Risk Assessment

Samantha Kuplicki's picture
Surgeon Changing Gloves

By Samantha Kuplicki MSN, MSN, APRN-CNS, AGNCS-BC, CWCN-AP, CWS, RNFA, CFCN

Surgical site infections (SSIs) are the most frequent complications in colorectal surgery procedures, with the documented incidence in literature ranging from 3% to 30%. (And, as we discussed in a previous installment, patient-specific risk factors can be the most challenging to control.) In response to these data, the American College of Surgeons and The Joint Commission’s Center for Transforming Healthcare launched a collaborative effort in 2012 to reduce colorectal SSIs.

Holly Hovan's picture
patient repositioning

By Holly Hovan MSN, APRN, CWOCN-AP

Friction and shear… what’s the difference and how do they cause pressure injuries? Are wounds caused by friction and shear classified as pressure injuries? What’s the easiest way to explain the differences between these critical components of the Braden Scale that are not always understood? How do I know if my patient is at risk?

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Holly Hovan's picture
patient mobility and activity

By Holly Hovan MSN, APRN, CWOCN-AP

The Braden category of activity focuses on how much (or how little) the resident can move independently. A resident can score from 1 to 4 in this category, 1 being bedfast and 4 being no real limitations. It is important to keep in mind that residents who are chairfast or bedfast are almost always at risk for skin breakdown.

Holly Hovan's picture
enteral nutrition feeding

By Holly Hovan MSN, APRN, CWOCN-AP

A common misconception by nurses is sometimes predicting nutritional status based on a resident's weight. Weight is not always a good predictor of nutritional status. Nutritional status is determined by many factors and by looking at the big picture.

Holly Hovan's picture
Moisture on Skin

When nurses hear the term moisture, they usually almost always think of urinary or fecal incontinence, or both. There are actually several other reasons why a patient could be moist. Continued moisture breaks down the skin, especially when the pH of the aggravating agent is lower (urine, stomach contents—think fistula, stool). When there is too much moisture in contact with our skin for too long, we become vulnerable to this moisture, and our skin breaks down. Increased moisture places a patient at risk for a pressure injury as the skin is already in a fragile state.

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Holly Hovan's picture
neuropathy testing for sensory perception (Braden Scale)

By Holly Hovan MSN, APRN, CWOCN-AP

As wound care professionals, the Braden Scale is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly in order to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of the Braden Scale may also contribute to a multitude of different scores; the resident behaves differently on different shifts, for example, asleep on night shift but up and about on days. What is the correct way to score them? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, transfer, receiving, and most importantly, with any change in condition.

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Margaret Heale's picture
delivery of high quality bedside care

by Margaret Heale, RN, MSc, CWOCN

Stepping forward into a model of care that is quantitative and objective is essential and most definitely the way we are headed in wound care and beyond. Using the word "care" in the same sentence with "quantitative" and "objective" may sound like an oxymoron, but care does not have to be fluffy and old-fashioned. What it must be is kind, gentle and authentic. My question is: how can the care we provide be kind, gentle, and authentic when the emphasis is so obviously on cold, hard measures and stark black and white comparisons with little value placed on the people who are the care providers?

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