While there have been significant improvements in technology and treatments, pressure ulcers and other wounds are still some of the most common problems in skilled nursing facilities today.
Pressure ulcers come at a high price. This not only includes the direct economic expenses of treatment, but the personal cost of pain, in addition to the liability risks to healthcare providers.
According to Karl Steinberg, MD, CMD, the following strategies can help skilled nursing facilities overcome clinical and legal problems associated with pressure ulcers. [1]
Consistently Document
There is no argument that there are cases where poor care can cause or contribute to the development of pressure ulcers. However, more than not skilled nursing facilities provide good care but find difficulty in demonstrating that all appropriate measure for pressure ulcers risk assessment and prevention have been put into place. This is where the crucial importance of documentation comes into play.
For example, it is not required to document each time a resident is turned and repositioned. Some caregivers may notate it and some may not. This inconsistency looks bad in a skilled nursing facility, as there is no way to prove what actually happened. Always document and always be consistent.
Reduce Liability
According to Dr. Steinberg, one of the most important measures a skilled nursing facility can take to reduce liability is to have “an active, knowledgeable, and engaged medical director.”
He says it is important for facilities to have internal guidelines for risk assessment and treatment for pressure ulcers. These should reflect the accepted guidelines from organizations such as the National Pressure Ulcer Advisory Panel (NPUAP).
Practice Prevention
Practicing prevention is key in skilled nursing facilities, as the majority of patients are at risk for developing pressure ulcers at some point.
Using pressure-reducing surfaces can aid in this prevention. Foam or air mattresses are most commonly used. Turning and repositioning the patient if they are not able to move themselves is crucial. It makes sense to offload the pressure areas, as this makes it less likely for the skin to break down.
In addition to the above, don’t let residents sit for long periods of time. It is also helpful to float heels and use heel protection devices when appropriate. While these are simple prevention methods, they can go a long way.
Educate Residents and Families
Educating the residents and families of skilled nursing facilities is one of the easiest ways to help them navigate through difficult times, and prepare them for the inevitable. If families and residents understand that skin breakdown is part of the dying process and not a cause of it, this may aid in the preparation. This education will also make them less likely to be upset down the road should skin condition develop, therefore reducing the chance of a lawsuit. These conversations are never easy, but the education and care will benefit everyone involved.
[1] Steinberg, Karl. “Pressure Ulcers: Changing habits can combat clinical and legal problems.” Long-Term Living. Web. 3 August 2012.
