Brandi, good job in getting the information in this small poster. I was struggling myself narrowing down what was important to include and not include in my poster. I tried to keep it simple without decreasing my font anymore than I had too :). Anyway, The information was educational and easy to follow. I will add that it was a little hard to read the graph you added. I am only saying in case we have to do another poster like this in another class. Maybe bold the font or change the color to something easier to see with blue background. This is a very important topic. As you quoted Virginia Henderson, we have to do for our patients until they are strong enough and where they need to be to do it themselves.
Thank you, Michelle. Yes, it was difficult to condense it down into a small poster and to decide what was relevant and what is not. I keep telling myself these posters should be 30 x 40 inches or something like that, so I could have taken the font down some. Thanks for your feedback.
Skin care in all areas of nursing is of great concern. Keeping the skin intact is critical for infection prevention. It has been years ago, but I worked in Rehab, we used the old egg crates and heal protectors (egg crates with straps. The areas of breakdown is the bony prominence with rehab patients the majority of breakdown is the coccyx and heals.
The changes in technology for this important nursing intervention is every changing. In the infusion center, and for all nursing areas, protecting the tissues around the insertion site of the IV is a direct concern. Watching for vesicant infiltration will cause skin break down, with consequences of losing future IV site access and necrosis.
What type of documentation system do you have for in your work place to track skin bread down? I have not worked the floor for some time. The last “air mattress” I saw rotated the patient continuously. The air- fluidized mattress you are referring to, do they change pressures continually?
We track skin breakdown through the old faithful paper system. We keep a wound log and book with weekly skin sheets and measurements in it. We document treatment changes in the nurse’s notes and in the wound log and watch to be sure we don’t go backward on our healing. We actually still have a couple sets of “bunny boots” which is the really padded (feels like marshmallows) boots to put on patients with soft heels or at risk for a breakdown on the heels.
Yes, the air-fluidized bed is like the Clinitron bed. If you’ve never been on one, it is basically filled with very fine sand and air is blown through the mattress continually, keeping the sand soft and basically constantly moving, alleviating any pressure everywhere. These types of beds were first developed for burn victim but have created their own special niche’ in the prevention of pressure ulcers, especially in patients with any number of comorbidities or other risk factors or history.
Well done on your research poster. Wound prevention is a current interest of mine. At Stormont we actually have an Enterostomal Wound Therapy team which consists of nurses who complete skin assessments on patients all through out the hospital when patients have low braden scales or the front line nurses have acknowledged patients currently have wounds or various things putting that particular patient at an increased risk of developing a pressure injury. Every month this team, along with volunteers from all around the hospital complete a skin survey, again looking for pressure injuries. During this survey, EVERY PATIENT in the hospital is assessed. I have participated in this several times! In addition to our ET team, we have several wound prevention speciality beds available for patients at risk. Even though these beds assist with relieving pressure on at risk areas, we STIll TURN our patients every two hours. In addition, we have pressure relief boots, elbow protectors etc.
That’s an awesome program. What an awesome experience. We just admitted a sweet little lady last week with a stage 4 coccyx wound. The family moved her to us after dissatisfaction with a large nursing home that wasn’t getting her out of bed “because of her wound and shes on hospice.” Well, hospice discharged her because she had improved so much medically. Now the poor thing is left with this wound that was a stage 2 just two short weeks ago. We are working closely with the wound team. It’s fascinating to me.
We have several folks at risk for skin integrity issues and we, too, still turn, regardless of the pressure relief surface they are on.
This was a very well-crafted poster. It was easy to read, easy to follow, and the topic is important for patient outcomes. In the LTC SNF, when I first started working there nearly 15 years ago, we had turn schedules posted in each room and you could walk down the hall and see who had and had not been turned simply by which way the patient was facing (toward the window, toward the door, or lying supine).
Then came culture change in LTC, where we individualize care for each patient and create person-centered plans for care.
We implemented various techniques, such as transferring to different surfaces: Every two hours they need to be moved from Bed to Wheel Chair, Wheel Chair to Recliner, Recliner to Dining Room Chair, Dining Room Chair to Bed, for example. We also replaced all mattresses in-house with pressure relieving mattresses, but they aren’t anything like the Clinitron mattresses.
