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Some residents have many risk factors for developing pressure ulcers. The nursing home has the responsibility to identify and evaluate these risk factors. They must then develop interventions to address the risk factors so a pressure ulcer does not develop. When you become involved with your loved ones care in a nursing home, you too should be aware of these risk factors, and ensure the staff are aware of any that your loved one has. Some of the risk factors include:

  • Impaired/decreased mobility and decreased functional ability;
  • Medical conditions, such as end stage renal disease, thyroid disease or diabetes mellitus;
  • Drugs such as steroids that may affect wound healing;
  • Impaired blood flow
  • Resident refusal of some aspects of care and treatment;
  • Cognitive impairment;
  • Exposure of skin to urinary and fecal incontinence;
  • Poor nutrition, malnutrition, and hydration deficits; and
  • A history of a healed pressure ulcer and its stage [if known] is important, since areas of healed Stage III or IV pressure ulcers are more likely to have recurrent breakdown.
  • Diabetic Neuropathy
  • An acute illness such as an upper respiratory infection, pneumonia, or congestive heart failure

Not all the risk factors can be modified or changed and some of those that can be changed, such as poor-nutrition, take time to be corrected even when there is immediate identification of the risk and appropriate interventions established. On the other hand, some risk factors can be removed promptly, such as pressure on a site.

A Nursing Home Surveyor will look to see if the nursing home staffs who are responsible for the resident’s care review each risk factor and its potential cause(s). They should identify those risk factors that increase the potential for pressure ulcers. The nursing home staff needs to decide what factor(s) can be modified, stabilized, or removed. Then the staff should determine what protocols need to be implemented for each individual resident.

Be safe and be informed!

JL

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A pressure ulcer can occur wherever circulation to the tissues of the body has been compromised by pressure. The staff in a nursing home must identify the individual resident at risk for developing pressure ulcers. The staff must also identify and evaluate each resident’s risk factors and changes in the resident’s condition. They must identify and evaluate factors that can be removed or modified and they must implement interventions to attempt to stabilize, reduce, or remove underlying risk factors. These interventions are to be individualized to each resident’s needs. The staff must monitor the impact of the interventions that were developed and then change or adjust the interventions if they don’t work and when they need to be modified. The nursing home staff must recognize and evaluate each resident’s risk factors and identify and evaluate all areas at risk of constant pressure.

In order to do this the nursing home should have a complete assessment program for an effective pressure ulcer prevention and treatment program. A comprehensive individual evaluation helps the facility to identify residents at risk of developing pressure ulcers, identify the level and nature of risk(s), and identify the presence of pressure ulcers. The nursing home can then use the information to develop and implement a comprehensive care plan that reflects each resident’s identified needs.

A Nursing Home Surveyor will look for a system or process to assure: assessments and interventions are appropriate, timely, implemented, monitored, and changed as needed. They will look for a process that ensures any change in condition is recognized, evaluated, reported to the doctor or Nurse Practitioner, and that the change is addressed. In addition, the Nursing Home Surveyor will look to see if the quality assessment and assurance committee helps the nursing home in the development and monitoring of processes and ensuring they follow accepted standards of practice.

Be safe and be informed!

JL

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