How To Implement a Skin Fair

2. How To Implement a Skin Fair Outcomes Congress Jeri Lundgren, RN, CWS, CWCN Pathway Healthcare Services Jody Rothe, RN, WCC MetaStar, Inc. December 2, 2009

3. Skin Care • Objectives for our learning session: • The importance of hydrating skin • How to handle fragile skin • Moisture – friend or foe • How to turn the frail elderly patient • What causes pressure and the stage definitions • Importance of nutrition • Overall care of the skin

4. What Is The Skin Care Fair? • A pressure ulcer prevention in-service with hands on activities that are fun! • Each activity covers one of the Braden Scale risk factors for pressure ulcers and includes a lesson learned from The Daily Post • Designed for the CNAs and direct staff • Use as a train the trainer activity for nurses

5. Tools • Skin Care Fair PowerPoint • Skin Care Fair Instructions with inventory list of required supplies • Take Home Sheet for the CNA • Braden Puzzle Pieces

6. Helpful Hints • The instructions contain humorous scripts and hints to ensure each activity’s success • Allow ½ hour to set up your program • Don’t leave fruit unattended; the residents will eat it! • Clean up with bleach wipes to maintain infection control

7. Benefits • Active learning and CNAs love the activities • Easy to provide • Door opener for nursing homes • Able to customize interventions to facility’s policies • Opportunity for nursing homes to reward staff

8. Skin Care Fair • 3 Categories of Activities: • Oh, My Precious Epidermis: Hands on Activities • Terrors of the Deep: View the stages of pressure ulcers • Solving the Puzzle of The Braden Scale

9. Oh, My Precious Epidermis

10. What is Pressure • Define pressure • What causes pressure?

11. Pressure Ulcer Prevention • Who can prevent pressure ulcers? • What prevents pressure ulcer? • How can pressure ulcers be prevented? • Why prevent pressure ulcers?

12. Under Pressure • Can you tolerate the pressure?

13. The Barren Desert

14. The Daily Post • Protect Dry Skin which can lead to friction injuries and skin tears • Use moisturizers frequently and as often as necessary • Always be on the look-out for skin changes

15. Fragile: Handle with Care

16. The Daily Post • Be cautious when changing incontinent products, bandages, or even their clothes • Your elder’s skin is very fragile and can tear easily

17. The Daily Post • Moisture from incontinence contributes to pressure ulcer development • Cleanse skin at the time of soiling • Select underpads/briefs that are absorbent and provide quick drying surface for the skin

18. The Barrier Reef

19. Barrier Reef ExerciseSee the water beading up on Right hand?

20. The Daily Post • Use a moisture barrier to help protect the skin from stool and urine • Barrier creams and ointments only work if they are applied, and applied correctly • These creams can be the first line of defense for your elder to stop a pressure ulcer before it develops

21. You’re Tearing Me Apart

22. The Daily Post • Simple movements, such as turning or lifting, can create friction and shearing, which can injure the skin • To move and reposition residents, use lifting devices and draw sheets • Avoid dragging

23. Critic’s Corner Taster’s Choice

24. The Daily Post • Weight loss is a risk factor for developing a pressure ulcer. • Appeal to a person’s appetite by serving food’s according to the person’s preferences and consistent with the person’s medical condition

25. Critic’s Corner Treasure Hunt

26. Treasure Huntthe picture on the right is view from glasses with petroleum Seeing through the resident’s eyes

27. The Daily Post • Poor nutrition is a risk factor in developing a pressure ulcer • Assist residents to eat as necessary • Notify the nurse if there is a decline or change in a resident’s eating habits • Choose supplements that are tasty • Consider choice in dining as a strategy to increase weight

28. Between a Rock and a Hard Place • Can you handle the pressure? • Yes you can and you can prevent pressure, too!

29. The Princess and the Pea

30. The Daily Post • Use support surfaces on beds and chairs to reduce pressure • Avoid donuts • Use pillows or devices to raise heels off the bed

31. Dorothy’s Shoes • Pressure and Blisters and Objects Oh My!

32. The Daily Post • Always be on the lookout for anything that could create pressure on the skin, including the feet

33. You’re Squeezing Too Tight

34. The Daily Post • Tissue Damage can occur in a short period of time. • Minimize Pressure • Be aware of who is at risk and the plan of prevention

35. Kick Up Your Heels

36. The Daily Post • Heels are especially vulnerable to pressure even on a good support surface • Heel elevation will help prevent pressure ulcers to the heels • Tip: On daily rounds monitor to ensure heels are off on the beds and equipment is being used appropriately

37. Under Pressure Exercise

38. The Daily Post • Reposition bedbound residents every two (2) hours • Reposition chairbound residents every one (1) hour • Use devices, such as pillows, cushions, to keep bony prominences from direct contact

39. Terrors of the Deep

40. The Daily Post • Stage IV pressure sores can take the longest to heal • In some residents, Stage IV ulcers can develop in a matter of hours (i.e., if left on the wrong surface too long)

41. Terrors of the Deep Stage 1 Stage 2 Stage 3 Stage 4

42. Puzzle • Can you solve the Braden Scale Puzzle?

43. Solving the Puzzleof The Braden Scale* Mobility Friction and Sheer Nutrition Moisture Activity Sensory Perception *Refers to The Braden Scale for Predicting Pressure Sore Risk, Barbara Braden and Nancy Bergstrom, 1988

44. This May Be the End of This Session, but This is the Beginning of Your Journey Home!

45. Contact Information: Jody Rothe, RN, WCC Quality Consultant MetaStar, Inc. 2909 Landmark Place Madison, WI 53713 (608) 274-1940 or (800) 362-2320, ext. 8271 www.metastar.com jrothe@metastar.com This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  9SOW-WI-PS-09-224.