New England Sinai Hospital is a Long Term Acute Care facility that serves a unique population of chronically critically ill patients. Patients are admitted from acute care hospitals for continued medical management of multiple illnesses. Patients have often had an extended and complicated stay in the acute care hospital. A large number of our patients are admitted directly from the ICU and require ventilators to assist them to breath. Due to the nature and length of their illness, they are in a severely deconditioned state with depleted protein stores (necessary for wound prevention and healing) and in most instances are at very high risk for pressure ulcer development. Sinai employs 3 full time wound care certified nurses to provide expert assessment, consultation and care for this fragile population.
Upon admission each patient is assessed by a Registered Nurse using an evidenced based tool called the Braden Pressure Ulcer Risk Assessment Scale to determine their risk of developing a pressure ulcer. Based on the assessment score, various preventative strategies are implemented:
Pressure reducing surfaces for bed and chair
Positioning wedges
Heel protectors
Frequent turning schedules
Nutrition consult
Protein supplementation for improved wound healing
Wound consult with certified wound care nurse if indicated
The certified wound care nurse examines each new admission within 48 hours to ensure that appropriate assessment and pressure ulcer prevention is implemented. Nursing staff visually assesses the patient’s skin each shift as they provide care and the Braden scale is repeated on a weekly basis.
This year we implemented two strategies to continuously improve pressure ulcer prevention for our patients. We identified that our current mattresses were not providing effective pressure reduction for our high-risk population. We purchased AtmosAire 4000 Self-Adjusting Mattresses (by Kinetic Concepts, In.) for every inpatient bed to provide state-of-the-art pressure redistribution. We also standardized our approach to skin care by implementing the Coloplast skin care line. Products include a body wash/shampoo, moisturizing ointment, perineal cleanser and protectant, moisture barrier and an anti-fungal moisture barrier.
Our expert team of wound care specialists provides regular educational programs regarding pressure ulcer prevention. They conduct “Pressure Ulcer Prevention Rounds” on individual units to provide staff with specific pressure ulcer prevention strategies for some of the more challenging high-risk patients.
We continue to review best practices/new research on an ongoing basis to drive further improvements in our care.
|
|
|
