Long-Term Care Survey Alert

Care planning stops a pressure ulcer in its tracks.

Who would have known an ambulatory resident with privileges to walk to the local market was at high risk for a pressure ulcer? Nurses at one Florida facility did.

The facility uses high-frequency ultrasound scans to screen all residents at admission for pre-ulcer patterns of edema invisible to the naked eye.

So even though the resident in question scored as low risk on the Braden, had good nutrition and was completely cognitively intact, his scan revealed a potential heel pressure ulcer - and F tag - waiting to happen.

The scan showed a phase 3 or the worst pre-ulcer condition, says Twalla Wahl, RN, BSN, who scans residents in Florida nursing facilities for Advanced Clinical Services. "Upon investigating the situation, the nurses found the resident had a habit of pushing down the back of his sneaker and putting his foot in over it, which caused pressure on his heel."

To turn the situation around, the nursing staff put a heel support in the resident's shoe to remind him not to push down on the back of it. "Within a few days, the edema began to decrease, and within two weeks, it was completely resolved," says Wahl. If the facility hadn't intervened, the resident could have developed a pressure ulcer on his heel very quickly had he become bedbound due to an acute illness, Wahl notes.

"And that pressure ulcer could have started him on a path of losing his ambulatory status, which leads to quality of life and clinical problems."