Archive for September, 2009

The wonders of electronic documentation

September 28, 2009

The Electronic Health Record (EHR) is here to stay. I noticed in several of the posts that there is a generalization of how easy it is to use and how great it is going to be. Be careful with this, because there is still a human component involved with EHR. And humans hate change. I currently work in a small community hospital that is in the middle of activating EHR and we seem to be doing it backwards. As a Nurse Clinician and Analyst for the EHR system, there a many bugs that need to be worked out. Which part of our current system interfaces with the new system? What new systems needed to be purchased to enhance the system we are trying to implement? The building of the EHR system is in its third year, and we certainly are having our ups and downs. What to add, where to add this assessment, where to add this reassessment? It can be very daunting and confusing, to say the least. Even for someone familiar with the system. Unfortunately EHR is not a cure-all, and hospitals attempting to introduce EHR into its system need to listen to what other facilities are doing right and doing wrong. There are definitely lots of both. Good luck with EHR.

Health Care Informatics online certificate program

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Financial Aid, comment

September 25, 2009

We accept barter and trade. This means you can pay for online classes without using cash. See the barter link below.

Original Post
September 17, 2009
Title: Financial Aid
Are there financial aid packages available for online learning of Healthcare Informatics, Nursing Health Assessment, and other nursing subjects?

Original Post:
September 9, 2009
Title: Is Online Learning Easier? (comment)
Many people think when you take an online course, its easier because you can use your books or other online resources whenever you need too. It is very easy get distracted when you are home. If you try to do school work with the TV on, or other distractions, you will not succeed. Some people need the structure of a class room to learn. I think it takes a disciplined, organized individual to do online learning. One person commented that some teacher "spoon feed" the class the information. I agree with her, when you take an online class, you have to teach and learn the information yourself. Although sometimes I get distracted at home, I force myself to stay in my office until my work is completed.

Original Post
August 31, 2009
Title: Is Online Learning Easier? (comment)
I am currently taking Advanced Health Assessment II with Dr. Johnson. This online learning has been a great learning experience for me!! I am used to the classroom setting but I agree that this way of learning helps with preparing for graduate school. I have just started graduate school and much of it is self-directed with deadlines. This course so far has taught me time management as well as self motivation. I look forward to future online course I may take in the future!

Original Post
August 20, 2009
Title: Is online learning easier? (comment)
After having many years of education under my belt I have decided that on-line education is like any type of education, you get out of it what you put into it. The student may work very hard toward the subject at hand and gather as much information as possible or the student may do the bare minimum to get by. The fact that there is so much information out on the Internet means you have the ability to locate a wide array of information; however the student must be leery of the information that is out online as verify it is from a reputable source. In order for an online course to be practical, especially in assessment, hands on education must be involved. It is important for the Nurse to be able integrate and to use the knowledge that they learned on their own, in a hands on situation where the assessment skills that they have read about come to fruition.

Original Post:
August 5, 2009
Is online learning easier? (comment)
I feel like the introduction of technology in education has greatly helped increase organizational skills. When you are part of an online class you must be very organized and independent. It requires a lot of good communication skills and requires one to be computer savvy. The student must read and acquire all of the information themselves from textbooks and other resources the course may provide. The instructor of the course is simply there to provide you with any questions you may have regarding the material. It is up to the student only to obtain the most important information from the reading material and to retain it for future use. I think that these skills will surely help me with graduate school when I start in the fall.

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I agree that online learning is much more challenging than traditional classroom learning. Teachers do spoon-feed the students the information that is needed in order to pass the exams. Whereas online instruction is based on the assignments given and one must be prepared for every aspect of that assignment and not just focus on what the teacher says will be on the exam. Granted, you have some students who are more comfortable with having an instructor available immediately for any questions or unclear information. Online classes also offer access to the instructor as often as needed but much of online instruction requires the student to do the research and try to come up with the appropriate responses on their own before referring to the instructor. Online instruction requires individuals to become more independent and in charge of their own learning at their own pace. For me it has been a godsend.

