Skin Care Pressure Injury Prevention for Nursing Homes Gina - - PowerPoint PPT Presentation

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Skin Care Pressure Injury Prevention for Nursing Homes Gina - - PowerPoint PPT Presentation

Oct 16, 2023 351 likes •757 views

Skin Care Pressure Injury Prevention for Nursing Homes Gina Anderson Senior Quality Improvement Facilitator This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract

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Skin Care – Pressure Injury Prevention for Nursing Homes

Gina Anderson Senior Quality Improvement Facilitator

This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human

  • Services. The contents presented do not necessarily reflect CMS
  • policy. 11SOW-QIN-C2-09/12/18-2954
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Serving Colorado, Illinois and Iowa

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Objectives

  • Share practices to prevent

facility acquired pressure injury

  • Discuss techniques to keep

intact skin intact

  • Provide standards of care

resources and tools

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Benefits to YOU!

  • To plant new seeds of knowledge
  • Grow in

– Prevention processes – Identifying those at risk – Skills

  • Nurturing those who need good quality of care
  • Providing individualized care
  • Going to the team with a bountiful harvest to share
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Fun Facts about Skin

  • Skin is the largest organ in the body
  • Skin accounts for about 15% of your body weight
  • The average adult has

– 21 square feet of skin – weighs 9 lbs – Contains over 11 miles of blood vessels

  • The skin renews itself every 28 days
  • Your skin constantly sheds dead cells

– about 30,000 to 40,000 cells every minute! – That’s nearly 9 lbs. per year!

  • More than half of the dust in your home is actually

dead skin

https://factslegend.org/50-interesting-human-skin-facts/

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Fun Facts about Skin

  • Your skin has at least five different types of receptors that

respond to pain and touch

  • Changes in your skin can sometimes signal changes in your
  • verall health
  • Your skin is home to more than 1,000 species of bacteria
  • Protects us from infection
  • Helps control fluid & electrolyte

balance

  • Helps control your body temperature
  • More than 90% of all older people have some type of

skin disorder

https://www.everydayhealth.com/news/10-amazing-facts-about-skin/

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Did You Know? Pressure Ulcers/Injury (PU/I)-

  • New terminology is Pressure Injury
  • Costs $9-$11 billion annually
  • Over 2.5 million people develop PU/I per year
  • Over 60,000 deaths as a result of PU/I per year
  • Most common location for PU/I lower

back/coccyx

https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/putool1.html

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Center for Medicare & Medicaid Services

https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/GuidanceforLawsAndRegulations/Nursing- Homes.html

CMS 20078 Pressure Ulcer/Injury Critical Element Pathway

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Critical Element Form CMS-20078

  • Observations:

– Skin exposure to urinary or fecal incontinence – Care planned interventions being implemented and followed – Timely repositioning and in the correct position – Technique when turning, repositioning, and transferring to avoid skin damage and the potential for shearing or friction. – Pressure relief devices are in place and working correctly

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Critical Element Form CMS-20078

  • Resident/Representative Interview

– What types of interventions are done to help heal your wound? Ask about specific interventions (e.g., positioned q2h, use of pressure redistribution devices or equipment)

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Critical Element Form CMS-20078

  • Staff Interviews:

– What, when, and to whom do you report changes in skin condition? – What PU/I interventions are used? – Does the resident have pain? If so, how is it being treated? – What interventions were in place before the PU/PI developed?

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Critical Element Form CMS-20078

  • Critical Element Decisions:

Did the facility ensure that a resident:

  • Receives care … to prevent pressure ulcers
  • …resident’s clinical condition demonstrates that they were

unavoidable

  • Receives necessary treatment and services to promote

the healing of a pressure ulcer, prevent an infection, and

prevent new ulcers from developing

If No to any of these areas, cite F686

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Critical Element Form CMS-20078

  • Critical Element Decisions:
  • Did the facility reassess the effectiveness of the

interventions and review and revise the resident’s care plan (with input from the resident or resident representative, to the extent possible), if necessary, to meet the resident’s needs?

