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PRESSURE INJURY SURVEY GUIDE
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The vProblem vof vPressure vInjuries v- vcorrect vanswers v-Pressure vinjury vdevelopment vplaces vhospitalized vpatients vat vrisk vfor vother vadverse vevents vand vincreases vresource vconsumption vand vhealthcare vcosts. vPreventing vpressure vinjuries vrequires vearly videntification vof vpersons vat vrisk vand vrapid vimplementation vof vprevention vinterventions. Pressure vinjury vprevention valso vrequires vmultidisciplinary veffort vand vadministrative vsupport. vPressure vinjury vquality vimprovement vteams vthat vare vfully vempowered vappear vto vhave vmore vsuccess vin vreducing vpressure vinjury voccurrence.1, v2, v 3 vNurses vand vnursing vcare vinterventions vplay van vimportant vrole vin vpressure vinjury vprevention vacross vhealthcare vsettings.
The vmeasurement vof vhospital-acquired vpressure vinjuries v(HAPI) vallows vorganizations vto vassess vthe vquality vof vtheir vprevention vcare, vevaluate vquality vimprovement vinitiatives, vand vexamine vinstitutional vstructures vand vprocesses vthat vmay vinfluence vtheir voccurrence. vThe vmeasurement vcan vbe vaccomplished vduring va vsurvey vto videntify vpressure vinjury vpresence vand vorigin. The vPressure vInjury vSurvey v- vcorrect vanswers v-Purpose To vdetermine vthe vrate vof vpressure vinjury voccurrence vand vstage vof vexisting vinjuries To vdetermine vthe vproportion vof vpatients vwho vreceived vskin vand vpressure vinjury vrisk vassessments To vdetermine vthe vproportion vof vat vrisk vpatients vwho vreceived vpressure vinjury vprevention To vdetermine vthe vtype vof vprevention vinterventions vimplemented vfor vat vrisk vpatients Goal Accurate vand vreliable vdata vcollection The vPressure vInjury vSurvey vTeam v- vcorrect vanswers v-Each vfacility vmust videntify va vteam vof vpersons vto vcollect vdata vfor va vpressure vinjury vsurvey. vLarge vhospitals vwill vneed vmultiple vteams. Mouse-over vto vview vexample vfor vlarger vhospitals Larger vHospital vTeam vComposition Head vTeam vLeader Individual vTeam vLeaders Team vMembers Support vStaff Mouse-over vto vview vexample vfor vsmaller vhospitals Smaller vHospital vTeam vComposition Head vTeam vLeader Team vMembers
For vchart vreview, vteam vmembers vcan vbe: Individuals vwith vskill vin vreading vpatient vrecord vdocumentation Individuals vwho vhave vreceived vpressure vinjury vteam vtraining Support vStaff v- vcorrect vanswers v-For vturning vassistance: Unlicensed vassistive vpersonnel vwill vbe vhelpful vfor vturning vpatients Pressure vInjury vSurvey vTeam vTraining v- vcorrect vanswers v-The vHEAD vTEAM vLEADER vis vresponsible vfor vtraining vIndividual vTeam vLeaders vand vPressure vInjury vTeam vMembers. Training Initial vTraining Review vTraining Inter-rater vReliability vStudies Confirm vthe vinter-rater vreliability vof vpressure vinjury videntification vand vstaging vamong vthe vpressure vinjury vsurvey vteam Should vbe vrepeated vat vleast vannually Initial vTraining v- vcorrect vanswers v-New vteam vleaders vand vmembers vshould vreceive vtraining von: Guidelines vand vprocedures vrequired vby vthe vorganization vfor vwhich vthe vdata vare vbeing vcollected For vNDNQI, vnew vteam vleaders vand vmembers vmust vbe vfamiliar vwith vNDNQI® vGuidelines vfor vData vCollection vand vSubmission von v Pressure vInjuries These vguidelines vprovide vspecific vdirections vfor vdata vcollection von vpressure vinjuries vand vpressure vinjury vprevention vthat vwill vbe vsubmitted vto vNDNQI Skin vassessment vfor vpressure vinjuries Pressure vinjury vrisk vassessment NPUAP vpressure vinjury vstaging vsystem Definition vof vStage v1-4 vpressure vinjuries Definition vof: Unstageable vpressure vinjuries Deep vTissue vPressure vInjury v(DTPI)
