stage III Full thickness tissue loss.
• Stage IV Full thickness tissue loss with exposed bone.
• Unstageable full tissue loss in which actual depth of the ulcer is completely obscured by slough or eschar.
THE TEAMCharge Nurse
Nurse Manager
Certified Nursing Assistant
JUST THE FACTS• Approximately 1.3 million people develop pressure ulcers each
year.
• According to Joint Commission approximately 60,000 people die from complications caused by pressure ulcers each year.
• The prevalence of pressure ulcers in long-term care settings range from 2.3%-28%.
• Cost of treatment for pressure ulcers range from 9.2-15.6 billion dollars in 2008.
• Almost 87% of verdicts and out of court settlements are awarded to families as a result of the patient acquiring a pressure ulcer.
THE PROBLEM Pressure ulcers can decrease the overall
quality of life, related treatment, cause pain, and increase the incidence of death.
Pressure ulcers can increase nursing home cost.
CURRENT APPROACH
The Braden Scale is the most commonly used skin assessment tool.
STARTING WITH THE BASICS
Turn Schedule
Lubricants/Moisture Barriers
Float Heels
Standard pressure reduction mattress
Weekly skin assessments
Reducing friction and shearing/use of draw sheets
Wheel chair overlay
Air mattress
Heel protectors
ACTION PLAN Continue to identify high risk patients
using braden scale Review patients conditions and
diagnoses monthly Review patient’s medications monthly Assess mobility status weekly
ACTION PLAN CONT…
Identify potential problems that could place the patient at high risk. Assess nutritional status weekly (monitor meal
intake) Monitor routine labs as ordered (albumin,
prealbumin) Assess for change in functional abilities Educate on common pressure areas to assess
“PUT IT INTO ACTION”
Implement pressure reduction algorithm to follow upon admission and as needed
Create pressure ulcer compliance sheets, rounds to be completed daily each shift by the charge nurse. Rounds will assess for compliance of pressure
ulcer reduction interventions as care-planned for each patient
New Admission
No Skin Breakdown
Present
Incontinence
Incontinence CareProper Briefs
Moisture BarrierPrompt Peri Care
Decreased Mobility
Pressure Reduction Surfaces
Heel ProtectorsFloat Heels
Turning/Repositioning
Below Ideal Body Weight
SupplementsDietician Consult
Labs
Skin Breakdown Present
Establish PlanRelieve Pressure
Start Vit. CZinc
Multi VitMoisturize Skin
Attempt To Identify Cause
Incontinence Bladder/Bowel
Incontinent CareProper Briefs
Moisture BarrierPrompt Peri Care
Decrease In Mobility
Pressure Reduction Surface
Heel ProtectorsFloat Heels
Turn/Reposition
Below Ideal Body Weight
SupplementWeekly WeightsDietician Consult
Wound Care Algorithm
Patient Name______________________ Room Number_________________
Date______________ Medical Record Number_______________
Nurse completing form __________________________
Certified Nursing Assistance taking care of patient __________________________________
Care Planned Interventions
Yes___ No___ Are all care planned pressure reduction interventions in place?
Yes___ No___ Is the patient cleaned and dried?
Yes___ No___ Does the resident have a foley catheter, if so is it secured properly? Yes___ No___
Yes___ No___ Are there any scheduled treatments, if are the dressings properly dated? Yes___ No___
Document meal percentages for the past 7 days.
Breakfast Lunch Dinner
Immediately correct in interventions that are not in place, and turn in documentation to Nurse Manager.
Pressure Ulcer Compliance Form
GOALS Patients skin will remain intact
There will be a reduction in the development of new pressure ulcers
Nurses will be able to better detect high risk patients
The interdisciplinary team will meet weekly on Thursday’s to evaluate the current approach, identify root causes of in-house pressure ulcers, and adjust the current process as necessary.
REFERENCES
Ayello, E., (2012). Predicting pressure ulcer risk. The Hartford Institute of Geriatric Nursing.
Retrieved January 26, 2013, from www.ConsultGeriRN.org
Becky, D., Posthauer, E., & Thomas, D., (2009). The role of nutrition in pressure ulcer
prevention and treatment: national pressure ulcer advisory panel white paper.
Nutrition White Paper.
Lynn, J., West, J., & Hausmann, S., (2007). Collaborative clinical quality improvement for
pressure ulcers in nursing homes. The American Geriatrics Society. Doi:
xdc10.1111/j.1532-5415.2007.01380.x.