Thursday, July 24, 2008

F314: Pressure Ulcers

Requirement:

The facility must prevent pressure ulcers and effectively treat those that are present.

Intent:

Pressure ulcer prevention must be promoted. Existing pressure ulcers must be treated appropriately, and the development of additional pressure ulcers must be prevented as well.

Common Reasons for Citing F314:

The lack of documentation and monitoring is the most common reason this tag is cited. Other causes include the care plan not being individualized for the resident with a pressure ulcer, failure of the communication process between CNA and nurse regarding the development of pressure ulcers, the lack of dietary intervention, failure of the nurse to notify the physician, the lack of pressure relieving devices even if not ordered, wound care not being provided per physician order, the nurse’s failure to maintain clean or sterile technique as indicated, using a shearing motion while turning and repositioning the resident, and providing wound care without cleaning up incontinence beforehand.

Preparation:

With the lack of documentation being the biggest factor with this citation, frequent chart audits are essential. It is also essential that nurses providing wound care be observed for their compliance with physician orders and established guidelines. Some facilities have had great success by having weekly skin rounds, in which an interdisciplinary team (including at a minimum the skin or wound care coordinator, MDS coordinator, DON or ADON, and dietician) shadow the treatment nurse as wound care is provided. This team based approach provides the opportunity for all of the above-mentioned audits to be done in a timely and efficient manner. It is also necessary to have an effective system in place for addressing CNA-nurse communication.

No comments: