CCC Opportunities for Improvement Corrective Education May 2014 Door Closure, Cylinder Storage, Working as a Team, Skin care, & Refusal of Care by Resident

Objectives At the completion of this presentation the staff will be able to: State the correct reason for closing a resident’s door Identify the location for storing partially filled and filled oxygen cylinders. Name to main goal of the CCC staff. Verbalize 2 ways to prevent pressure wounds.

Doors to Rooms To allow doors to close, all beds must be kept with the head of the bed touching the wall. All doors are to be closed in case of a fire. Doors are not to be closed when caring for a resident. To provide the resident privacy, pull the curtain entirely around the resident’s bed.

Oxygen Cylinder Storage It is a regulatory requirement that full and partially used oxygen cylinders be stored separately.

Oxygen Cylinder Storage in CCC In CCC the Oxygen Cylinders are stored in storage areas located near room 27 Cylinders in the storage on the left are partially filled Cylinders in the storage on the right are full cylinders Each door is labeled as to which type of cylinders are stored. Partially filled and completely full cylinders should not be stored together

Working as a Team We are all individuals and we are all different. We have different beliefs, cultures and live styles. An effective team works together to reach a common goal. More importantly, they put these goals first before their individual pursuits.

Goal CCC’s first goal is to care for the residents. This goal should be the focus of all staff. Sometimes it’s not easy to work together because of their differing opinions and attitude. We need to create a culture that honors differences of opinion and varying points of view.

Pressure Ulcers These areas include: Occiput Ears Scapula Spinous Processes Shoulder Elbow Iliac Crest Sacrum/Coccyx Ischial Tuberosity Trochanter Knee Malleolus Heel Toes A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

Types of Wounds Friction Shear Skin Tear Is a tissue damage that occurs when skin slides on a surface. Shear Is a deep tissue injury that occurs when skin sticks to a surface and the small vessels tear. Skin Tear Is the separation of the epidermis and dermis or both from the underlying structures.

Types of Wounds Neuropathic/Diabetic Wound Perineal Dermatitis It is often associated with diabetes mellitus. Wounds result from damage to the nerves and have an arterial perfusion deficit. Perineal Dermatitis It is commonly due to urinary or fecal incontinence leading to inflammation, erosion and or secondary infection such as Candida Albicans It may have blistering, erosion and serous exudate

Wound Stages Stage I-Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area. Stage 2-Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

Wound Stages Stage 3-Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling. Stage 4-Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Wounds Unstageable-Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Suspected Deep Tissue Injury-Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Wound Prevention Residents must be turned or repositioned every two hours. Skin needs to be kept clean and day. Linen should be free from winkles

Use the Waffle overlay for patients who have a Braden score of 14-18. Wound Prevention Use the Waffle overlay for patients who have a Braden score of 14-18. Use the Waffle Cushion to the right as a pillow for patients who are ALOC, Sedated or Ventilated

Wound Prevention Consider a specialty bed

When the Resident refuses Treatment Following the chain of command to report the treatment being refused. Report the refusal to the physician Thoroughly document the refusal including the date and time of the refusal. Document what is being refused and the resident’s reason for refusing the treatment. Discuss refusals at IDT meeting.

Thank You