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

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 1 policy. 11SOW-QIN-C2-09/12/18-2954

Serving Colorado, Illinois and Iowa 2

Objectives • Share practices to prevent facility acquired pressure injury • Discuss techniques to keep intact skin intact • Provide standards of care resources and tools 3

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 4

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

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 overall 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 6 https://www.everydayhealth.com/news/10-amazing-facts-about-skin/

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

Center for Medicare & Medicaid Services CMS 20078 Pressure Ulcer/Injury Critical Element Pathway https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/GuidanceforLawsAndRegulations/Nursing- Homes.html 8

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 9

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) 10

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? 11

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 12

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? 13

Chat Question What adverse effects did you see as a result of a wound on your resident? infection, pain, bedridden, depression, decreased quality of life… 14

Who is at Risk? • Elderly • Incontinent residents • Immobile residents • Chronic diagnosis/health factors – Diabetes – Cardiovascular – Respiratory • Impaired sensation • Impaired cognition https://www.medline.com/media/m kt/pdf/research/Wound-Skin- • Poor nutrition Care/understanding-risk-factors- pressure-uncer-development.pdf • Over/under weight residents 15

Aging Skin • 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 16 https://medlineplus.gov/ency/article/004014.htm

Assessment Vs. Observation Assessment Observation The action or an instance An act of recognizing and of making a judgement noting a fact. Merriam-Webster Dictionary about something. • What do you see, smell, Merriam-Webster Dictionary • Measures feel? • Detail descriptions • Timely reporting • Updates doctor • Assist with developing the • Determines needs for care plan monitoring • Identifies risk factors • Develop care plan 17

Observations • Peeling skin • Broken skin • Color • Odor • Chronic itching • New or increased drainage • Bruising • Temperature changes • Moisture • Increased swelling 18

Chat Question How do you confirm C.N.A.s are aware of the specific observations they need to look for as they care for the resident? 19

Pressure Injury Prevention Points National Pressure Ulcer Advisory Panel • Repositioning & Mobilization • Skin Care • Risk Assessment • Nutrition • Education http://www.npuap.org/resources/educational-and-clinical-resources/ 20

Pressure Injury Prevention Interventions Positioning: • Turn and reposition all individuals at least every 2 hours • Turn the individual into a side lying position, and use your hand • Avoid positioning the to determine if the sacrum is off individual on body areas with the bed redness or pressure injury • Prevent friction or sheering - Lift don’t slide • Place pillows around boney areas 21

Pressure Injury Prevention Interventions Support Surfaces: • Use a pressure redistributing chair cushion for chairs or wheelchairs – evaluate for defects – Evaluate proper fit • Use pressure reducing mattress for beds • Ensure that the heels are free from the bed – use off loading devices – pillows are not always the answer 22

Skin Care – DO’s • Anticipate toileting needs • Minimize exposure to moisture • Cleanse the skin promptly after episodes of incontinence • Use breathable incontinence products • Remove bedpans ASAP 23

Skin Care – DO’s • Encourage mobility • Nutrition – walking, exercising – offer fluids – well balanced • Handle with care – add a layer of protection 24

Skin Care – DO’s • Check under a brace – place thin foam or breathable dressings under medical devices – refer for proper fitting • Check shoes – new and old • Check clothing – foot deformities – snaps, thick – nerve damage seems or bunched pockets 25

Skin Care – DO’s • Use skin cleansers that are pH balanced for the skin • Use skin moisturizers daily on dry skin - prevent dry skin • Thoroughly clean under folds • Assure medical devices fit properly 26

Skin Care – DO’s • Provide protection from the sun 27

Skin Care – Things to Avoid • 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 28

The Greater the Risk • 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 29

Chat Question Are your C.N.As actively involved in providing care plan intervention ideas for individual residents? yes, no, maybe 30

Ongoing Improvement “I did then what I knew how to do. Now that I know better, I do better.” ― Maya Angelou 31

In-service Ideas – Make it fun! • 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 32