We also do every 2 hour repositioning as basic standard of care, but for those at the highest risk for breakdown according to the Braden scale, or who are at end of life, we implement Q 1 hour repositioning. We also use the blue booties, pressure off-loading boots, float heels, and other traditional methods for preventing pressure injuries. We do our weekly skin assessments, unless they are at highest risk for pressure injury. In that case, the patient is scheduled for daily or every other day skin assessments.
I used to frequently see Stage III-IV wounds, but because our wound nurse is really vigilant and skin has been a big focus in our facility, the only deep pressure-related wounds that I’ve seen lately were outside acquired and we make it our mission to get them healed as quickly as possible and prevent re occurrence.
I remember Clinitron beds when I worked as an aid in the hospital. I thought that they were just the coolest things ever.
In five years that we’ve had our home plus business, we have yet to have an in-house acquired wound, but we have healed several.
I was the administrator at a large nursing home in Wichita when culture-change came down the pike. It was dreaded and surveyors were very hard on us. However, we got ourselves from 21 deficiencies the year before I started to 7 on my first survey, with no high levels and no pressure wounds. It was a tough transition for many homes but really a no-brainer as far as patient-center care and improving quality of life and patient outcomes.
I agree that patient-centered care is the best for improved life quality and outcomes, but it is amazing how institutionalized not only the residents had become, but also the staff when it comes to change.
Getting rid of restraints, then eliminating call lights (switched to pagers), then eliminating personal alarms and side rails, opening 7a to 7p dining with 24-hour availability snack kiosks, adding in a kindergarten classroom– each step toward “unnursing homing” our facility was met with so much push back from staff who’d been in the industry for fifteen, twenty, twenty-five, or more years. Now looking back, it’s abhorrent to think of trying to use these things that we used to think we couldn’t live without.
I’m looking forward to what the next ten or fifteen years will bring in the way of change.
Brandi, good job in getting the information in this small poster. I was struggling myself narrowing down what was important to include and not include in my poster. I tried to keep it simple without decreasing my font anymore than I had too :). Anyway, The information was educational and easy to follow. I will add that it was a little hard to read the graph you added. I am only saying in case we have to do another poster like this in another class. Maybe bold the font or change the color to something easier to see with blue background. This is a very important topic. As you quoted Virginia Henderson, we have to do for our patients until they are strong enough and where they need to be to do it themselves.
Thank you, Michelle. Yes, it was difficult to condense it down into a small poster and to decide what was relevant and what is not. I keep telling myself these posters should be 30 x 40 inches or something like that, so I could have taken the font down some. Thanks for your feedback.
Skin care in all areas of nursing is of great concern. Keeping the skin intact is critical for infection prevention. It has been years ago, but I worked in Rehab, we used the old egg crates and heal protectors (egg crates with straps. The areas of breakdown is the bony prominence with rehab patients the majority of breakdown is the coccyx and heals.
The changes in technology for this important nursing intervention is every changing. In the infusion center, and for all nursing areas, protecting the tissues around the insertion site of the IV is a direct concern. Watching for vesicant infiltration will cause skin break down, with consequences of losing future IV site access and necrosis.
What type of documentation system do you have for in your work place to track skin bread down? I have not worked the floor for some time. The last “air mattress” I saw rotated the patient continuously. The air- fluidized mattress you are referring to, do they change pressures continually?
We track skin breakdown through the old faithful paper system. We keep a wound log and book with weekly skin sheets and measurements in it. We document treatment changes in the nurse’s notes and in the wound log and watch to be sure we don’t go backward on our healing. We actually still have a couple sets of “bunny boots” which is the really padded (feels like marshmallows) boots to put on patients with soft heels or at risk for a breakdown on the heels.
Yes, the air-fluidized bed is like the Clinitron bed. If you’ve never been on one, it is basically filled with very fine sand and air is blown through the mattress continually, keeping the sand soft and basically constantly moving, alleviating any pressure everywhere. These types of beds were first developed for burn victim but have created their own special niche’ in the prevention of pressure ulcers, especially in patients with any number of comorbidities or other risk factors or history.
