Q: Why is it so important to assess the skin at admission?
As a leader, you are in charge of financial stability, quality standards and patient care. After 11 months of hard work, you take vacation for 10 days. Upon return, you find out there was survey with an F-Tag 314 for an in-house Stage IV pressure ulcer.
The surveyor interviewed then observed the nurse performing the wound dressing and reviewed the wound documentation. The wound nurse in your facility comes every Tuesday, and the surveyors came on Wednesday. The regular nurse got anxious and was not able to answer questions and missed the Braden Scale assessment.
Documentation showed skin assessment was missed at the time of admission, and the wound was discovered when it was stage II. Secondary to the patient’s immobility and recent back surgery, the wound progressed to stage IV quickly. No one documented a wound description, risk factors or the unavoidable status of the skin injury. Late detection, inadequate risk assessment and poor documentation lead to this citation.
Long-term care can be a punitive environment. No matter how many boxes you check, something may be missed. But this may not be the case if we develop a system of accountability. For example, in the above case, simple steps like conducting a Braden assessment at admission, performing a weekly skin assessment, providing nurse education, ensuring diligence to accurate risk assessment and better documentation could have prevented the F-Tag.
The F-Tag was given to the facility secondary to the lack of assessment and documentations at the time of admission. For providers to have knowledge regarding skin injury, risk factor and the possibility of healing or non-healing are empowering for the patient and the staff. Every patient deserves respect with empathy and should not be treated as “just a number.”
From the November 2023 Issue of McKnight's Long-Term Care News