AND

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I believe that online classes prepare you to enter graduate school. Graduate students must be responsible for large amounts of information that must be self-taught. It would be impossible to expect to get everything you need for an exam, or eventually your career, from the classroom as a graduate student. I like that in NR534 Advanced Health Assessment (as taught by Dr. Johnson) I am responsible for reading the book, completely the interactive exercises, and memorizing the basic information. I then go to clinical and exam a patient using the knowledge I have taught myself along with guidance through the exam from my preceptor. I learn how to perform an assessment on a patient from information from the book and experience of my clinical faculty. I am forced to be productive at home because I am expected to report to clinical prepared to use the knowledge from the book without getting a lecture from my clinical preceptor. I feel better prepared for the graduate classes I will take in the fall knowing that I can guide my learning and get the information I need from the books at home.

Original Post:
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

Online Advanced Health Assessment Course,

Online Nursing Education,

Online Health Care Informatics certificate program

Barter and Online Healthcare Nursing Education

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Bedsores treatment, comment

September 25, 2009

When it comes to bedsores, prevention is clearly worth more than any cure. Wheelchair-bound or bedridden people should shift their positions regularly. They should be bathed frequently and dried thoroughly, and their skin should be lubricated with a mild, non-irritating lotion. They should have clean, dry, tight-fitting, unstarched cotton sheets; loose-fitting clothes; plenty of air circulation; a healthy diet; and some sort of regular exercise – even if a caregiver has to move their limbs. To cushion sensitive areas, try an "eggcrate" foam mattress overlay, a water-filled mattress, or a sheepskin pad over the bedsheets. Consider a variable-pressure mattress with separate sections that can be inflated and deflated independently to adjust pressure on the patient’s body. A change in a patient’s condition demands immediate attention, some examples include, but are not limited to: (1) A person is going to remain bedridden or immobile for an extended period, cannot move or is very weak, and is beginning to develop bedsores. The person may need regular attendance by a nurse or other trained health-care provider. (2) The sore produces a discharge, which may contain pus or become foul smelling; or if the sore turns black. This indicates an infection or tissue death (Gangrene); get immediate medical attention.

Original Post
September 7, 2009
Title: Documentation of Bedsores, comment

Having worked in the NICU for many years, we see several issues with skin breakdown. For the micro-preemies who are lacking the epidermis (or extremely thin epidermis)- it is especially hard to not have skin breakdown, anything that potentially touches their skin will cause breakdown. All of these babies are considered critically ill therefore require several EKG leads, pulse oximetry probes and other transcutaneous monitors. These monitors should be repositioned every couple of hours to minimize the damage and burns. Documenting and notifying the physician of skin breakdown is EXTREMELY important with these patients as they are at such high risk for infections.

Original Post
August 20, 2009
Title: Documentation of Bedsores, comment

This is very true about the documentation of bed sores being incorrect. In the ICU where I work at, we actually document initially if there are any sores as soon as the patient arrives. It is located in the admission assessment. After that it is up to the nurses top document if there have been any changes in the skin integrity of the patient. Multiple time we see a skin assessment documented with a stage one/two pressure ulcer when reality is that it is incontinence associated dermatitis. Most time the IAD can resolved by either timely cleansing of the person, the insertion of a rectal tube and foley catheter (if not previously present) and some type of barrier ointment. In a way prevention is the best medicine for IAD and Pressure Ulcers, in companied with good core and forensic assessment skills. If the pt is having large loose stools, create a prevention to keep the skin intact.

Original Post
August 3, 2009
Title: Documentation of Bedsores, comment

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

Advanced Health Assessment Online Class

Advanced Health Assessment II Online Class

Health Care Informatics Online Certificate Program

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Medical information and the Internet

September 25, 2009

It is becoming increasingly difficult to gauge the reliability of health information on the web. Just until recently, it was extremely difficult for many people to search for healthcare information, but advances in technology, such as the Internet, are making it more accessible. Patient centered medical information on the Internet could provide healthcare professionals with the opportunity to learn more about patients’ and relatives’ concerns and to refer them to such reliable sources of information when and where appropriate. However, little has been done to assess, control, and assure the quality of this medical information that has flooded the web. Difficulty in judging the validity of this influx of medical information thus poses a problem for people using the Internet. The Internet can be a good source of information on common health problems, but advice obtained through the web should not be a substitute for routine care by a family doctor or other medical professional.

