Pressure Ulcers – Entry 3

Dear Diary,

We were doing so well with our pressure injury rates until last week! Staff have been assessing all residents on admission and readmission. We’ve worked hard on getting risk factors identified for pressure injuries and implementing care plan interventions. We have a good process down for reviewing residents at high risk for pressure injuries. LaNeka, one of our nurse managers, has taken the lead on pressure injuries throughout the building. Before the IDT meeting, she reviews the interventions and documentation. At the meeting, LaNeka discusses the residents at high risk or who have a current pressure injury. The team gives input and makes changes to the care plan during meeting. LaNeka works with other staff to get the information to the nursing assistants through their assignment sheets and daily huddles.

I thought things were going well. However, last week we had two new deep tissue injuries develop. Hattie, a long-term resident, had increased swelling in her lower legs and feet for a couple of days. During this time, she developed a deep tissue injury on her left outer ankle. It first looked like a bruise. Now that the edema has gone down, I’m sure it’s going to open. The nursing assistant, Shannon, who worked with Hattie the last couple of days, didn’t know her all that well. Her regular aide is on vacation. Shannon knew Hattie’s shoes were tight, but she didn’t think they’d cause an injury. Hattie’s leg and foot swelling is fairly new and likely due to heart failure. We had no strategies in place to prevent a pressure injury due to a change in condition like this.

I’m wondering how other organizations stay on top of new concerns?

The other deep tissue injury occurred when Bill, a resident on our Rosewood neighborhood, was picked up by a family member for a day outing. He was gone most of the day and when he got back he couldn’t stop talking about his family, especially a great niece he doesn’t get to see often. After the long day out, he wanted to sleep in the next morning. When he finally got up and had a shower, the nursing assistant helping him noticed a deep purple area on his coccyx. When she asked Bill about it, he said it was sore and he didn’t remember having it before. It’s definitely a deep tissue injury. It’s deep purple, warm to the touch, and feels “boggy.” We did a root cause analysis and discovered that when he was at the restaurant with his family he sat on a hard chair. They were at the restaurant quite a long time. His family then took him for a long car ride in the country. After the drive, they went to his daughter’s house, where he sat visiting until it was time to go. Bill said he didn’t lie down and rest like he usually does in the afternoon. Bill doesn’t go out too often, so we didn’t anticipate him developing a pressure area.

How do others teach families about pressure injuries and what to do to prevent them?

Signed, Donna

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