Pressure Ulcers: Facility Assessment Checklists

Transcription

1 Pressure Ulcers: Facility Assessment Checklists A facility system assessment is a starting point for a quality improvement project. The checklists included in this booklet will be most useful if you take a critical look at your current practices. Directions for Pressure Ulcers: Facility Assessment Overview Questionnaire To be completed by a direct care or interdisciplinary team. Consult with appropriate staff in answering certain questions and completing checklists. If you answer No to any of the questions below, please proceed immediately to the checklist referenced by the page after the question. If you answer Yes to a question, the process is always complete and done so consistently. Please continue to the next question. If you answer In Progress to any of the below questions, the need is being addressed but needs improvement. Pressure Ulcers: Facility Assessment In Progress Does your facility have a process to screen residents for pressure ulcer risk? (page 2) Does your facility have a process to develop and implement care plans for residents who have been found to be at risk or have a pressure ulcer? (pages 3-4) Does your facility complete a comprehensive assessment for residents who are found to have pressure ulcers upon screening or, if there is no screening process in place, another time? (page 5) For residents who have pressure ulcers, does your facility have a process for monitoring treatment and prevention? (page 6) Does your facility have a policy for pressure ulcer prevention and management? (page 7) Does your facility have initial and ongoing education on pressure ulcer prevention and management for all relevant staff? (page 8) When completing each checklist on the following pages: If you answer Yes to all of the questions, the process is always complete and done so consistently. Continue to the next checklist. If you are not sure, or answer No to one of the questions, choose one or more elements on which to focus your quality improvement. If you answer to one or more of the questions, the process is not always complete and/or not always done consistently.

2 Pressure Ulcers: Facility Assessment Checklists: page 2 Pressure Ulcers: Screening for Pressure Ulcer Risk A screening assessment is a brief assessment or question that determines if the resident is at risk for pressure ulcers. It does not include a thorough assessment of the pressure ulcer or what needs to be done if the resident is found to have a pressure ulcer upon screening. Does your facility s screening process include the following components? Do you screen all residents for pressure ulcer risk at the following times? Upon admission Upon readmission When change in condition With each MDS assessment If resident is not currently deemed at risk, is there a plan to rescreen at regular intervals? Do you use either the Norton or Braden pressure ulcer risk assessment tool? (If yes, STOP. If No, please continue to next question.) Note: Federal regulations (F-314) recommend the use of standardized risk assessment tools. If you are not using the Norton or Braden risk assessment, does your screening address the following areas? Impaired mobility: Bed Chair Incontinence: Urine Stool Nutritional deficits: Malnutrition Feeding difficulties Diagnosis of: Diabetes mellitus Peripheral vascular disease Contractures Hx of pressure ulcers

3 Pressure Ulcers: Facility Assessment Checklists: page 3 Pressure Ulcers: Developing Care Plans Does the resident care plan address the following interventions and risk factors (as they apply)? Impaired mobility Assist with turning, rising, position Encourage ambulation Limit static sitting to 1 hour at any one time Pressure relief Support surfaces bed Support surfaces chair Pressure relieving devices Repositioning Check for bottoming out in bed and chair (To determine if a patient has bottomed out, the caregiver should place his or her outstretched hand, palm-up, under the mattress overlay below the existing pressure ulcer or that part of the body at risk for pressure formation. If the caregiver can feel that the support material is less than an inch thick at this site, the patient has bottomed out.) Nutritional improvement Supplements Feeding assistance Adequate fluid intake Dietician consult as needed Urinary incontinence Cause identified and treated as appropriate Toileting plan Wet checks Treat causes Assist with hygiene Fecal incontinence Cause identified and treated as appropriate Toileting plan Soiled checks Skin condition check Check intactness Color Sensation Temperature continued on next page >

4 Pressure Ulcers: Facility Assessment Checklists: page 4 Pressure Ulcers: Developing Care Plans Treatment Physician prescribed regimen Appropriateness to wound staging Treatment reassessment time frame Pain Screen for pain related to ulcer Choose appropriate pain med Provide regular pain med administration Reassess effectiveness of med Assess/treat side effects Change, increase or decease pain med as needed Infection Dressing containment Keep dressing dry/intact Assess for s/sx infection