Health Promotion/Disease Prevention Online Class

Patient Education & Counseling Online Class

Health Care Informatics Online Certificate Program

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The Elderly and the Internet, comment

September 25, 2009

Social networking has become a way for the elderly to communicate with friends and family. More and more are moving away from email and logging into social networking sites, such as Facebook, MySpace and Twitter. Why are they choosing to use these social networking sites over email? Simply for the convenience, and the fact that they can reach people they have not communicated with in a long time. With email, you have to have an actual address, which limits who they are able to communicate with. While this has become a great tool for parents and grandparents to connect with their family, some of the younger generations are not so keen on the idea that their parents or grandparents are able to be added to their "friend list." Retirement is a wonderful concept, but the reality is that most people are not able to retire and maintain the standard of living they are accustomed to. Not only are those who retire needing to find supplemental income, many people who have not had to work are finding it nearly impossible to survive in this economy without some form of income. Therefore, they are logging onto the Internet to search for home business opportunities. Once they have found what they would like to pursue, they start using the Internet for information and for marketing purposes. Social networking sites have made it possible for the elderly who have chosen to find a way to make an income from home to network with others. These sites are a great way to find support, as well as market their business. Many people reaching the age of retirement are using the Internet to make plans for traveling. The Internet is an excellent tool for people to find the best deals and best places to go. The mature users of the Internet population have grown over the last few years, as well as the reasons for which the elderly are using the Internet. There are many more people ages 55 and over that are more familiar with how to use the Internet due to training through work, which allows for more people in this age group to access the Internet for a variety of reasons. With the increase in the need for a supplemental income after retirement, more people will turn to the Internet for business opportunities. Internet businesses will begin to target more people in this age group, which will increase mature Internet users. Will the elderly someday dominate the Internet? With the users becoming younger and younger each year, it is not likely, but they will definitely make up a significant percentage.

Original Post
September 7, 2009
Title: The Elderly and the Internet, comment
Having my grandmother who lives in another state send all of us daily emails has had a positive effect on not only us, but also my grandmother. She is sick and unable to travel, she finds comfort in sending out emails and jokes to her family. She has even recently joined Facebook! Which was shocking to me at first. But the more the elderly do stay in touch with friends and family the better! I have read many articles in the past regarding the importance of keeping your mind stimulated as you age and never stop learning. So for the elderly to branch out and learn new technology, can only bring them a wealth of information, and keep there minds stimulated!

Original Post:
August 26, 2009
The Elderly and The Internet, comment
While I agree that the Internet has enabled the elderly as well as many others an opportunity to research health information. The elderly must be aware that all sites do not contain quality accurate medical information and that the researchers should use caution. Information should be taken from sites with long established history for providing credible and reliable medical information. Now, from a purely mental health prospective, the Internet provides an opportunity for the elderly to connect with family, senior citizen groups, and other outside activities that they would otherwise not have any access. In this day of modern technology, not many family members are reachable by home phones; therefore cell phones, email, and text messages are the norms for communication. In fact, if one wants to keep in touch with family and especially the teenaged family members, email and text messages are their best chance for communication. In addition, with the limited amount of patience and attention teenagers’ exhibit, a brief and not so personal interaction with elderly relatives is about all they can stand. So if text messaging is the chosen method of communication, one must become well informed about the text language. In addition, for many elderly people having the ability to stay in regular contact with family members does as much or more for their psyche than anything else does.

