Pressure Ulcer Development

Directions:

• Read the policy below and decide if it reflects best practice for a skilled nursing facility.
• Research current evidence-based practice regarding the attached policy to determine if changes need to occur.
• Describe in detail what you would change in the current policy citing the evidence you gathered.
• Please include and cite at least 1 scholarly resource using APA format.

 

 

Pressure Ulcer Prevention and Managing Skin Integrity

 

1. PURPOSE

 

1. To maintain the integrity of residents’ skin and overall health.
2. To effectively identify residents who are at risk for skin breakdown.
3. To provide early interventions for residents with skin breakdown and minimize associated risks.
4. To educate staff, residents, and families on measures to prevent skin breakdown.

 

1. POLICY

Nursing is solely responsible for all aspects of the skin risk assessment and will assess and manage skin integrity for all residents. Risk for pressure ulcer development will be evaluated using the Braden Scale. Skin inspections will be completed on admission for all residents. Any resident with a Braden score < 8 shall have skin inspections done every month. Residents with a Braden score > 8 do not need further skin inspections done.

 

• DEFINITIONS

 

1. Risk assessment: identification of the potential risk that a resident will contribute to the likelihood for developing skin breakdown.
2. Skin Inspection: a head to toe assessment of residents, intended to detect skin breakdown.
3. Interventions: the steps taken by care providers to increase monitoring of the skin and reduce or alleviate pressure on body parts to minimize or eliminate the risk of skin breakdown.

 

1. PROCEDURE

 

1. 1. All residents will be assessed one time, on admission to the skilled nursing facility. This will include a head to toe assessment, paying close attention to bony prominences and skin folds.
   2. Screening, using the Braden Scale, will be completed by an RN, LPN, or CNA. This must be documented in the medical record.
   3. Residents with a Braden score < 8 will have assessments done every month until reaching a score of 8 or higher.
   4. All interventions must be documented in the medical record.

 

1. INTERVENTIONS

 

1. Patient Repositioning and Turning; required once per shift.
2. Cleanse and dry skin at routine intervals and at the time of soiling;

recommend tub bath once per week.

1. Proper Nutrition; provide meals high in carbohydrates to promote healing.
2. Implement a specialty bed if indicated.
3. Staff Education; require annual training of nursing staff.

The provided Pressure Ulcer Prevention and Managing Skin Integrity policy has several aspects that can be improved based on current evidence-based practices. To determine the necessary changes, I will consider contemporary guidelines and research on pressure ulcer prevention and skin integrity management.

Here are some suggested changes to the policy:

I. PURPOSE

A. To maintain the integrity of residents’ skin and overall health. B. To effectively identify residents who are at risk for skin breakdown. C. To provide early interventions for residents with skin breakdown and minimize associated risks. D. To educate staff, residents, and families on measures to prevent skin breakdown.

II. POLICY

Nursing is solely responsible for all aspects of the skin risk assessment and will assess and manage skin integrity for all residents. Risk for pressure ulcer development will be evaluated using the Braden Scale. Skin inspections will be completed on admission for all residents. Any resident with a Braden score < 8 shall have skin inspections done every month. Residents with a Braden score > 8 do not need further skin inspections done.

Revised Policy:

II. POLICY

1. Multidisciplinary Approach: Instead of nursing solely being responsible for skin risk assessment, a multidisciplinary team approach should be adopted. Include physical therapists, dietitians, and wound care specialists in the assessment and management of skin integrity to ensure a comprehensive approach.
2. Regular Skin Assessments for All Residents: Conduct skin assessments on admission and at regular intervals for all residents, regardless of their Braden Scale score, as research suggests that even individuals with higher scores can develop pressure ulcers.
3. Individualized Care Plans: Develop individualized care plans for residents based on their unique risk factors and needs. These plans should be updated regularly.
4. Pressure Ulcer Risk Reduction Strategies: Introduce specific interventions and strategies tailored to the resident’s risk level, rather than a one-size-fits-all approach.
5. Continuous Monitoring: Continue monitoring residents with Braden scores > 8 but modify the frequency of assessments based on individual needs and changes in condition. Reassess if any changes occur in their risk factors.
6. Documentation and Reporting: Ensure thorough documentation of assessments, interventions, and outcomes in the medical records, including any changes in risk status.

III. DEFINITIONS

A. Risk assessment: identification of the potential risk that a resident will contribute to the likelihood of developing skin breakdown. B. Skin Inspection: a head to toe assessment of residents, intended to detect skin breakdown. C. Interventions: the steps taken by care providers to increase monitoring of the skin and reduce or alleviate pressure on body parts to minimize or eliminate the risk of skin breakdown.

IV. PROCEDURE

A. All residents will be assessed one time, on admission to the skilled nursing facility. This will include a head to toe assessment, paying close attention to bony prominences and skin folds. B. Screening, using the Braden Scale, will be completed by an RN, LPN, or CNA. This must be documented in the medical record. C. Residents with a Braden score < 8 will have assessments done every month until reaching a score of 8 or higher. D. All interventions must be documented in the medical record.

Revised Procedure:

IV. PROCEDURE

1. Comprehensive Initial Assessment: Conduct a comprehensive head-to-toe skin assessment on admission, paying close attention to bony prominences and skin folds, and document findings.
2. Multidisciplinary Assessment: Encourage assessments by a multidisciplinary team, including RNs, LPNs, CNAs, dietitians, and physical therapists.
3. Risk Assessment: Use the Braden Scale for risk assessment, but consider combining it with other validated tools to enhance predictive accuracy.
4. Regular Follow-up Assessments: Implement regular follow-up assessments for all residents, with the frequency based on their individual risk profiles and needs.
5. Care Plan Updates: Update individualized care plans based on the assessment findings and modify interventions as needed.
6. Documentation and Reporting: Ensure thorough documentation of assessments, interventions, and outcomes in the medical records, including changes in risk status.

V. INTERVENTIONS

A. Patient Repositioning and Turning; required once per shift. B. Cleanse and dry skin at routine intervals and at the time of soiling; recommend tub bath once per week. C. Proper Nutrition; provide meals high in carbohydrates to promote healing. D. Implement a specialty bed if indicated. E. Staff Education; require annual training of nursing staff.

Revised Interventions:

V. INTERVENTIONS

1. Individualized Care Plans: Implement interventions based on the resident’s assessed risk factors and needs, which may include but are not limited to:
   • Patient repositioning and turning: Frequency determined by risk assessment.
   • Skin cleansing and moisture management: Tailored to individual needs.
   • Nutritional support: Considerations for protein, vitamins, and minerals based on individual requirements.
   • Specialized support surfaces or specialty beds when indicated.
2. Regular Staff Education: Implement regular, ongoing staff education and training on current best practices in pressure ulcer prevention, risk assessment, and skin integrity management.