5 Pressure Ulcers: Facility Assessment Checklists: page 5 Pressure Ulcers: Assessment and Reassessment Does your comprehensive pressure ulcer assessment include the following components? Do you have a tool available to document pressure ulcer assessment? Does your current assessment of pressure ulcers include: Location Stage Size Undermining/tunneling Wound bed (tissue) Drainage/exudate Peri wound tissue (color, temp, bogginess, and fluctuation) Need for debridement Is the resident s pressure ulcer reassessed: Weekly Daily if worsening or high risk Does reassessment include: Size Tunneling Sinus tracts Presence of necrotic tissue Exudate Granulation Epithelialization Color photos, diagram, or drawing Are the following related factors considered in your assessment/reassessment: Mechanical forces (shearing, friction, pressure) Pronounced bony prominences Poor nutrition Altered cutaneous sensation

6 Pressure Ulcers: Facility Assessment Checklists: page 6 Pressure Ulcers: Monitoring Treatment and Prevention Does your facility s process for monitoring treatment and prevention include the following? Does your facility use a pressure ulcer tracking tool to document treatment and healing? (If No, skip to question 3.) Does the tracking form include the following: Date Stage Current treatment Color photo, diagram, or drawing Size Depth Appearance (e.g., redness, presence of discharge, eschar formation) Does your facility have protocols to follow if current pressure ulcer treatment is ineffective? Does your facility have protocols to follow if ulcers are found to be non-healing? Does your facility monitor pressure ulcers for the presence of infection (e.g., foul smell, greenish drainage, cellulitis, osteomyelitis)? Is there a list of possible interventions for the resident at each level of risk (low, moderate, or high), that nursing staff may implement to prevent pressure ulcer development? Does your facility have a protocol for management of tissue loads (e.g., positioning, pressure relieving mattresses, dynamic mattress overlay)? Are there adequate supplies to provide preventive interventions to all residents who require them (e.g., adequate pressure reducing or relieving mattresses/chair cushions)? Are pressure reducing or pressure relieving mattresses/chair cushions in good repair? Are pressure reducing/relieving supplies available to staff on all shifts and whenever needed? Does your facility have protocols regarding pressure ulcer prevention that includes the following: Monitoring residents for incontinence Need for assistance with mobility and bed mobility Weight loss Nutritional deficiency Dehydration

7 Pressure Ulcers: Facility Assessment Checklists: page 7 Pressure Ulcers: Elimination Does the pressure ulcer elimination process include the following components? Does your facility s policy include a statement regarding your facility s commitment to pressure ulcer prevention and management? Does your facility s policy include screening, assessment, and monitoring of residents for pressure ulcers? Does your facility s policy address measures that should be taken to prevent pressure ulcers in residents? If the resident is not currently deemed at risk, does your facility s policy state that residents should be screened for pressure ulcer risk at regular intervals? Does your facility s policy state that residents who are at risk for pressure ulcers be screened at the following times: Upon admission Upon readmission When a change in condition occurs With each MDS assessment Does your facility s policy state that residents at high risk for pressure ulcers should be screened daily? Does your facility s policy include who, how, and when pressure ulcer program effectiveness should be monitored and evaluated? Prompt assessment and treatment Specification of appropriate pressure ulcer risk and monitoring tools Steps to be taken to monitor treatment effectiveness Pressure ulcer treatment techniques that are consistent with clinically-based guidelines Optimize the resident s ability to perform ADLs and participate in activities Does your facility s policy address steps to be taken if pressure ulcer is not healing? Does your facility s policy address a protocol for communication of reporting pressure ulcer staging/healing to the designated MDS personnel to ensure correct coding?

8 Pressure Ulcers: Facility Assessment Checklists: page 8 Pressure Ulcers: Staff Training and Education Does your facility s training and education program include the following components? Yes No Are new staff assessed for their need for education on pressure ulcer prevention and management? Are current staff provided with ongoing education on the principles of pressure ulcer prevention and management? Does education staff provide discipline-specific education for pressure ulcer prevention and management? Is there a designated clinical expert available at the facility to answer questions from all staff about pressure ulcer prevention and management? Is the education provided at the appropriate level for the learner (e.g., CNA vs. RN)? Does the education include staff training on documentation methods related to pressure ulcers (e.g., location, stage, size, depth, appearance, exudate, current treatment, effect on ADL s, pressure relieving devices used, nutritional support)? Document available at MO PU May 2008 This material was prepared by Primaris, the Medicare Quality Organization for Missouri, 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 policy.