Original Post
April 29, 2009
The Elderly and the Internet
The Internet has become not only a useful tool for the elderly by providing a lifeline to friends and family, but also offers a source of references for those seeking health information. Health Promotion (2006) notes: “because individuals will be increasingly responsible for their own health, they will need access to quality information that has not been readily available in the past.” They also go on to recommend “Net Wellness, an electronic consumer health information services that provides the best possible health information to the broadest possible populations.” This site not only provides consumers with information on health topics, they also assists in locating health centers and provides a reference library. In addition, the site will respond to health related questions, drawing upon a panel of almost 500 experts. It has become a one-stop shopping mall for the health information consumer. As long as the resources are available (computer and hook-up), the ease of using a computer is readily mastered for most, regardless of age. My mother has been proficient on her PC for many years, and in the Human Resource office of the organization where I work, Bob, a 94-year old volunteer, has assisted customers with filling out on-line applications for several years. I think he is always amazed by the number of younger people that are not comfortable on the computer and takes a sense of pride in his skill level. By using the computer to broaden one’s knowledge of health promotion, we all become wiser consumers, including those of all ages.

Online Computer Class for Senior Citizen Healthcare Workers

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Is Online Learning Easier? (comment)

September 24, 2009

Approximately 20 years ago, I participated in a program when I returned to college for my professional nurse’s degree; where I challenged a particular subject to obtain a passing grade. I had been an LPN working in a Recovery Room for 18 years. I felt that I had many years of experience during this time, that I could study from about 2-3 suggested texts and then take a very difficult exam. After studying for six different subjects, and passing the exams, I then entered my senior nursing year to matriculate and only take my two nursing courses in college. I had done this, go to college, and work full-time to achieve my AAS in nursing. I was very confident going into this online program, as I knew I was very organized and structured, and felt I could accomplish this with ease. In my nursing classes, I had to deal with sometimes very much younger students, sometimes right out of high school. They did not share my passion for nursing and I found them to be very disruptive in the class. I found my professors very helpful, willing to assist me when I ran into trouble, and often sharing their nursing experiences with us. I often scored extremely high on my exams and my labwork. Therefore, again, I thought, I would definitely do very well with online classes. Well, 20 years have passed, I’m not as young, and can’t remember quite like I did in the past and I am very tired after working sometime 9-10 hours in the hospital. Although I can go to my office and study, often spending 3-4 hours on either the computer or reading, I find I am very limited to what the professors can share with me. They do not always get back to me right away if I have a question or problem, which I can certainly understand. In addition, even though the Internet opens up a completely new world to the student, I have not yet grasped even one tenth of the capabilities of the Internet and how it can assist me. This is very upsetting to me, but I have chosen this route to obtain my bachelors in nursing. Yes, it is more convenient for me at this time in my life, it is easier as I am in the comfort of my home that I have been away from for 9 -10 hours, but sometimes I feel that the cons outweigh the pros—in my particular case. I only have this and another course to go, and I am getting a little discouraged at the present.

Original Post
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

 Online Nursing Education

Tags: , , ,

Financial Aid

September 17, 2009

Are there financial aid packages available for online learning of Healthcare Informatics, Nursing Health Assessment, and other nursing subjects?

Original Post:
September 9, 2009
Title: Is Online Learning Easier? (comment)
Many people think when you take an online course, its easier because you can use your books or other online resources whenever you need too. It is very easy get distracted when you are home. If you try to do school work with the TV on, or other distractions, you will not succeed. Some people need the structure of a class room to learn. I think it takes a disciplined, organized individual to do online learning. One person commented that some teacher "spoon feed" the class the information. I agree with her, when you take an online class, you have to teach and learn the information yourself. Although sometimes I get distracted at home, I force myself to stay in my office until my work is completed.

Original Post
August 31, 2009
Title: Is Online Learning Easier? (comment)
I am currently taking Advanced Health Assessment II with Dr. Johnson. This online learning has been a great learning experience for me!! I am used to the classroom setting but I agree that this way of learning helps with preparing for graduate school. I have just started graduate school and much of it is self-directed with deadlines. This course so far has taught me time management as well as self motivation. I look forward to future online course I may take in the future!