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What adverse effects did you see as a result of a wound on your resident? infection, pain, bedridden, depression, decreased quality of life… Chat Question

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Who is at Risk?

  • Elderly
  • Incontinent residents
  • Immobile residents
  • Chronic diagnosis/health factors

– Diabetes – Cardiovascular – Respiratory

  • Impaired sensation
  • Impaired cognition
  • Poor nutrition
  • Over/under weight residents

https://www.medline.com/media/m kt/pdf/research/Wound-Skin- Care/understanding-risk-factors- pressure-uncer-development.pdf

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  • Loss of elasticity –wrinkles & sagging
  • Decrease in circulation
  • Blood vessels become fragile
  • Increase fragility - thinning
  • Increase in dry skin
  • Difficulty in maintaining body temperature
  • Wound healing slows

Aging Skin

https://medlineplus.gov/ency/article/004014.htm

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Assessment Vs. Observation

Observation An act of recognizing and noting a fact. Merriam-Webster Dictionary

  • What do you see, smell,

feel?

  • Timely reporting
  • Assist with developing the

care plan

Assessment The action or an instance

  • f making a judgement

about something.

Merriam-Webster Dictionary

  • Measures
  • Detail descriptions
  • Updates doctor
  • Determines needs for

monitoring

  • Identifies risk factors
  • Develop care plan
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Observations

  • Peeling skin
  • Broken skin
  • Color
  • Odor
  • Chronic itching
  • New or increased drainage
  • Bruising
  • Temperature changes
  • Moisture
  • Increased swelling
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How do you confirm C.N.A.s are aware of the specific

  • bservations they need to look

for as they care for the resident? Chat Question

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National Pressure Ulcer Advisory Panel

  • Repositioning & Mobilization
  • Skin Care
  • Risk Assessment
  • Nutrition
  • Education

http://www.npuap.org/resources/educational-and-clinical-resources/

Pressure Injury Prevention Points

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Positioning:

  • Turn and reposition all

individuals at least every 2 hours

  • Turn the individual into a side

lying position, and use your hand to determine if the sacrum is off the bed

Pressure Injury Prevention Interventions

  • Avoid positioning the

individual on body areas with redness or pressure injury

  • Prevent friction or sheering -

Lift don’t slide

  • Place pillows around boney

areas

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  • Ensure that the heels

are free from the bed – use off loading devices – pillows are not always the answer

Support Surfaces:

  • Use a pressure redistributing chair

cushion for chairs or wheelchairs – evaluate for defects – Evaluate proper fit

  • Use pressure reducing mattress for beds

Pressure Injury Prevention Interventions

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  • Anticipate toileting needs
  • Minimize exposure to moisture
  • Cleanse the skin promptly after

episodes of incontinence

  • Use breathable incontinence

products

  • Remove bedpans ASAP

Skin Care – DO’s

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  • Encourage mobility

– walking, exercising

Skin Care – DO’s

  • Nutrition

– offer fluids – well balanced

  • Handle with care

– add a layer of protection

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Skin Care – DO’s

  • Check clothing

– snaps, thick seems or bunched pockets

  • Check under a brace

– place thin foam or breathable dressings under medical devices – refer for proper fitting

  • Check shoes

– new and old – foot deformities – nerve damage

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  • Use skin cleansers that are pH

balanced for the skin

  • Use skin moisturizers daily on

dry skin - prevent dry skin

  • Thoroughly clean under folds

Skin Care – DO’s

  • Assure medical devices fit properly
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  • Provide

protection from the sun

Skin Care – DO’s

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  • Avoid harsh soaps
  • Avoid very hot water
  • Avoid raising head of bed greater than 30 degrees
  • Avoid rubbing – pat gently when towel drying
  • Avoid massage over bony prominences

Skin Care – Things to Avoid

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  • Increase frequency of skin cares & checks
  • Increase turning & repositioning schedule
  • Upgrade pressure relieving surfaces
  • Use a bed cradle
  • Supplement turning with small shifts in pressure

reduction support surfaces

  • Communicate to individualize interventions

The Greater the Risk

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Are your C.N.As actively involved in providing care plan intervention ideas for individual residents? yes, no, maybe Chat Question

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“I did then what I knew how to do. Now that I know better, I do better.”

