Long-Term Care Survey Alert

Don't let the road to good intentions end up paved with F314 tags.

A toileting and hygiene program can help stop pressure ulcers in their tracks - or put them on the fast track for happening.

Example: Toileting residents or giving them a bedpan based on their own elimination schedule helps promote continence. But residents at very high risk for skin breakdown who sit on the toilet or bedpan for even short intervals can develop a pressure ulcer.

"For example, people who are receiving chemotherapy and have reduced platelets can get large bruises and skin breakdown after being on a bedpan for only 10 to 15 minutes," cautions Kathleen Thimsen, MSN, RN, ET, APN, principal of RARE Consulting Group in Bella Vista, AR. "That's why individualized care planning even for placing a person on the bedpan is very important."

Another example: People with multiple sclerosis who have decreased sensation can sit on a bedpan or commode for long periods without experiencing discomfort, warn the Multiple Sclerosis Society's nursing home guidelines for care of people with MS. Thus, the person may forget she is sitting on a bedpan.

Solutions: Don't rely on patients with decreased sensation below the waist to turn on the call light to ask nursing staff to help them get off the commode or bedpan. Note the time when they get on the bedpan or commode and check on them frequently, the guidelines advise. "The nursing assistants can  use pocket timers set to go off in five or 10 minutes to make sure they remember to  get the resident off the bedpan or remind her to do so," suggests Paula Schaadt, LPN, at Laurels of Shane Hill in Rockford, OH.

CNAs can also use a buddy system where they remind each other to get a resident off the pot in time to prevent tissue ischemia.

Standardize Pericare

Staff who become overzealous with their cleaning protocol and scrub the resident's skin to remove feces can actually cause skin breakdown, cautions Thimsen. That's where the right perineal cleaners come into the skin care picture. These cleaners are made with a surfactant ingredient that allows the staff to remove feces more easily. 

Practice tips: Nursing staff at Minnewaska Lutheran Home use the entire system of incontinence products offered by its vendor, which includes skin wipes that contain a substance that protects the skin, says DON Karen Johnson. RN.. DON at the Starbuck, MN  "Before that, we were constantly using peri-sprays and zinc oxide and aloe vera, which was nonstandardized, confusing - and more expensive," she says.

Editor's Note: Find out how one Find out how one facility standardized its pericare procedure to improve skin care (see the January 2005 issue of Eli's Long-Term Care Survey Alert).