Mucosal vMembrane vPressure vInjuries Pressure vinjury vappearance Review vschematic vdrawings vand vexample vpictures vof vpressure vinjuries vby vstage Bedside vobservation vof vpressure vinjuries vby vstage Determination vof vwhether vthe vpressure vinjury vis vrelated vto va vmedical vdevice Other vwound vtypes vand vskin vinjuries vfor vdifferentiation vfrom vpressure vinjuries Differentiation vamong vcommunity-, vhospital-, vand vunit-acquired vpressure vinjuries Data vfor vextraction vfrom vthe vpatient vrecord New vteam vleaders vand vmembers vshould vparticipate vin va vpractice vsurvey v(pilot vtest) vof vdata vcollection vprocedures. v Acceptable vinter-rater vreliability vof vpressure vinjury videntification vand vstaging vshould vbe vestablished. vNDNQI vhospitals vcan vaccess vinter-rater vreliability vforms von vthe vmember vweb vsite. Review vTraining v- vcorrect vanswers v-Prior vto veach vsurvey, vteam vleaders vand vteam vmembers vwho vhave valready vreceived vinitial vtraining vshould vreview: Guidelines vestablished vby vthe vorganization vfor vwhich vthe vdata vare vbeing vcollected For vNDNQI, vteam vleaders vand vmembers vshould vreview vNDNQI® vGuidelines vfor vData vCollection vand vSubmission von vPressure vInjuries Skin vassessment vfor vpressure vinjuries Pressure vinjury vstaging vdefinitions vand vexample vpictures Definitions vof vother vwound vtypes vand vskin vinjuries vand vdifferentiation Acceptable vinter-rater vreliability vof vpressure vinjury videntification vand vstaging vshould vbe vestablished vat vleast vannually. Scheduling vthe vSurvey v- vcorrect vanswers v-Frequent vpressure vinjury vsurveys vallow vhospitals vto: closely vmonitor vchanges vin vpressure vinjury vrates rapidly vimplement vcorrective vmeasures The vSurvey vmust vbe vconducted von vall vparticipating vunits vduring vone vcalendar vday... ...to vavoid vdouble vcounting vpatients vthat vare vtransferred vbetween vunits. Each vhospital vcan vchoose vthe vcalendar vday vduring vthe vmonth vthey vwill vcollect vthe vpressure vinjury vdata
Additional vdata vmay vinclude: pressure vinjury vlocation specific vdevices vcausing vdevice-related vpressure vinjuries a vcomprehensive vroot vcause vanalysis. Be vthorough. vRecord vresponses vto vall vpressure vinjury vitems. The vPatients v- vcorrect vanswers v-Identify vpatients vthat vwill vbe vINCLUDED vin vthe vsurvey. Generate va vlist vof vALL vpatients vassigned vto vthe vunit No vminimum vstay vrequired Patients vof vany vage Count vthe vnumber vof vpatients von vthe vlist vand vrecord vthis vnumber vas vthe v"Unit vCensus vat vStart vof vStudy" Identify vpatients vthat vwere vEXCLUDED vfrom vthe vsurvey. EXCLUDE: Patients vnot von vthe vunit vduring vthe vsurvey Patients vor vparent/guardian vof vpatients vwho vrefuse vthe vexam Patients vwhose vcondition vmake vit vunsafe vfor vthem vto vbe vturned o vPatients vwho vare vactively vdying vand vfor vwhom vpressure vinjury vprevention vis vno vlonger va vtherapeutic vgoal Count vthe vnumber vof vpatients vthat vwere vexcluded vfrom vthe vsurvey Subtract vthe vnumber vof vEXCLUDED