Pressure Ulcer Prevention
::
::
::
::
::
::
::
::
::
::
::
::
|
|
TARGET REASSESSMENTS ACCORDING TO RISK LEVEL
Nursing home residents with a Braden Scale score of 18 or less on admission are considered to be “at risk” for PU (5). Ideally, all these at-risk residents should be reassessed weekly for four weeks following admission. If the numbers render this task impractical, then target first those residents at highest risk.
- Tier 1: Residents with Braden scores below 11
New nursing home residents with Braden Scale scores below 11 are considered to be at very high risk for PU. At the very least then, these new residents should be the first to receive the four weekly reassessments, again using the Braden scale. Results of the reassessments should guide the residents’ care plans.
- Tier 2: Residents with at-risk scores and limited mobility
Primary risk factors for pressure ulcers are immobility and limited activity levels (6). Given this, the second-tier target group should be new residents with Braden Scale scores between 18 and 11 who are chair-fast, bedbound, or unable to reposition themselves. This second-tier group is likely to include the most residents—and may include more residents than necessary because of a tendency among nursing home staff to underestimate the number of residents capable of independently repositioning themselves. Use our performance assessment to accurately identify those who are unable to reposition themselves and thus at greater risk for PU. This assessment is also discussed in Step 3.
- Tier 3: All other residents with at-risk Braden scores
All other new residents with Braden Scale scores of 18 or less ideally should be reassessed weekly for four weeks. Those with greater mobility are less at risk, but if their Braden scores signifies risk and staff can manage it, then yes, these residents should be routinely reassessed.
- If necessary, reduce the number of weekly reassessments
If after targeting residents as noted above, the nursing staff still cannot complete all reassessments, then reduce the number of weekly reassessments to two or three within a four week period. Use residents’ Braden scores to guide the cutbacks, reducing first the number of reassessments for those with higher Braden scores—or less risk. Thus, you should cut back first for tier 3 residents, then for tier 2 residents, and only as a last resort for tier 1 residents, those at greatest risk.
We recognize that use of this “triage system” may result in substandard care for some at-risk residents. This is truly regrettable but possibly unavoidable. If a facility is seriously short-staffed, as many are, then it is naïve to think that the services provided won’t suffer. In such a case, we believe it is ethically and clinically justifiable to concentrate first on providing proper care to those most in need, as determined by objective, valid assessments. This triage plan seems preferable to the usual practice in many nursing homes of providing substandard care to all at-risk residents, a system that ensures that none get what they really need.
(prev | next)
|
|
|
