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 Admissio

n

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.