vpatients vfrom vthe v"Unit vCensus vat vStart vof vStudy." This vis vyour v"Number vof vPatients vIncluded vin vthe vSurvey." The vPatients v- vcorrect vanswers v-The vsurvey vshould vbe vperformed vwhen vthe vmajority vof vpatients vare vpresent von vthe vunit. Plan vto vexamine vpatients vwho vwill vbe vtransferred vor vdischarged vfirst. Prioritize vpatients vbased von vinfection vcontrol vprinciples. Wash vyour vhands vbefore vand vafter veach vpatient vencounter Use vgloves Provide vexplanations. The vsurvey vprocess vshould vbe vexplained vto vpatients vas va vquality vimprovement vstudy von vskin vbreakdown vthat vcan voccur vfrom vpressure Patient vquestions vshould vbe vanswered
The vskin vinspection vshould vnot vproceed vif vthe vpatient vor vparent/guardian vrefuses vto vparticipate. Conduct vthe vStudy v- vSkin vInspection v- vcorrect vanswers v-Inspect vthe vskin vof veach vpatient vfrom vhead-to-toe vto vassess vskin vintegrity vand vdetect vexisting vpressure vinjuries. Look vclosely vat vall vbony vprominences vand vbody vsurfaces vsubject vto vpressure vor vpressure vin vcombination vwith vshear. A vhandheld vmirror vmay vbe vused vto vvisualize vthe vposterior vsurface vof veach vheel For vneonates vand vpediatric vpatients, vpay vparticular vattention vto vthe vskin vover vthe vocciput Examine vthe vskin/soft vtissue vunder vand varound vtubing vand vother vmedical vdevices. vFor vexample: Inspect vthe vskin vunder vstockings, vsequential vcompression vdevices, vsplints, vbraces, vcervical vcollars, vcasts, vand vtraction vboots Inspect vthe vskin vunder voxygen vand vurinary vcatheter vtubing Inspect vthe vskin vunder voxygen vand vurinary vcatheter vtubing Inspect vthe vskin varound vnasogastric vand vorogastic vtubing Examine vthe vbridge vof vthe vnose, vnares, vand vnasal vseptum vof vpatients vreceiving vcontinuous vpositive vairway vpressure v(BIPAP, vCPAP) Inspect vthe vskin vunder vtracheostomy vflanges, vties, vand vinflation vtubing Carefully vexamine vthe voral vcavity vof vany vpatient vwith van vendotracheal vtube vin vplace. vBe vcareful vnot vto vdisplace vthe vtube. Examine vcommon vsites vfor voximetry vprobes v(ears, vfingers, vtoes) Do vnot vremove vor vdisplace vany vdevice vthat vis vnot vordinarily vremoved vin vcourse vof vpatient vcare. Do vnot vremove vany vdressing vor vdevice vfor vwhich vthere vis va vphysician vorder vto vNOT vremove vor vreposition vsaid vdevice. Conduct vthe vStudy v- vSkin vInspection v- vcorrect vanswers v-Identify vpressure vinjuries. Do vnot vinclude varterial vulcers, vvenous vulcers, vdiabetic vfoot vulcers, vskin vtears, vmoisture vassociated vskin vdamage v(including vincontinence vassociated vdermatitis vand vintertriginous vdermatitis), vmedical vadhesive vrelated vskin vinjury v(MARSI), vepidermal vstripping vor vtrauma v(including vburns, vabrasions vand vbruises).
vassessment vshould vinclude va vskin vassessment vand va vpressure vinjury vrisk vassessment. The vNDNQI vstandard vfor vdocumentation vof vadmission vskin vassessment vand vpressure vinjury vrisk vassessment vis vwithin v 24 vhours vof vadmission The vIHI vand vHRET vrecommend vthat vthese vassessments vbe vcompleted vwithin v 4 vhours vof vadmission vand vthe v 2014 vInternational vPressure vUlcer v Guideline vrecommends vwithin v 8 vhours. Regardless vof vthe vtime vof vdocumentation, vpressure vinjury vrisk vfactors vshould vbe vaddressed vas vsoon vas vthey vare videntified. Skin vand vpressure vinjury