Pressure Injuries
True or False?
A documented stage 2 pressure injury on a client's shin is fairly common and explainable.
Pressure injuries typically develop in areas where bony prominences regularly make contact with a surface of some type. Pressure injuries that develop in unusual places such as a shin are often caused by an external device. Documentation should thoroughly explain an unusually placed pressure injury.
How many weeks of supplies can be ordered at one time to satisfy a treatment order?
2 weeks
True or False?
There is a brand new directive that says when a SOC is completed for a client with a new ostomy, the opening clinician must call the driveway report into Derrick or Precious.
True
See Slide
When a QA auditor reviews an occurrence report that states "MD's office called. Office member, Pam notified", what will the auditor look for next?
The auditor will look for further documentation that shows we closed the loop on the client problem.
This includes documenting the physician's response.
How often must an RN supervisory visit occur for clients without a wound?
Every 30 days. Plotted every 3rd week.
This visit is always plotted early by CMs to allow for unforeseen circumstances.
A nurse performs a SOC for a male client who has a dressing on his left heel. Clinical attachments describe the wound as a full thickness diabetic ulcer. When the nurse asks for permission to assess the heel the client, the client says "Do not disturb the dressing. It was changed in the hospital yesterday and is not due again until tomorrow" What actions must the nurse take?
1) The nurse should explain the importance of consistent wound assessments in compliance with state and Bayada regulations.
2) Complete an occurrence report reflecting the missed assessment.
3) Determine if a return visit is possible for the next day.
If a client is admitted to Home Health Services following a R TKR with staples that must be removed by a Bayada clinician in a week, what item(s) should the SOC clinician Order?
1) Staple Remover
2) Steri-Strips
True or False?
Even though a new stoma will shrink significantly over the next 6-8 weeks, it is important to measure its size and enter it into the ICC for tracking.
True
See Slide
True or False?
During a QA survey, LVV will be required to conduct (3) in-home visits. Each visit will begin with the auditor requesting to see the contents of the Red Folder. He or she will check to see if the appropriate forms are complete and legible.
True
These forms are required by the state and Bayada policy.
How often must an RN assess a client with an active wound?
A minimum of every other week
At what point can an unstageable pressure injury be reclassified? What stage is it likely to convert to?
Unstageable pressure injuries may be reclassified as a stage 3 or 4 once enough of the wound bed is visible to accurately determine the extent of tissue damage.
See Slide
If a client is admitted onto service with a foley catheter, what supplies should the SOC clinician order?
1) Replacement foley(s)
2) Insertion kit(s)
3) Saline
4) Flushing syringe
True or False?
It is critically important to document when a client has settled on a particular stoma appliance, or that the client is trialing a particular appliance.
Appliance ID #'s should be included.
True
The more specific information provided for our client's with a new stoma, the more efficient care will be.
True or False?
It is Bayada Policy that Each client have written instructions regarding their wound care physically in the home.
True
This is always requested by the QA Auditor
See Slide
Considering the fact that every wound care referral is accepted based on the availability of a willing and teachable caregiver, what are two critical elements that should be evident in nursing's documentation?
1) Documented progress of the client/caregiver's ability to perform the treatment based on hands-on demonstrations.
2) Decrease in visit frequency
Full-thickness loss of skin, in which adipose tissue is visible. Undermining and tunneling may occur. Fascia, muscle, tendon, ligament, cartilage and/or bone are not exposed. What stage am I?
Stage 3 Pressure Injury
See Slide
Why is there a limit on how many supplies can be ordered at one time?
Supplies/Resources are lost when clients are:
1) Rehospitalized
2) Have treatment orders changed by a physician
See Slide
How should the SOC clinician plot skilled nursing calendar visits to begin management of a client with a new stoma?
Skilled nursing should plan to visit 2x weekly for the first 2-3 weeks plotting visits to coincide with the appliance change schedule.
Why is it so important to routinely reconcile every client's medications throughout an episode?
See Slide
Intact or non-intact skin with localized area of persistent non-blanchable deep red, maroon, purple discoloration or a blood-filled blister. What stage am I?
Deep Tissue Injury (DTI)
See Slide
A client is being treated with targeted NPWT using a Solventum KCI VAC. The nurse notes that the client has only one week's worth of dressings and cannisters remaining. What should the clinician do?
Call 1-800-275-4524 to order supplies
See Slide
A client on caseload for a new stoma is ready for discharge. The asks "How will I get my supplies now that Bayada is discharging me?"
See Slide
How long does a clinician have to complete documentation for any given visit?
What is LVV's current percentage goal for documentation completion in 24 hour or less?
24 hours
LVV's Goal is 75%
Nursing is currently at 53.7%