This document discusses preventing pressure ulcers (bedsores) in hospitals. It notes that Medicare no longer pays for bedsores acquired in hospitals. The author advocates using the Braden scale to assess risk and repositioning patients every two hours to reduce pressure. Low air-loss flotation beds can help redistribute pressure from bony areas. The goal is to eliminate all bedsores through preventative measures like regular skin checks, keeping skin clean and dry, and consistent repositioning.

1. Inservice-on-Demand ®
A Library of Nursing Inservice Videos
For Preventing Never-Events

2. Intervention for
Prevention
Zero Tolerance for Bedsores
By
Thomas A. Sharon, R.N., M.P.H.
© 2008 all rights reserved

3.  Medicare reports that 13% of all
hospital patients develop decubitus
ulcers
 Defense lawyers have argued in court
that some bedsores are unavoidable
 We nurses dare not think in those
terms because we have a duty to take
preventive action
 Therefore, we must act in accordance
with one overriding principle . . .
YES, WE CAN ELIMINATE
BEDSORES!

4. Zero Tolerance for Bedsores
 As of October 1, 2008 Medicare, Medicaid
and private insurers are no longer paying
for care related to treating pressure ulcers
that occur during hospitalization
 The CMS (Centers for Medicare Services),
an arm of the Federal Government that
determines health care reimbursement
policy, now considers all pressure ulcers as
an event that should never happen
 Therefore, it is crucial to identify patients
with bedsores upon admission, determine
who is at risk, and implement the required
action

5. Admission Assessments of Skin Integrity
 Visualize all areas of skin for integrity and
color
 Palpate for temperature and moisture
 Check turgor
 Look inside the mouth to check for
dryness of mucous membranes
 Document all wounds, scars, rashes and
other abnormalities
PREVENTION STARTS WITH ASSESSMENT

6. When you find a patient with
existing pressure ulcers, then
prevention becomes even more
important, because we have to
avoid further deterioration.

8. Identifying Who is at Risk: the Braden Scale
 Age over 60
 Spinal cord paralysis
 Stroke
 Nervous system disease
 Poor circulation
 Diabetes
 Confined to bed
 Altered level of consciousness
 Confusion
 Bladder incontinence
 Bowel incontinence
 Diarrhea
 Anemia
 Dehydration
 Malnutrition
 Obesity
 Emaciation
 Reduced mobility (traction or body cast)

10. The Root Cause of Pressure Ulcer is
Pressure
This is a time-factor injury
Stage 2
Stage 1
Stage 3 Stage 4

11. Intervention for Prevention of Bedsores
 Reposition the patient from side
to back to the other side every
two hours (no exceptions).
 Keep the skin clean and dry
 Check skin integrity every shift
Supplies and Equipment
 Foam rubber heel pads
 Sheepskin bed pads
 Low air-loss flotation bed
 Drawsheets and Chux

12. Turning and Repositioning Record
Supine Right Lateral Left Lateral
09:00 11:00 13:00
11:00 13:00 15:00
2 hrs. 2 hrs. 2 hrs.
Supine Right Lateral Left Lateral
17:00 19:00 21:00
19:00 21:00 23:00
2 hrs. 2 hrs. 2 hrs.
Supine Right Lateral Left Lateral
01:00 03:00 05:00
03:00 05:00 07:00
2 hrs. 2 hrs. 2 hrs.

13. Low Air-Loss Flotation Beds
 Redistribute pressure from bony
prominences
 Must be utilized for all patients at risk

14. Thank you for listening
 This inservice-on-demand video is part of
our library of educational clips that can be
made available to you and your colleagues
 The only cost effective way to achieve the
clinical transformation needed to stem the
tide of never-events in hospitals is:
INSERVICE-ON-DEMAND ®
For more information contact
Thomas A. Sharon, RN, MPH
305-866-2858
nursetom@msn.com