vrisk vassessments vare vnow vroutinely vperformed vin vthe vEmergency v Department v(ED) vas va vstarting vpoint vfor vpressure vinjury vprevention vprotocols. In vthe vUnited vStates, varrival vto van vinpatient vacute vrehabilitation vunit vis vconsidered va vnew vfacility vadmission veven vif v"transferred" vfrom van vacute vcare vhospital. Early vand vcomprehensive vassessment vof vthe vskin vwill videntify vpressure vinjuries vpresent von vadmission. Existing vpressure vinjuries vare va vrisk vfactor vfor vaddition vpressure vinjuries. Admission vSkin vand vPressure vInjury vRisk vAssessments v- vcorrect vanswers v-Skin vAssessment Review vthe vmedical vrecord vof veach vpatient vfor vdocumentation vof va vskin vassessment vperformed von vadmission Determine vif vthe vadmission vskin vassessment vwas vperformed vwithin vthe vdesignated vtime vperiod Pressure vInjury vRisk vAssessment Review vthe vmedical vrecord vof veach vpatient vfor vdocumentation vof va vpressure vinjury vrisk vassessment vperformed von vadmission Many vhospitals vembed vdocumentation vof vthe vpressure vinjury vrisk vassessment vin vthe vadmission vskin vassessment Determine vif vthe vadmission vrisk vassessment vwas vperformed vwithin vthe vdesignated vtime vperiod
Identify vthe vmethod vused vto vassess vpressure vinjury vrisk von vadmission v(instrument/clinical vfactors) Identify vthe vadmission vrisk vassessment vscore v(if van vinstrument vwas vused vto vassess vrisk) Pressure vInjury vRisk vAssessment v- vcorrect vanswers v-Clinical vpractice vguidelines von vpressure vinjury vprevention vrecommend va vstructured vapproach vto vpressure vinjury vrisk vassessment vthrough vuse vof va vrisk vassessment vinstrument, videntification vof vadditional vrisk vfactors v(e.g., vage, vpoor vperfusion, vpoor voxygenation, vskin vconditions vsuch vas vexisting vpressure vinjuries) vand vclinical vjudgment. The vinstrument vused vto vassess vpressure vinjury vrisk vshould vbe vvalid vand vreliable. Adult vpatient vpressure vinjury vrisk vshould vbe vassessed vusing van vinstrument vvalidated vfor vthe vadult vpopulation. A vnumber vof vrisk vassessment vtools vare vavailable vfor vuse vin vadult vpopulations The vBraden vScale1, v 8 vand vthe vNorton vScale2, v 8 vhave vbeen vvalidated vfor vadult vuse vin vresearch vstudies. vThese vare vthe vtwo vscales vmost vcommonly vused vin vthe vUnited vStates. Pediatric vpatient/Neonate vpressure vinjury vrisk vshould vbe vassessed vusing van vinstrument vvalidated vfor vthe vpediatric vand vneonate vpopulation. The vBraden vQ3, v6, v 9 vwas vtested vin vPICU vpatients vage v 21 vdays vto v 8 vyears The vGlamogram vScale4, v6, v 7 vwas vtested vin vpediatric vpatients vage v 1 vday vto v 18 vyears The vNeonatal vSkin vRisk vAssessment vScale v(NSRAS)5, v 6 vwas vtested vin vNeonatal vIntensive vCare vUnit vpatients vage v26-40 vweeks vgestation Pressure vInjury vRisk vAssessment v- vcorrect vanswers v-Other vclinical vfactors vmay vplace vthe vpatient vat vpressure vinjury vrisk. Existing vinstruments vdo vnot vcapture vall vpressure vinjury vrisk vfactors vfor vall vpatients Studies vhave videntified va vvariety vof vrisk vfactors vimportant vto vpressure vinjury vdevelopment vthat vshould vbe vconsidered vin vaddition vto vthose vmeasured vby vrisk vassessment vtools. Poor vskin vstatus, vexisting vpressure vinjuries Decreased vperfusion vand voxygenation Increased vbody vtemperature, vadvanced vage, vpoor vgeneral vhealth vstatus.
