Passing on the risk by ProQuest


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									         Skin care

      Passing on the risk
      Long-term care providers need to closely monitor and manage skin conditions
      before and after hospital transfers. Many breakdowns can go unnoticed

      By Julie E. Williamson
      Avoiding skin breakdown and
      pressure ulcers is an ongoing chal-
      lenge for long-term care providers
      as they care for an older, sicker and
      increasingly compromised resi-
      dent population. And those chal-
      lenges become even greater when
      residents are transferred back and
      forth among care settings.
         With as much as a $70,000 price
      tag on complex pressure ulcer
      treatment—and the fact that the
      Centers for Medicare & Medicaid
      Services no longer reimburses for
      avoidable pressure ulcers—pro-
      viders must be intently focused
      on maintaining good skin health
      and ensuring that they don’t bear
      the financial burden of treating

                                                                                                                                                                     Photo: iStockphoto
      preventable deep tissue injuries
      and skin breakdown that occurred
      on another facility’s watch. That
      isn’t always easy, though, sources
      acknowledge.                              skin health while a resident is        It is incumbent upon long-term care providers to be aware of all residents’
         Not only is a lack of commu-           in its care, and all the way up        skin conditions upon admission or discharge, according to experts.
      nication between skilled nursing          to the point of transfer, but it
      and acute care facilities still all too   can’t always count on the same         ity. More focus is typically given to    tinuum have a responsibility to
      common, each setting’s care prior-        level of due diligence when the        cardiac and respiratory status.”         the resident or patient to ensure
      ities—and protocols—can differ            resident is admitted to another           Sometimes, caregivers in acute        that skin integrity doesn’t fall by
      greatly, which makes it more likely       setting, particularly a hospital       care settings aren’t even aware of       the wayside.
      that a resident will not receive con-     where tending to the immediate,        the skin breakdown risks, which             “Creating seamless care is
      sistent, seamless care.                   acute illness takes precedence         explains why transferred residents       really what we’re talking about
         “It would seem reasonable              over other potential risks, such       often aren’t repositioned, off-load-     here,” stresses Dr. James Spahn,
      that there should be an agreed            as skin breakdown.                     ed or adequately assessed.               CEO/founder of EHOB Inc, an
      upon transfer protocol or process            “Typically, the focus on trans-        “It is possible to have an elderly    Indianapolis-based manufacturer
      between healthcare organizations          fers is with the paperwork and in      person in a hospital bed for three       of pressure ulcer prevention and
      within a specific locale,” says Alex-     getting the [resident moved]—          to four days and the skin condition      treatment products.
      is Roam, nursing home services            and not on the resident’s needs        being overlooked,” notes Roxanne            “Keeping skin healthy requires
      program manager for Primaris, a           before, during and after the trans-    Merkes, certified wound nurse            every setting to really know the
      Columbia, MO-based nonprofit              fer,” explains Deborah Bakerjian,      and skin care team member for            physiological status of the person
      healthcare consulting firm. “How-         assistant adjunctive professor at      Cedar Lake Health Care Com-              being transitioned in and out of
      ever, this is not always the case.”       the University of California, San      munity in West Bend, WI.                 their care, and this information
                                                Francisco, and chair of Advancing         One point experts agree on is         must be provided in a timely,
      No skin in the game                       Excellence in American Nursing         that proper skin care is anything        accurate way. You can’t have that
      A long-term care provider can             Homes’ clinical advisory work-         but a back-burner issue, and that        without effective, ongoing com-
      do a great job of maintaining             group. “Skin is not seen as a prior-   caregivers ac
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