Original Post
August 20, 2009
Title: Is online learning easier? (comment)
After having many years of education under my belt I have decided that on-line education is like any type of education, you get out of it what you put into it. The student may work very hard toward the subject at hand and gather as much information as possible or the student may do the bare minimum to get by. The fact that there is so much information out on the Internet means you have the ability to locate a wide array of information; however the student must be leery of the information that is out online as verify it is from a reputable source. In order for an online course to be practical, especially in assessment, hands on education must be involved. It is important for the Nurse to be able integrate and to use the knowledge that they learned on their own, in a hands on situation where the assessment skills that they have read about come to fruition.

Original Post:
August 5, 2009
Is online learning easier? (comment)
I feel like the introduction of technology in education has greatly helped increase organizational skills. When you are part of an online class you must be very organized and independent. It requires a lot of good communication skills and requires one to be computer savvy. The student must read and acquire all of the information themselves from textbooks and other resources the course may provide. The instructor of the course is simply there to provide you with any questions you may have regarding the material. It is up to the student only to obtain the most important information from the reading material and to retain it for future use. I think that these skills will surely help me with graduate school when I start in the fall.

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I agree that online learning is much more challenging than traditional classroom learning. Teachers do spoon-feed the students the information that is needed in order to pass the exams. Whereas online instruction is based on the assignments given and one must be prepared for every aspect of that assignment and not just focus on what the teacher says will be on the exam. Granted, you have some students who are more comfortable with having an instructor available immediately for any questions or unclear information. Online classes also offer access to the instructor as often as needed but much of online instruction requires the student to do the research and try to come up with the appropriate responses on their own before referring to the instructor. Online instruction requires individuals to become more independent and in charge of their own learning at their own pace. For me it has been a godsend.

AND

Original Post
August 3, 2009
Title: Is Online Learning Easier? (comment)
I believe that online classes prepare you to enter graduate school. Graduate students must be responsible for large amounts of information that must be self-taught. It would be impossible to expect to get everything you need for an exam, or eventually your career, from the classroom as a graduate student. I like that in NR534 Advanced Health Assessment (as taught by Dr. Johnson) I am responsible for reading the book, completely the interactive exercises, and memorizing the basic information. I then go to clinical and exam a patient using the knowledge I have taught myself along with guidance through the exam from my preceptor. I learn how to perform an assessment on a patient from information from the book and experience of my clinical faculty. I am forced to be productive at home because I am expected to report to clinical prepared to use the knowledge from the book without getting a lecture from my clinical preceptor. I feel better prepared for the graduate classes I will take in the fall knowing that I can guide my learning and get the information I need from the books at home.

Original Post:
July 20, 2009
Title: Is Online Learning Easier?
While at work last night we had a discussion of the different types of programs where nurses can earn their BSN and/or MSN. I was surprised that the majority of nurses said they preferred the traditional classroom over online or distance programs. The view was there would not be the instructor support to help with elements of a course that the student was not able to understand. I look at this experience totally opposite, with the entire Internet at my disposal; I can research any topic and find the answers myself. In a classroom I would be limited to what the instructor was putting forth. Yes, I can always later do the online research but how often will that happen. I think in the classroom, instructors consciously or subconsciously teach to how they will test to insure the success of their students. With online learning, I am responsible for learning the material and have no idea what specific topics will be on an exam. It isn’t that it is easier to do an online degree program; it requires the desire to look for and learn the information as opposed to having it spoon-fed.

Online Advanced Health Assessment Course, Online Nursing Education, Online Health Care Informatics certificate program

Tags: , , , , , ,

Documentation on Bedsores, comment (part 2)

September 15, 2009

When performing a skin assessment the obvious places to look for pressure ulcers are the sacrum, elbows, and heels. We can not forget to look in the unlikely places, such as the back of the head, ear lobes and around an ET tube. Doing many prevalence studies at numerous hospitals, I found many pressure ulcers that are missed or with improper documentation. I found that often fungal rashes, healed pressure ulcers, blanchable redness, and moisture related maceration are staged as a pressure ulcer. One hospital that recently changed to computer charting, has a system that can list all patients that were documented with pressure ulcers on a given day. What we found useful for the wound care nurse to do, was monthly pull up a list of all pressure ulcers that were documented and validate them. While doing this educating the staff nurse. After doing this for several months, when the quarterly prevalence was performed, there was markable improvement in documentation.

Original Post
September 7, 2009
Title: Documentation on Bedsores, comment

Having worked in the NICU for many years, we see several issues with skin breakdown. For the micro-preemies who are lacking the epidermis (or extremely thin epidermis)- it is especially hard to not have skin breakdown, anything that potentially touches their skin will cause breakdown. All of these babies are considered critically ill therefore require several EKG leads, pulse oximetry probes and other transcutaneous monitors. These monitors should be repositioned every couple of hours to minimize the damage and burns. Documenting and notifying the physician of skin breakdown is EXTREMELY important with these patients as they are at such high risk for infections.

Original Post
August 20, 2009
Title: Documentation of Bedsores, comment

This is very true about the documentation of bed sores being incorrect. In the ICU where I work at, we actually document initially if there are any sores as soon as the patient arrives. It is located in the admission assessment. After that it is up to the nurses top document if there have been any changes in the skin integrity of the patient. Multiple time we see a skin assessment documented with a stage one/two pressure ulcer when reality is that it is incontinence associated dermatitis. Most time the IAD can resolved by either timely cleansing of the person, the insertion of a rectal tube and foley catheter (if not previously present) and some type of barrier ointment. In a way prevention is the best medicine for IAD and Pressure Ulcers, in companied with good core and forensic assessment skills. If the pt is having large loose stools, create a prevention to keep the skin intact.

Original Post
August 3, 2009
Title: Documentation of Bedsores, comment

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

Tags: , , , ,

Documentation on Bedsores, comment

September 15, 2009

When performing a skin assessment the obvious places to look for pressure ulcers are the sacrum, elbows, and heels. We can not forget to look in the unlikely places, such as the back of the head, ear lobes and around an ET tube. Doing many prevalence studies at numerous hospitals, I found many pressure ulcers that are missed or with improper documentation. I found that often fungal rashes, healed pressure ulcers, blanchable redness, and moisture related maceration are staged as a pressure ulcer. One hospital that recently changed to computer charting, has a system that can list all patients that were documented with pressure ulcers on a given day. What we found useful for the wound care nurse to do, was monthly pull up a list of all pressure ulcers that were documented and validate them. While doing this educating the staff nurse. After doing this for several months, when the quarterly prevalence was performed, there was markable improvement in documentation.

Original Post
September 7, 2009
Title: Documentation on Bedsores, comment

Having worked in the NICU for many years, we see several issues with skin breakdown. For the micro-preemies who are lacking the epidermis (or extremely thin epidermis)- it is especially hard to not have skin breakdown, anything that potentially touches their skin will cause breakdown. All of these babies are considered critically ill therefore require several EKG leads, pulse oximetry probes and other transcutaneous monitors. These monitors should be repositioned every couple of hours to minimize the damage and burns. Documenting and notifying the physician of skin breakdown is EXTREMELY important with these patients as they are at such high risk for infections.

Original Post
August 20, 2009
Title: Documentation of Bedsores, comment

This is very true about the documentation of bed sores being incorrect. In the ICU where I work at, we actually document initially if there are any sores as soon as the patient arrives. It is located in the admission assessment. After that it is up to the nurses top document if there have been any changes in the skin integrity of the patient. Multiple time we see a skin assessment documented with a stage one/two pressure ulcer when reality is that it is incontinence associated dermatitis. Most time the IAD can resolved by either timely cleansing of the person, the insertion of a rectal tube and foley catheter (if not previously present) and some type of barrier ointment. In a way prevention is the best medicine for IAD and Pressure Ulcers, in companied with good core and forensic assessment skills. If the pt is having large loose stools, create a prevention to keep the skin intact.

Original Post
August 3, 2009
Title: Documentation of Bedsores, comment

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

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Documentation on Bedsores, comment

September 15, 2009

Since the new CMS guidelines came into effect, many hospitals have put into effect new policies and procedures around documentation. Focusing on skin assessments on admission, braden scores, consultations, physician and nurse documentation. Being an ER nurse we really found it difficult to understand the importance of pressure ulcer documentation on arrival. With being overwhelmed with so many critical patients, I found it hard to remember to do a skin assessment. If we were able to do photo documentation, it would help make such a difference. What a great tool to help the nurses and protect the hospitals! I hope someday my hospital will implement the same!