Calculate vhow vlong vbefore vthe vsurvey vthe vlast vpressure vinjury vrisk vassessment vwas vdocumented. vThis vcan vbe vreported vas vthe vnumber vof vhours, vdays, vor vweeks Determination vof vtime vsince vthe vlast vdocumented vpressure vinjury vrisk vassessment vcan vbe vused vto vevaluate vwhether vthe vunit vstandard vfor vrisk vreassessment vis vbeing vmet. The vpatient vrecord vmay valso vbe vexamined vto videntify vthe vregularity vof vprevious vassessments Pressure vInjury vRisk vReassessment v- vcorrect vanswers v-Identify vthe vmethod vused vto vperform vthe vLAST vpressure vinjury vrisk vassessment v(instrument/clinical vfactors). If vinstrument vwas vused vto vperform vthe vlast vpressure vinjury vrisk vassessment, vreport vthe vscore vdocumented vin vthe vpatient's vrecord. Possible vscores vvary vby vinstrument. Braden vScale vscores vrange vfrom v 6 vto v 23 Norton vScale vscores vrange vfrom v 5 vto v 20 Braden vQ vscores vrange vfrom v 7 vto v 28 NSRAS vscores vrange vfrom v 6 vto v 24 Hospitals/units vmay vsometimes vuse vother vscales vto vreassess vpressure vinjury vrisk v(e.g. vGlamorgam, vWaterlow, vand vCubbin-Jackson) vor vmay vuse vsubscales vof vlarger vscales v(e.g. vonly vthe vactivity vand vmobility vsubscales). For vNDNQ vparticipating vhospitals, vreport vthe vuse vof vother vscales vor vsubscales vof vlarger vscales vas videntified vin vNDNQI vGuidelines. Pressure vInjury vRisk vStatus v- vcorrect vanswers v-Determine vwhether vthe vpatient vis v"At vRisk" vfor vpressure vinjury vdevelopment vbased von vthe vLAST vpressure vinjury vrisk vassessment. Determination vof vpatient vrisk vstatus v(at vrisk/not vat vrisk) vshould vfollow vguidelines vestablished vfor vthe vinstrument vused vto vassess vpressure vinjury vrisk. For vthe vBraden vScale, va vscore vof v 18 vor vless vindicates vthat vthe vpatient vis vat vrisk vfor vpressure vinjuries
For vthe vNorton vScale, va vscore vof v15-16 vor vless vindicates vthe vpatient vis vat vrisk vfor vpressure vinjuries For vthe vBraden vQ, va vscore vof v 16 vor vless vindicates vthe vpatient vis vat vrisk vfor vpressure vinjuries For vthe vNSRAS, va vscore vof v 13 vor vhigher vindicates vthe vneonate vis vat vrisk vfor vskin vinjury Pressure vInjury vRisk vStatus v- vcorrect vanswers v-The vLAST vpressure vinjury vrisk vassessment vmay vhave videntified vother vclinical vfactors vthat vplaced vthe vpatient v"At vRisk" vfor vpressure vinjury vdevelopment. Skin vStatus Existing vpressure vinjuries History vof vpressure vinjuries General vskin vstatus Decreased vperfusion vand voxygenation Peripheral vvascular vdisease Hypotension Use vof vvasopressors Nutrition vRelated vExamples Recent vweight vloss Protein venergy vmalnutrition Age vRelated vExamples Older vage Gestational vprematurity Surgery vRelated vExamples Operation vgreater vthan v 4 vhours The vnumber vof vhypotensive vepisodes vintra-operatively Low vbody vtemperature vintra-operatively Additional vExamples Exposure vto vpressure vfrom va vmedical vdevice vsuch vas voxygen vtubing, vCPAP vmask, vcervical vcollar, vetc. Spinal vcord vinjury Increased vbody vtemperature Patient vrisk vstatus vbased von vscale vscore vand/or vother vclinical vfactors vshould vbe vcommunicated vduring vshift-to-shift vand vtransfer vreports. Pressure vInjury vPrevention vin vUse vfor v"At vRisk" vPatients v- vcorrect vanswers v- Review vthe vmedical vrecord vof veach vpatient vwho vis vat vpressure vinjury vrisk vto
