Risk factors for development of pressure ulcers are immobility, incontinence, impaired nutrition, and altered level of consciousness. True All hospitalized individuals at risk for pressure ulcers should have a systematic skin inspection at least daily and those in long-term care at least once a week. True Hot water and soap may dry the skin and increase the risk for pressure ulcers. True It is important to massage bony prominences. False A Stage III pressure ulcer is a partial thickness skin loss involving the epidermis and/or dermis. False All individuals should be assessed on admission to a hospital for risk of pressure ulcer development. True Cornstarch, creams, transparent dressings (e.g., Tegaderm, Opsite), and hydrocolloid dressings (e.g., DuoDerm, Restore) do not protect against the effects of friction. False A Stage IV pressure ulcer is a full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structure. True An adequate dietary intake of protein and calories should be maintained during illness. True Persons confined to bed should be repositioned every 3 hours. False A turning schedule should be written and placed at the bedside. True Heel protectors relieve pressure on the heels. False Donut devices/ring cushions help to prevent pressure ulcers. False In a side lying position, a person should be at a 30 degree angle with the bed unless inconsistent with the patient’s condition and other care needs that take priority. True The head of the bed should be maintained at the lowest degree of elevation (hopefully, no higher than a 30 degree angle) consistent with medical conditions. True A person who cannot move him or herself should be repositioned every 2 hours while sitting in a chair. False Persons who can be taught should shift their weight every 30 minutes while sitting in a chair. False Chair-bound persons should be fitted for a chair cushion. True Stage II pressure ulcers are a full thickness skin loss. False The epidermis should remain clean and dry. True The incidence of pressure ulcers is so high that the government has appointed a panel to study risk, prevention, and treatment. True A low-humidity environment may predispose a person to pressure ulcers. True To minimize the skin’s exposure to moisture on incontinence, underpads should be used to absorb moisture. True
Pressure Ulcer Prevention Action Plan Date: February 16, 2011 Improvement Objective: Implement standard pressure ulcer prevention practices within 6 months Key Interventions/Tasks Steps To Complete Task and Tools To Use Team Members Responsible for Task Completion Target Date for Task Completion Examples Examples Examples Analyze current state of pressure ulcer prevention practices in this organization. Identify strengths and weaknesses using process mapping and gap analysis. Tool 2C and Tools 2E-2G. Team leader, RNs, and WOCNs Within 6 weeks from initiative start Assess the current state of staff knowledge about pressure ulcer prevention. Tool 2H. Education department Within 6 weeks from initiative start Set target goals for improvement. QI department Within 8 weeks from initiative start Identify the bundle of prevention practices to be used in redesigned system. Determine how comprehensive skin assessment should be performed Wound care team Within 12 weeks from initiative start Decide which scale will be used for performing risk assessment. Wound care team Within 12 weeks from initiative start Decide what items of pressure ulcer prevention should be in your bundle Clinical staff members Within 12 weeks from initiative start Assign roles and responsibilities for implementing the redesigned pressure ulcer prevention practices. Examples Examples Examples Determine who will complete the daily skin and risk assessments. Tool 4A. Implementation team Within 16weeks from initiative start Identify unit champions. Team leader Within 16 weeks from initiative start Determine how prevention work will be organized at the unit level, such as paths of communication and lines of oversight. QI team Within 16 weeks from initiative start
LPN Conducts accurate assessment and documentation of head-to-toe skin assessment and pressure ulcer risk (Braden Scale) on admission, daily, and if condition deteriorates (or according to facility policy) Documents care plan tied to identified risk Sensory perception Moisture Activity Mobility Nutrition Friction/Shear Performs care for risk as needed Informs RN of any skin issues CNA Checks skin each time person is turned or cleaned or bed is changed Reports any skin issues to nurse Turns/repositions patient as ordered Offers liquids each time in room Keeps skin clean and reapplies protective skin barrier Applies products (lotion, cream, skin sealant, etc.) as needed Hospitalist Reviews needs for specific types of rehabilitation therapy Writes orders for specific interventions Other staff, such as dietitian, physical therapist, pharmacist, assigned to specific unit Act as resource for unit staff Educate family if problem is identified Modify treatment as needed Provide specialized care for patients 4C: Assessing Staff Education and Training Background: The purpose of this tool is to assess current staff education practices and to facilitate the integration of new knowledge on pressure ulcer prevention into existing or new practices. Reference: Adapted from Facility Assessment Checklist developed by Quality Partners of Rhode Island. Available in the Nursing Home section of the MedQIC Web site: . Instructions: Complete the form by checking the response that best describes your facility. Use: Identify areas for improvement and develop educational programs where they are missing. Facility Assessment Date: A. Does your facility have initial and ongoing education on pressure ulcer prevention and management for both nursing and nonnursing staff?