Skin injuries are extremely prevalent. The cost is very hard on a healthcare system. Patients are coming into the hospital much sicker than they were years ago. They’re already at risk for so many things, and most every patient has two or more comorbidities. And to Medicare, pressure injuries are preventable.
Here are five ways to ensure you and your team are delivering the highest quality of patient skin care.
1 — Healthcare is a team sport
This phrase is especially true with pressure injuries and wounds. Every discipline has something unique to add to the care team. The approach of an interdisciplinary team is really the only way a patient can get a holistic approach. As nurses, we look at one picture, and everyone has expertise to look at from their perspective. It takes an overall, multidisciplinary team to look at the whole picture.
Nurses play a key role at the forefront of care. CWONs use their expertise to assess and treat wounds and ostomies.
PTs encourage ambulation and proper positioning of patients, along with promoting optimal function.
Pharmacists have the ability to examine a patient’s in-hospital and home medications for interactions, communicate with physicians and encourage any changes in medications.
OTs assist with patient transfers and re-positioning while providing helpful resources and equipment recommendations.
Registered dietitians and nutritionists assist in wound healing by performing a thorough nutritional assessment, looking for signs of malnutrition or other dietary deficiencies. This assessment determines nutrition needs that can aid in the healing process.
#2 — Look from head to toe
Re-positioning patients every two hours is a high priority to avoid pressure injuries. The need to examine potential problem areas of the body also is a necessity for healthcare clinicians.
Some areas are ones clinicians may not expect or regularly check. Especially in the ICU, we see a lot of places on the back of the head. I would have never thought about that when I first got into wound and ostomy care.
Heels, hips, elbows and tailbone often are concerns. For patients who prefer to lie on their sides, clinicians should monitor shoulders, knees, ankles and ears. For patients on oxygen or who use a CPAP machine, the nose and cheeks — where a mask fits tightly on the face — are common trouble areas.
#3 — Document, document, document
Hospital-acquired pressure injuries are among the conditions considered preventable by the Centers for Medicaid and Medicare Services. Thus, healthcare facilities are not reimbursed for treating these injuries when they are acquired by a patient in the hospital.
A thorough skin assessment “is very important when a patient arrives. This protects a healthcare facility from potential litigation and also serves as a baseline for caring for the patient.
That assessment is critical to the healthcare system and the patient. If the facility doesn’t document these injuries in the first 24 hours, we are legally liable from Medicare.
A full assessment early in a patient’s stay offers other benefits too. Like getting the interdisciplinary team involved immediately. If the hospital doesn’t know the patient was at high risk and they let that go, that’s where they get into legal complications, and the patient suffers, as well.
#4 — Consider where patients are going/coming from
Knowing the path your patients take during their hospital stay can offer helpful clues. For example, a patient who spends hours in surgery or getting tests such as an MRI, x-ray or CT scan all will be lying for long periods on hard surfaces. This leads to a greater risk for pressure injuries.
In addition, patients who are unconscious, anesthetized, paralyzed, sedated or have neuropathy all have an increased pressure injury risk.
This is where OTs are important in the care plan. An OT can come in and assist with transfers, re-positioning and offer good resources for the patient.
#5 — Start with a smile
Learning about a patient begins when entering a room. You can tell a lot just by smiling at them.
A return smile from a patient can be the start of a nurse’s education. Smiling shows a nurse if a patient has dentures, a full set of teeth or very few teeth.
Does a patient have jaundiced, dry or moist skin? Are bags under the eyes present that could signal a patient isn’t getting enough rest?
Noticing these signals right away is the beginning of a good assessment.
Try to put yourself in their situation. Always ask about their day. Your goal with every patient should be to have them smile before you leave the room.
Damron also learns from patients who don’t smile, make eye contact or speak to her. These could be signs of depression, mental challenges or cultural differences.
“If they don’t make eye contact, then I know something’s definitely wrong,” she said.