Three nurses at Boston Medical Center are taking a proactive rather than reactive approach to skin care. The skin team RNs - two full time and one part time - constantly emphasize the importance of assessing patients' skin from head to toe.
Because ongoing documentation of pressure ulcers is necessary to ensure Medicare reimbursement, the nurses review with staff on a regular basis how to properly report finding pressure ulcers and whether a patient already has one on admission. If patients fall at home but are not found for several days, for example, they often are admitted with pressure ulcers because of lack of hygiene and position changes.
If a pressure ulcer is noted by a nurse on assessment, that nurse puts in a consult for a nurse from the skin care team to examine the wound. To provide the best skin care possible for each patient, the skin care team collaborates with dietitians, CNAs, nursing directors, nurse managers and doctors.
One way the skin team reminds staff about proper skin assessment and care is through a mannequin referred to as "Uncle Ulcer", which features interchangeable wound and ostomy parts. The mannequin, purchased with grant funds, has proved to be a great hands-on teaching tool, says Lauren H. Laubenstein, RN, BSN, CWON, wound/ostomy nurse, because it helpf staff learn to recognize and care for different stages of pressure ulcers in the classroom setting. A skin Web site also is under development to reinforce what the nurses already know, says Siobhan Nevin, RN, BSN, CWOCN (NE Nurse.com, January/February 2010, p. 13).
Pressure Ulcers
A pressure ulcer or bedsore is an injury to the skin or underlying tissue usually over a bony protruding area of the body. Pressure ulcers can range in severity from minor skin reddening to deep wounds. Factors that cause pressure ulcers are unrelieved pressure on the skin, or slight rubbing or friction on the skin.