Tailored vto vthe vpatient's vrisk vfactors Promptly vinitiated Consistently vapplied Evidence vsuggests vthat van vevidence-based vProgram vof vPressure vInjury vPrevention vcan vreduce vpressure vinjury voccurrence. Strategies vto vgenerate vstaff venthusiasm vand vmaintain vadherence vto vthe vProgram vof vPressure vInjury vPrevention vshould vbe vemployed. vLeadership vsupport vis vcritical vto vsuccess. Daily vSkin vAssessment v- vcorrect vanswers v-A vpurpose vof vongoing vskin vassessments vis vto vdetect vpressure vinjuries. The vskin vof vpatients vat vrisk vfor vpressure vinjuries vshould vbe vinspected vfrom vhead- to-toe vat vleast vdaily. Ideally, vthe vskin vwill vbe vinspected vfor vpressure vinjuries vmore voften vthan vdaily vsuch vas vevery vshift These vassessments vshould vbe vintegrated vinto vusual vcare vroutines vand vpractices vfor vconsistency vin vperformance The vhead-to-toe vskin vinspection vshould vbe vdocumented vwith vclear videntification vof vpressure vinjury vpresence vor vabsence von vassessment. v Note: vThe vdevelopment vof va vpressure vinjury vplaces vthe vpatient vat vhigher vrisk vfor vadditional vpressure vinjuries. Review vthe vpatient's vmedical vrecord vto vdetermine vhow voften vskin vassessments vhave vbeen vperformed. Documentation vin vthe vpatient vrecord vmay vbe vused vto vevaluate vwhether vthe vunit vstandard vfor vskin vassessment vhas vbeen vmet Determine vif vthere vwas vdocumentation vfor vany vcontraindication vto vthe vskin vassessment. For vNDNQI vparticipating vhospitals, vreport vthe vfrequency vof vskin vassessments vas videntified vin vNDNQI vGuidelines. Pressure vRedistribution vSurface vUse v- vcorrect vanswers v-Support vsurfaces vare vused vto vredistribute vpressure von vskin vand vsubcutaneous vtissue vor valternate vparts vof vthe vbody vexposed vto vpressure.
Support vsurfaces vare vused vto vredistribute vpressure von vskin vand vsubcutaneous vtissue vor valternate vparts vof vthe vbody vexposed vto vpressure. Support vsurfaces vare vused vto vredistribute vpressure von vskin vand vsubcutaneous vtissue vor valternate vparts vof vthe vbody vexposed vto vpressure. Support vsurfaces vare vmade vup vof vvarious vcomponents vincluding vair, vgel, vwater vand vvarious vtypes vof vfoam. vHigh vspecification vfoam vis vpreferred. These vmaterials vare vused vto vmake vmattresses, voverlays, vspecialty vmattresses vor vchair vcushions vthat vredistribute vpressure vover vtissues. Support vsurfaces vmay vhave vadditional vfeatures vsuch vas valternating vpressure, vair vfluidization, vlow vair vloss, vmulti-zones, vturn vassist vor vlateral vrotation. Select va vsupport vsurface vthat vconsiders vthe vpatient's vlevel vof vimmobility vand vinactivity; vneed vfor vshear vreduction; vneed vfor vmicroclimate vmanagement; vcomfort; vsize vand vweight; vrisk vfor vdeveloping vnew vpressure vinjuries vand vnumber, vseverity vand vlocation vof vexisting vpressure vinjuries.2, v 3 Minimize vthe vtime vlag vbetween videntification vof vpressure vinjury vrisk vand vplacing vthe vpatient von vthe vcorrect vsurface. Continue vto vturn/reposition vall vpatients vat vrisk vfor vpressure vinjuries vregardless vof vthe vsupport vsurface vin vuse. Routinely vcheck vthe vsupport vsystem vis vworking vproperly. Pressure vRedistribution vSurface vUse v- vcorrect vanswers v-Pillows vor vheel vprotection vdevices vshould vbe vused vto vremove vpressure vfrom vthe vheels. Suspend/"float" vheels voff vthe vsurface vof vthe vbed vby vplacing va vpillow vunder vthe vlower vlegs vso vthat vthe vheels vare vfree vof vpressure Avoid vareas vof vhigh vpressure, vespecially vunder vthe vAchilles vtendon. Heel vprotection vdevices vshould vcompletely velevate vthe vheels voff vthe vmattress Consider vuse vof va vmulti-layer vsilicone vbordered vfoam vdressing von vthe vheels vto vminimize vshear vinjury vin vhigh vrisk vpatients