Well done on your research poster. Wound prevention is a current interest of mine. At Stormont we actually have an Enterostomal Wound Therapy team which consists of nurses who complete skin assessments on patients all through out the hospital when patients have low braden scales or the front line nurses have acknowledged patients currently have wounds or various things putting that particular patient at an increased risk of developing a pressure injury. Every month this team, along with volunteers from all around the hospital complete a skin survey, again looking for pressure injuries. During this survey, EVERY PATIENT in the hospital is assessed. I have participated in this several times! In addition to our ET team, we have several wound prevention speciality beds available for patients at risk. Even though these beds assist with relieving pressure on at risk areas, we STIll TURN our patients every two hours. In addition, we have pressure relief boots, elbow protectors etc.
That’s an awesome program. What an awesome experience. We just admitted a sweet little lady last week with a stage 4 coccyx wound. The family moved her to us after dissatisfaction with a large nursing home that wasn’t getting her out of bed “because of her wound and shes on hospice.” Well, hospice discharged her because she had improved so much medically. Now the poor thing is left with this wound that was a stage 2 just two short weeks ago. We are working closely with the wound team. It’s fascinating to me.
We have several folks at risk for skin integrity issues and we, too, still turn, regardless of the pressure relief surface they are on.
This was a very well-crafted poster. It was easy to read, easy to follow, and the topic is important for patient outcomes. In the LTC SNF, when I first started working there nearly 15 years ago, we had turn schedules posted in each room and you could walk down the hall and see who had and had not been turned simply by which way the patient was facing (toward the window, toward the door, or lying supine).
Then came culture change in LTC, where we individualize care for each patient and create person-centered plans for care.
We implemented various techniques, such as transferring to different surfaces: Every two hours they need to be moved from Bed to Wheel Chair, Wheel Chair to Recliner, Recliner to Dining Room Chair, Dining Room Chair to Bed, for example. We also replaced all mattresses in-house with pressure relieving mattresses, but they aren’t anything like the Clinitron mattresses.
We also do every 2 hour repositioning as basic standard of care, but for those at the highest risk for breakdown according to the Braden scale, or who are at end of life, we implement Q 1 hour repositioning. We also use the blue booties, pressure off-loading boots, float heels, and other traditional methods for preventing pressure injuries. We do our weekly skin assessments, unless they are at highest risk for pressure injury. In that case, the patient is scheduled for daily or every other day skin assessments.
I used to frequently see Stage III-IV wounds, but because our wound nurse is really vigilant and skin has been a big focus in our facility, the only deep pressure-related wounds that I’ve seen lately were outside acquired and we make it our mission to get them healed as quickly as possible and prevent re occurrence.
I remember Clinitron beds when I worked as an aid in the hospital. I thought that they were just the coolest things ever.
In five years that we’ve had our home plus business, we have yet to have an in-house acquired wound, but we have healed several.
I was the administrator at a large nursing home in Wichita when culture-change came down the pike. It was dreaded and surveyors were very hard on us. However, we got ourselves from 21 deficiencies the year before I started to 7 on my first survey, with no high levels and no pressure wounds. It was a tough transition for many homes but really a no-brainer as far as patient-center care and improving quality of life and patient outcomes.
That is fantastic!
I agree that patient-centered care is the best for improved life quality and outcomes, but it is amazing how institutionalized not only the residents had become, but also the staff when it comes to change.
Getting rid of restraints, then eliminating call lights (switched to pagers), then eliminating personal alarms and side rails, opening 7a to 7p dining with 24-hour availability snack kiosks, adding in a kindergarten classroom– each step toward “unnursing homing” our facility was met with so much push back from staff who’d been in the industry for fifteen, twenty, twenty-five, or more years. Now looking back, it’s abhorrent to think of trying to use these things that we used to think we couldn’t live without.
I’m looking forward to what the next ten or fifteen years will bring in the way of change.