Original Post
September 7, 2009
Title: Documentation on Bedsores, comment

Having worked in the NICU for many years, we see several issues with skin breakdown. For the micro-preemies who are lacking the epidermis (or extremely thin epidermis)- it is especially hard to not have skin breakdown, anything that potentially touches their skin will cause breakdown. All of these babies are considered critically ill therefore require several EKG leads, pulse oximetry probes and other transcutaneous monitors. These monitors should be repositioned every couple of hours to minimize the damage and burns. Documenting and notifying the physician of skin breakdown is EXTREMELY important with these patients as they are at such high risk for infections.

Original Post
August 20, 2009
Title: Documentation of Bedsores, comment

This is very true about the documentation of bed sores being incorrect. In the ICU where I work at, we actually document initially if there are any sores as soon as the patient arrives. It is located in the admission assessment. After that it is up to the nurses top document if there have been any changes in the skin integrity of the patient. Multiple time we see a skin assessment documented with a stage one/two pressure ulcer when reality is that it is incontinence associated dermatitis. Most time the IAD can resolved by either timely cleansing of the person, the insertion of a rectal tube and foley catheter (if not previously present) and some type of barrier ointment. In a way prevention is the best medicine for IAD and Pressure Ulcers, in companied with good core and forensic assessment skills. If the pt is having large loose stools, create a prevention to keep the skin intact.

Original Post
August 3, 2009
Title: Documentation of Bedsores, comment

The hospital where I currently work also includes documentation of existing pressure ulcers on admission of a patient. However, the protocol asks you to assess the patient’s skin then to document on paper what the ulcer looks like, stage, size, drainage, etc. The paper charting does not require a picture of the pressure ulcer that was found by assessment of the RN. I think this leaves a wide margin for error. It is probable that some ulcers will not be documented correctly. I believe that a photo would be advantageous to the medical record along with perhaps a computerized charting system where you can label with an X any area of the body that has breakdown and then attach a photograph to the document. Also the documentation I work with does not allow for updates on how the pressure ulcer heals or worsens. This also leaves room for criticism and error. I think my place of work would benefit from photo/computerized documentation of pressure ulcers.

Original Post:
July 31, 2009
Title: Documentation of Bedsores, comment

I found this post and other comments relative to my new nursing job. As an experienced ER nurse, we found little time to assess or document pressure ulcers. With the new CMS guidelines that came out this past October, Medicare will not longer be reimbursing for facility acquired pressure ulcers. My new nursing role focuses on prevention and education. I was very surprised how little I knew about pressure ulcers from working in the ED. Yet it is so vital that our assessment starts there. The photo proof documentation mentioned in this Post sounds like an excellent idea. One of the hospitals I work with, just installed a whole new soft ware program for nursing documentation. It is really easy to chart your skin assessments and pressure ulcers. With drop down choices, body diagrams. But the wound care nurse still has to validate the floor nurses documentation with her own patient assessment every month. I helped her with this, and it was very time consuming. It was double the work in my eyes. Yet we did find, many pressure ulcers that were resolved and many that were staged incorrectly, as well as several that were missed by the RN. Even though we have many different technologies to help us with our documentation and assessment, it still comes down to basic education.

Original Post:
June 17, 2009
Title: Documentation of Bedsores
Joint Commission and CMS (Medicare) has set a Patient Safety Goal of not allowing bedsores to occur during hospitalizations. My institution uses technology to document existing wounds at the time of admission assessment. We are a totally computerized charting hospital. When we identify an existing wound, we bring up a screen of the body and insert a photo of the wound into the patient’s medical record. This feature allows us to prevent lawsuits and receive the correct reimbursement of that patient’s hospitalization. Health assessment no longer has to rely on a verbal or hand written dictation to describe history and physical assessments!

Tags: , , , ,


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