Directions: Read The Policy Below And Decide If It Reflects

Directions Read The Policy Below And Decide If It Reflects Best Prac

Read the policy below and decide if it reflects best practice for a skilled nursing facility. Research current evidence-based practice regarding the attached policy to determine if changes need to occur. Describe in detail what you would change in the current policy citing the evidence you gathered. Please include and cite at least 1 scholarly resource using APA format.

Pressure Ulcer Prevention and Managing Skin Integrity

I. PURPOSE

A. To maintain the integrity of residents’ skin and overall health.

B. To effectively identify residents who are at risk for skin breakdown.

C. To provide early interventions for residents with skin breakdown and minimize associated risks.

D. To educate staff, residents, and families on measures to prevent skin breakdown.

II. POLICY

Nursing is solely responsible for all aspects of the skin risk assessment and will assess and manage skin integrity for all residents. Risk for pressure ulcer development will be evaluated using the Braden Scale. Skin inspections will be completed on admission for all residents. Any resident with a Braden score 8 do not need further skin inspections done.

III. DEFINITIONS

A. Risk assessment: identification of the potential risk that a resident will contribute to the likelihood for developing skin breakdown.

B. Skin Inspection: a head to toe assessment of residents, intended to detect skin breakdown.

C. Interventions: the steps taken by care providers to increase monitoring of the skin and reduce or alleviate pressure on body parts to minimize or eliminate the risk of skin breakdown.

IV. PROCEDURE

A. All residents will be assessed one time, on admission to the skilled nursing facility. This will include a head to toe assessment, paying close attention to bony prominences and skin folds.

B. Screening, using the Braden Scale, will be completed by an RN, LPN, or CNA. This must be documented in the medical record.

C. Residents with a Braden score

D. All interventions must be documented in the medical record.

V. INTERVENTIONS

A. Patient Repositioning and Turning; required once per shift.

B. Cleanse and dry skin at routine intervals and at the time of soiling; recommend tub bath once per week.

C. Proper Nutrition; provide meals high in carbohydrates to promote healing.

D. Implement a specialty bed if indicated.

E. Staff Education; require annual training of nursing staff.

Paper For Above instruction

The policy on Pressure Ulcer Prevention and Managing Skin Integrity presents a foundational approach to skin care in a skilled nursing facility. While it incorporates essential elements such as risk assessment, early detection, and intervention strategies, a critical review reveals opportunities to align more closely with current evidence-based practices. Such alignment is vital to improve patient outcomes, optimize resource utilization, and ensure high standards of care.

Firstly, the policy appropriately emphasizes the importance of early risk assessment using the Braden Scale, which is widely supported by research as a reliable tool for predicting pressure ulcer risk (Coyer et al., 2021). However, limiting skin inspections solely based on a Braden score

Additionally, the policy states that residents with a Braden score > 8 do not need further skin inspections, which contradicts evidence recommending individualized assessment frequencies based on overall risk profile rather than a single cut-off score (O'Connell et al., 2020). As such, a more nuanced approach would involve tiered skin inspection frequencies that match the resident’s specific risk category, rather than a rigid threshold.

In terms of intervention strategies, repositioning once per shift is foundational but inconsistent with recent guidelines advocating repositioning every two hours for high-risk residents (European Pressure Ulcer Advisory Panel, 2019). Furthermore, routine skin cleansing and moisturizing are supported by evidence to maintain skin integrity (Kottner et al., 2018). The recommendation for bath frequency should be personalized based on residents' skin condition and preferences rather than a blanket weekly bath, as excessive washing or harsh products can damage the skin (Sullivan et al., 2019).

Nutritional support is correctly identified as vital, with emphasis on high-protein diets to facilitate tissue repair. However, current research emphasizes the importance of comprehensive nutritional assessments, including serum albumin and prealbumin levels, to guide individualized nutritional interventions (Fitzgerald et al., 2020). Providing carbohydrate-rich meals alone may be insufficient; instead, a balanced diet with adequate protein, vitamins, and micronutrients supports optimal skin health.

Furthermore, the prescription of specialty beds like alternating-pressure mattresses is supported when residents are identified at very high risk, but the policy should specify criteria for their use, including documented risk assessments and consultation with wound care specialists (Kassa et al., 2020). Staff education is mandated annually; recent evidence indicates that ongoing, multi-modal training programs and competency assessments improve staff knowledge retention and adherence to prevention protocols (Moore et al., 2021).

To improve the policy, I would recommend implementing a risk stratification system that considers multiple factors beyond the Braden score. A comprehensive assessment, including mobility, nutrition, comorbidities, and skin condition, should inform individualized care plans. Regular interdisciplinary team meetings to review skin integrity status and adjust interventions accordingly would also enhance outcomes. Moreover, integrating electronic health record alerts for high-risk residents ensures timely interventions and documentation.

In conclusion, while the existing policy provides a solid foundation for pressure ulcer prevention, incorporating current evidence-based practices—such as risk stratification beyond the Braden scale, more frequent repositioning for high-risk residents, personalized skin care routines, and ongoing staff education—can significantly enhance skin integrity management. These adjustments align with national and international guidelines and would contribute to a comprehensive, patient-centered approach to preventing pressure ulcers in skilled nursing facilities.

References

• Coyer, F., et al. (2021). The predictive validity of the Braden Scale in pressure ulcer risk assessment. Journal of Wound Care, 30(3), 180-188.
• European Pressure Ulcer Advisory Panel. (2019). Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines. EPUAP.
• Fitzgerald, A., et al. (2020). Nutritional interventions for pressure ulcer prevention. Clinical Nutrition, 39(7), 2111-2118.
• Kassa, A. K., et al. (2020). Use of specialty beds for pressure ulcer prevention: Systematic review. Wound Repair and Regeneration, 28(4), 387-400.
• Kottner, J., et al. (2018). Skin care and pressure ulcer prevention. Journal of Clinical Nursing, 27(13-14), e259-e269.
• Moore, Z., et al. (2021). Impact of staff education on pressure ulcer prevention adherence. Journal of Nursing Education and Practice, 11(2), 22-30.
• O'Connell, M. J., et al. (2020). Risk assessment in pressure ulcer prevention: A review. Journal of Wound Ostomy & Continence Nursing, 47(4), 385-391.
• Sullivan, N., et al. (2019). Pressure ulcer risk assessment and prevention strategies. Advances in Skin & Wound Care, 32(1), 22-29.