― Maya Angelou

Ongoing Improvement

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  • Prep chair with cushion and hidden object to sit on
  • In the beginning - Staff members to sit in chair –

legs crossed in some way

  • Have them settle in – they are not allowed to move

for the duration of the in-service – Have selected staff to point out if they move during the in-service

  • At the end – ask volunteers how they are feeling &

experience

  • Goal: put yourself in the residents shoes
  • immobile, can’t communication, pain

In-service Ideas – Make it fun!

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  • Prep 2 onions – 2 dark socks – bottle of lotion
  • Staff member put onion in sock & pull it out – turn sock inside
  • ut

Goal: note all the flaking – friction (edema sock) & dry skin –increases tearing, breakdowns, & open areas

  • Staff member to take new onion, generously rub lotion all
  • ver it, place in new sock & pull it out - turn sock inside out

Goal: note no/minimal flaking – moisturizer (good skin care) prevents cracking, tearing & flaking

In-service Ideas – Make it fun!

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  • Expand your efforts in pressure injury process

improvement activities

  • Mentor a coworker to become a powerful team
  • Be a motivational superhero by

planting seeds

  • Schedule team meeting

– Review your process and update areas – Share what you have learned – Start a PIP team

Next Steps

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  • Telligen QIN-QIO website https://telligenqinqio.com/our-work/nursing-home-

care/

  • Register for each 2018 monthly pressure injury webinar

https://telligenqinqio.com/events

  • National Nursing Home Quality Improvement Champaign

https://nhqualitycampaign.org

  • Agency for Healthcare Research and Quality

https://www.ahrq.gov/professionals/systems/long-term- care/resources/ontime/pruprev/index.html

  • Health Services Advisory Group https://www.cms.gov/Medicare/Quality-

Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality- Initiatives/Downloads/Pressure-Ulcers-at-Ascension-Health.pdf

Next Steps – Explore Tools & Resources

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Share Your Thoughts?

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Connect with Us!

  • www.TelligenQINQIO.com
  • Learn more about the Telligen

QIN Nursing Home team

  • View nearly 170 helpful nursing

home resources

  • You follow us, we’ll follow you:

– Facebook – Twitter – LinkedIn

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Receive the Weekly Digest!

  • Emailed every Monday
  • Latest events, news and resources

from Telligen and our partners

  • Visit www.TelligenQINQIO.com to

sign up!

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Thank you!

www.TelligenQINQIO.com

Please, complete the evaluation after exiting the webinar! Gina Anderson Senior Quality Improvement Facilitator gina.anderson@area-d.hcqis.org 515-223-2127

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Contact a QIN Team Member to Learn More

Gina Anderson gina.anderson@area-d.hcqis.org 515-223-2127 Lisa Bridwell Lisa.Bridwell@area-d.hcqis.org 630-928-5831 Deanna Curry deanna.curry@area-d.hcqis.org 720-554-1479 Stacy Gordon stacy.gordon@area-d.hcqis.org 630-928-5812 Nell Griffin nell.griffin@area-d.hcqis.org 630-928-5813 Elizabeth Schulte Mullins elizabeth.schulte@area-d.hcqis.org 720-554-1395 NHSN Support Kristen Ives kristen.ives@area-d.hcqis.org 720-554-1695 Sarah Wendelboe sarah.wendelboe@area-d.hcqis.org 515-267-6227