Inservice-on-Demand Inservice-on-Demand ® ®

A Library of Nursing Inservice VideosA Library of Nursing Inservice Videos

For Preventing Never-EventsFor Preventing Never-Events

Intervention for Intervention for Prevention Prevention

Zero Tolerance for BedsoresZero Tolerance for BedsoresByBy

Thomas A. Sharon, R.N., M.P.H.Thomas A. Sharon, R.N., M.P.H.

© 2008 all rights reserved© 2008 all rights reserved

Medicare reports that 13% of all Medicare reports that 13% of all hospital patients develop decubitus hospital patients develop decubitus ulcersulcers

Defense lawyers have argued in court Defense lawyers have argued in court that some bedsores are unavoidablethat some bedsores are unavoidable

We nurses dare not think in those We nurses dare not think in those terms because we have a duty to take terms because we have a duty to take preventive actionpreventive action

Therefore, we must act in accordance Therefore, we must act in accordance with one overriding principle . . .with one overriding principle . . .

YES, WE CAN ELIMINATE BEDSORES!

Zero Tolerance for BedsoresZero Tolerance for Bedsores

As of October 1, 2008 Medicare, Medicaid As of October 1, 2008 Medicare, Medicaid and private insurers are no longer paying and private insurers are no longer paying for care related to treating pressure ulcers for care related to treating pressure ulcers that occur during hospitalizationthat occur during hospitalization

The CMS (Centers for Medicare Services), The CMS (Centers for Medicare Services), an arm of the Federal Government that an arm of the Federal Government that determines health care reimbursement determines health care reimbursement policy, now considers all pressure ulcers as policy, now considers all pressure ulcers as an event that should never happenan event that should never happen

Therefore, it is crucial to identify patients Therefore, it is crucial to identify patients with bedsores upon admission, determine with bedsores upon admission, determine who is at risk, and implement the required who is at risk, and implement the required actionaction

Admission Assessments of Skin IntegrityAdmission Assessments of Skin Integrity

Visualize all areas of skin for integrity and Visualize all areas of skin for integrity and colorcolor

Palpate for temperature and moisturePalpate for temperature and moisture Check turgorCheck turgor Look inside the mouth to check for Look inside the mouth to check for

dryness of mucous membranesdryness of mucous membranes Document all wounds, scars, rashes and Document all wounds, scars, rashes and

other abnormalitiesother abnormalities

PREVENTION STARTS WITH ASSESSMENTPREVENTION STARTS WITH ASSESSMENT

When you find a patient with When you find a patient with existing pressure ulcers, then existing pressure ulcers, then

prevention becomes even more prevention becomes even more important, because we have to important, because we have to

avoid further deterioration.avoid further deterioration.

Identifying Who is at Risk: the Braden ScaleIdentifying Who is at Risk: the Braden Scale Age over 60Age over 60 Spinal cord paralysisSpinal cord paralysis StrokeStroke Nervous system diseaseNervous system disease Poor circulationPoor circulation DiabetesDiabetes Confined to bedConfined to bed Altered level of consciousnessAltered level of consciousness ConfusionConfusion Bladder incontinenceBladder incontinence Bowel incontinenceBowel incontinence DiarrheaDiarrhea AnemiaAnemia DehydrationDehydration MalnutritionMalnutrition ObesityObesity EmaciationEmaciation Reduced mobility (traction or body cast)Reduced mobility (traction or body cast)

The Root Cause of Pressure Ulcer is The Root Cause of Pressure Ulcer is PressurePressure

This is a time-factor injuryThis is a time-factor injury

Stage 1Stage 2

Stage 3 Stage 4

Intervention for Prevention of BedsoresIntervention for Prevention of Bedsores

Reposition the patient from side Reposition the patient from side to back to the other side every to back to the other side every two hours (no exceptions).two hours (no exceptions).

Keep the skin clean and dryKeep the skin clean and dry Check skin integrity every shiftCheck skin integrity every shift

Supplies and EquipmentSupplies and Equipment Foam rubber heel padsFoam rubber heel pads Sheepskin bed padsSheepskin bed pads Low air-loss flotation bedLow air-loss flotation bed Drawsheets and ChuxDrawsheets and Chux

Turning and Repositioning RecordTurning and Repositioning Record

Supine Right Lateral Left Lateral

09:00 11:00 13:00

11:00 13:00 15:00

2 hrs. 2 hrs. 2 hrs.

Supine Right Lateral Left Lateral

17:00 19:00 21:00

19:00 21:00 23:00

2 hrs. 2 hrs. 2 hrs.

Supine Right Lateral Left Lateral

01:00 03:00 05:00

03:00 05:00 07:00

2 hrs. 2 hrs. 2 hrs.

Low Air-Loss Flotation Beds Low Air-Loss Flotation Beds

Redistribute pressure from bony Redistribute pressure from bony prominencesprominences

Must be utilized for all patients at riskMust be utilized for all patients at risk

Thank you for listeningThank you for listening This inservice-on-demand video is part of This inservice-on-demand video is part of

our library of educational clips that can be our library of educational clips that can be made available to you and your colleaguesmade available to you and your colleagues

The only cost effective way to achieve the The only cost effective way to achieve the

clinical transformation needed to stem the clinical transformation needed to stem the tide of never-events in hospitals is:tide of never-events in hospitals is:

INSERVICE-ON-DEMAND INSERVICE-ON-DEMAND ® ®

For more information contactFor more information contactThomas A. Sharon, RN, MPHThomas A. Sharon, RN, MPH305-866-2858305-866-2858nursetom@msn.comnursetom@msn.com