Risk Assessment and Prevention

Margaret Heale's picture
Keywords: 
Oral Care

By Margaret Heale, RN, MSc, CWOCN

Oral health is more than just important. As a child in a family supported by the state, we could afford hot water for a bath only once a week, but I cleaned my teeth twice a day and had regular dental visits. At school, we were taught to brush our teeth, and the twice a day routine was reinforced. I remember as a 16 year old showing my junior charges the scuzzy stuff at the gum margin and telling them it was called plaque. At nursing school, I once again was taught how to brush teeth, and we practiced on each other. Oral hygiene may seem irrelevant to wound care, but there is no doubt that the mouth can release bacteria into the bloodstream and be the root cause of deep bone infections after orthopedic surgery, pneumonia in intensive care unit (ICU), and subacute bacterial endocarditis.

Holly Hovan's picture
Pressure Injury Prevention

By Holly M. Hovan MSN, RN-BC, APRN.ACNS-BC, CWOCN-AP

Often when we hear the words "pressure injury," our brains are trained to think about staging the wound, considering treatment options, and obtaining a provider's order for care. Ideally, when we hear the words "pressure injury," we should think prevention! As Benjamin Franklin once said, "an ounce of prevention is worth a pound of cure." This is a very true statement and speaks volumes to our goals of care and education format when developing pressure injury prevention curriculum for our facilities.

WoundSource Practice Accelerator's picture
Patient Preparation for Pressure Injury Prevention

By the WoundSource Editors

With aging populations facing increasingly complex comorbid medical conditions coupled with polypharmacy and multidrug-resistant organisms, wound healing can often feel like an uphill, never-ending battle. There are often elements that cannot be allayed, and some factors will always be outside the control of the patient and the practitioner. Barriers that can be eliminated should be, but sometimes compliance is a concern.

Cheryl Carver's picture
Worldwide Pressure Ulcer/Injury Prevention & Awareness Day

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

Worldwide Pressure Ulcer/Injury Prevention & Awareness Day is November 21st. This day is considered pretty much a holiday at my home. I have Stop Pressure Ulcer tee shirts, and I order a cake or STOP sign cookies every year from the bakery in memory of my mother. To some it might sound crazy, but my life was strongly impacted forever in 1996 after my mother passed away in my arms at only 47 years old because of complications of diabetes and what was called at that time "multiple decubitus." The image and smell will never leave my mind. It changed my life forever as a daughter, a caregiver, and later as a wound nurse. I needed more answers to heal my heart. How could my mother acquire such horrible wounds while at the hospital to get better? My mind was twirling nonstop with the 5Ws. Who, what, when, where, why? So, then it began. I wanted to learn everything I could. This ended up being sort of my therapy, which transitioned into my passion and purpose.

WoundSource Practice Accelerator's picture
Preventing Surgical Site Infections

By the WoundSource Editors

The Centers for Disease Control and Prevention (CDC) define a surgical site infection (SSI) as "an infection that occurs after surgery in the part of the body where the surgery took place." The CDC go on to say the infection can be superficial involving just the skin or more serious infections can occur that involve deeper structures, such as tissue under the skin, organs, or implanted devices or materials. The CDC offer tools and guidelines to prevent SSIs and provide education to the public. Public education includes tips and advice on how to prevent patient surgical sites from becoming infected. Although such steps may not always prevent a surgical wound from becoming infected, it is always important to involve the patient in postoperative care.

WoundSource Practice Accelerator's picture
Surgical Wound Infection Assessment

By the WoundSource Editors

With an associated cost of $3.5 billion to $10 billion spent annually on surgical site infections (SSIs) and complications in the United States, it is important to know how to assess for surgical wound complications. There is a difference between the normal cascade response and a brewing infection. Symptoms of infection are often the first clue that there is more occurring in the wound than meets the eye.

WoundSource Editors's picture
Risk Assessment Standardization

By the WoundSource Editors

The prevalence of pressure injuries among certain high-risk patient populations has made pressure injury risk assessment a standard of care. When utilized on a regular basis, standardized assessment tools, along with consistent documentation, increase accuracy of pressure injury risk assessment, subsequently improving patient outcomes. Conversely, inconsistent and non-standardized assessment and poor documentation can contribute to negative patient outcomes, denial of reimbursement, and possibly wound-related litigation.

Susan Cleveland's picture
Skin Assessment Interview

By Susan M. Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

As a Director of Nursing, your assessment skills must be tiptop. How are the skills of the staff you are entrusting with the care of our older residents in long-term care? Have you given the staff the tools and time required to accomplish comprehensive and compassionate assessments?

Heidi Cross's picture
Risk Factors for Unavoidable Ulcers

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

According to the Agency for Healthcare Research and Quality, more than 17,000 lawsuits related to pressure ulcers (PUs) are filed annually in the United States, second only to wrongful death lawsuits. One of the greatest gifts to defense attorneys was when the Centers for Medicare & Medicaid Services (CMS) published F-Tag 314, finally acknowledging that some ulcers can occur despite best care. The facility essentially can maintain, “Hey, we did everything we were supposed to, and despite that, the patient developed that pressure ulcer”—that is, the ulcer was unavoidable. To prove unavoidability, proper documentation (proof) of best care needs to be in place, as well as documentation that all proper prevention and treatment measures were implemented.

Heidi Cross's picture
Risk Assessment

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

When looking at medical charts from a legal perspective, one of the areas closely scrutinized is the risk assessment for skin breakdown and pressure ulcer development. Completing a risk assessment is considered a standard of care. Was the patient adequately assessed, and was this done in a timely fashion? Was it repeated at regular intervals, with a change in condition, or on readmission? Do scores seem appropriate for the patient's condition? Is there consistency among health practitioners? Were the results used to institute evidence-based and appropriate prevention and treatment measures and care plans? Or do the results seem to simply languish in the chart? What are the standards of care related to this?