Suspend/elevate/"float" vheels voff vthe vsurface vof vthe voperating vtable Pad vbody vsurfaces vthat vwill vbe vexposed vto vpressure vwhile vin vthe vsurgical vposition Consider vuse vof va vprophylactic vmulti-layer vpolyurethane vfoam vdressing vwith vsilicone vborder von vthe vsacrum vto vminimize vshear vinjury vin vhigh vrisk vpatients Do vnot vposition vdirectly von va vmedical vdevice. Pad vbody vsurfaces vfrom vOR vdevice vrelated vpressure Place vthe vpatient von va vpressure-redistributing vsupport vsurface vpost-operatively Begin vturning/repositioning vthe vpatient vin vthe vrecovery vroom Position vpatient voff v"operative vposition" vafter vsurgery Additional vconsiderations vfor vpatients vundergoing vinterventional vand vradiological vprocedures Use va vpressure-redistributing vmattress von vthe vtransport vcart/stretcher Use va vpressure-redistributing vmattress vor voverlay von vthe vinterventional/radiology vtable vfor vlonger vprocedures Consider va vprophylactic vdressing von vthe vsacrum vfor vlong vprocedures von vhigh vrisk vpatients. Elevate vheels Document vthe vtype vof vpressure vredistribution vsurface(s) vin vuse. Pressure vRedistribution vSurface vUse v- vcorrect vanswers v-Review vthe vpatient's vmedical vrecord vfor vdocumentation vof vpressure vredistribution vsurface vuse. vThis vincludes vreview vfor vdocumentation vof vheel vsuspension/elevation/"floating" vand vstrategies vto voff-load vbody vsurfaces vexposed vto vpressure vfrom vmedical vdevices vand voverlying vskin vfolds. Determine vif vthere vwas vdocumentation vfor vany vcontraindication vto vpressure vredistribution vsurface vuse. Look vfor vdocumentation vindicating vpatient vnon-adherence vto vpressure vredistribution vsurface vuse. The vpatient vand vfamily vshould vbe veducated von vthe vuse vof va vpressure vredistribution vsurface vfor vpreventing vpressure vinjuries vand vadvised vthat vnon- adherence vto vthe vplan vof vprevention vmay vlead vto vpressure vinjury vdevelopment
For vNDNQI vparticipating vhospitals, vreport vpressure vredistribution vsurface vuse vas videntified vin vNDNQI vGuidelines. Routine vRepositioning v- vcorrect vanswers v-The vpurpose vof vturning/repositioning vpatients vis vto vreduce vthe vduration vand vmagnitude vof vtissue vpressure. vCare vshould vbe vtaken vduring vrepositioning vto vminimize vshear. Patients vin vbed Studies vsuggests vthat vthe vturning/repositioning vfrequency vshould vbe vinfluenced vby vthe vindividual vand vthe vsupport vsurface vin vuse. Many vclinicians vstart vby vturning vimmobile vpatients vevery v 2 vhours vwhile vin vbed vas vthis vis va vcommon vpractice vfor vpatients vunable vto vturn/reposition vthemselves. Repositioning vfrequency vcan vbe vtailored vbased von vthe vindividual's vtissue vtolerance, vlevel vof vactivity vand vmobility, vgeneral vmedical vcondition, voverall vtreatment vgoals, vskin vcondition vand vcomfort. Patients vwho vare vat vhigher vrisk vwill vlikely vneed vto vbe vturned/repositioned vmore vfrequently vthan vevery v 2 vhours. Specialized vsupport vsurfaces vmay vreduce vthe vfrequency vof vturning/repositioning.2- 4 vPatients vshould vbe vrepositioned vroutinely vregardless vof vthe vsupport vsurface vused. The vpatient's vskin vmust vbe vclosely vmonitored vto vdetermine vtissue vresponse vto vthe vturning/repositioning vschedule. vIf vpossible, vavoid vturning vpatients vonto vreddened vskin. Slow, vgradual vturns vmay vbe vneeded vto vstabilize vpatient vhemodynamic vand voxygen vstatus vwhile vturning.1, v 5 Premature vneonates vshould vbe vmonitored vfor vapnea, vbradycardia/tachycardia, vand voxygen vrecovery vtime vto vdetermine vtheir vresponse vto vthe vturning vschedule. Document vthe vtime vthe vpatient vwas vturned/repositioned vand vthe vposition vadopted. Routine vRepositioning v- vcorrect vanswers v-Patients vin vBed Avoid va v 90 vdegree vside-lying vposition Position vpatients vin va v 30 vdegree vside-lying vposition Use vpillows, vblankets vor vpositioning vdevices vto vmaintain vpatient vbody valignment vand vprevent vpressure von vbony vprominences
