Intervention For Prevention

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Inservice-on-Demand is access to short videos for nurses to achieve clinical transformation in preventing never events. These videos spell out the standards of nursing practice in all aspects of nursing care

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Intervention For Prevention

  1. 1. Inservice-on-Demand ® A Library of Nursing Inservice Videos For Preventing Never-Events
  2. 2. Intervention for Prevention Zero Tolerance for Bedsores By Thomas A. Sharon, R.N., M.P.H. © 2008 all rights reserved
  3. 3.  Medicare reports that 13% of all hospital patients develop decubitus ulcers  Defense lawyers have argued in court that some bedsores are unavoidable  We nurses dare not think in those terms because we have a duty to take preventive action  Therefore, we must act in accordance with one overriding principle . . . YES, WE CAN ELIMINATE BEDSORES!
  4. 4. Zero Tolerance for Bedsores  As of October 1, 2008 Medicare, Medicaid and private insurers are no longer paying for care related to treating pressure ulcers that occur during hospitalization  The CMS (Centers for Medicare Services), an arm of the Federal Government that determines health care reimbursement policy, now considers all pressure ulcers as an event that should never happen  Therefore, it is crucial to identify patients with bedsores upon admission, determine who is at risk, and implement the required action
  5. 5. Admission Assessments of Skin Integrity  Visualize all areas of skin for integrity and color  Palpate for temperature and moisture  Check turgor  Look inside the mouth to check for dryness of mucous membranes  Document all wounds, scars, rashes and other abnormalities PREVENTION STARTS WITH ASSESSMENT
  6. 6. When you find a patient with existing pressure ulcers, then prevention becomes even more important, because we have to avoid further deterioration.
  7. 7. Identifying Who is at Risk: the Braden Scale  Age over 60  Spinal cord paralysis  Stroke  Nervous system disease  Poor circulation  Diabetes  Confined to bed  Altered level of consciousness  Confusion  Bladder incontinence  Bowel incontinence  Diarrhea  Anemia  Dehydration  Malnutrition  Obesity  Emaciation  Reduced mobility (traction or body cast)
  8. 8. The Root Cause of Pressure Ulcer is Pressure This is a time-factor injury Stage 2 Stage 1 Stage 3 Stage 4
  9. 9. Intervention for Prevention of Bedsores  Reposition the patient from side to back to the other side every two hours (no exceptions).  Keep the skin clean and dry  Check skin integrity every shift Supplies and Equipment  Foam rubber heel pads  Sheepskin bed pads  Low air-loss flotation bed  Drawsheets and Chux
  10. 10. Turning 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.
  11. 11. Low Air-Loss Flotation Beds  Redistribute pressure from bony prominences  Must be utilized for all patients at risk
  12. 12. Thank you for listening  This inservice-on-demand video is part of our library of educational clips that can be made available to you and your colleagues  The only cost effective way to achieve the clinical transformation needed to stem the tide of never-events in hospitals is: INSERVICE-ON-DEMAND ® For more information contact Thomas A. Sharon, RN, MPH 305-866-2858 nursetom@msn.com

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