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Preventing Pressure Sores Cheat Sheet by

pressure     prevention     sores

Introd­uction

The goal is to eliminate or avoid pressure ulcers. By incorp­orating a few simple steps, as part of a continual plan, the risk of developing new pressure ulcers or aggrev­iating existing pressure sores can be minimized.

Pressure Sore Risk Factors

Tasks

• Reposition based on indivi­dua­lized needs, but at the very least every 2 hours.
• Encourage residents to shift position every 15 minutes in their chair.
• Make sure that walking and range of motion gets done daily.
• Use moisture barriers.
• Assist residents to bathroom often.
• Offer the residents fluids frequently and make the dining experience enjoyable. Report any changes you observe.
• Lift residents rather than dragging across sheets.
• Maintain head of bed at lowest position that is comfor­table for resident.
• Float residents heels off the sheets.
• Look at resident’s skin closely each time you make contact, report skin that stays red longer than 30 minutes, feels warm or is blistered.
 

Decubitus Stages

Credit­:ht­tp:­//w­ww.l­og­ica­lim­age­s.com/

Weekly Skin Assessment

This checklist should be completed weekly as per facility policy. All areas of skin requiring treatment should have a thorough record of docume­ntation in the chart per facility protocol. Check box if the item reflects the resident’s assess­ment. If the answer is “yes” to 3 or more of the questions, the facility should be implem­enting a “Skin Tear Prevention Protocol.” Review and revise the care plan to ensure skin care as needed.

Weekly Skin Assessment Observ­ations

chec­koff
Obse­rva­tions
Comm­ents
Any reddened areas that remain after 30 minutes of pressure reduction?
______­___­___­___­___­___­___­___­___­______
Any rashes?
______­___­___­___­___­___­___­___­___­______
Any bruises?
______­___­___­___­___­___­___­___­___­______
Any open lesions, cuts, lacera­tions, or skin tears? (Indicate even if being treated.)
______­___­___­___­___­___­___­___­___­______
Any blisters?
______­___­___­___­___­___­___­___­___­______
Any open ulcers (indicate even if being treated.)
______­___­___­___­___­___­___­___­___­______
Excess­ively dry or flaky skin?
______­___­___­___­___­___­___­___­___­______
Any edema?
Location: __________

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Comments

Carlascheats Carlascheats, 12:03 13 Nov 18

Great info-reference cheat for both licensed and unlicensed staff

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