Marlee Craker and Jazz White

Skin is the largest organ of the body and is important for a variety of reasons.

These include protection against the outside environment, thermal regulation, detection

of sensations, and endocrine functions. As a result, maintaining skin integrity is vital for

an individual to live a happy and healthy life (Internet Brands, 2021). Changes in skin

integrity, such as from prolonged pressure or friction resulting in injury to the skin and

underlying tissue, causes a reduction in proper blood flow to the area which results in

redness and ultimately a wound if left untreated (Virginia Department of Behavioral

Health & Developmental Services). Risk factors for changes in skin integrity include

impaired functional mobility, altered sensory awareness, incontinence, limited activity,

impaired range of motion (ROM), impaired nutritional status, altered skin integrity, pain,

and impaired circulation (Hall, 2013). Research has shown that changes in skin integrity

acquired in hospitals could cost more than $26.8 billion for the hospitals and ultimately

lead to being a major economic burden on the health care system (Padula &

Delarmente, 2019). In addition to the cost, changes in skin integrity can also lead to

prolonged hospitalization, increased pain, infection, and possibly death of the patient

(Armour-Burton et al., 2013). Lastly, statistics from the CDC show in 2004, 11% of

skilled nursing facility (SNF) residents had changes in skin integrity, stage II being the

most common (Park-Lee & Caffrey, 2009). As a result, maintaining skin integrity and

treating changes in skin integrity in these residents is important for the SNF to not only

save money but to improve their quality of care, well-being, and overall health.
 To help eliminate changes in skin integrity in the SNF, the occupational therapy

(OT) manager will implement new policies. This includes administering the Braden

Scale on the residents’ arrival. This will look at risk factors such as sensory perception,

moisture, activity, mobility, nutrition, and friction and shear to help predict pressure sore

risk of each resident (Braden & Bergstrom, 1988). If residents are at risk, they will be

put on a list and will be seen biweekly by the wound care team that is being created by

the OT manager. This will allow the wound care team to fill in the table below and track

changes in skin integrity for those residents at risk. This will also allow for a

collaborative approach, where each wound care team member will work together with

the help of the resident to track and plan treatment for changes in their skin integrity.

The implementation of the wound care team will allow the hospital to track measurable

outcomes and the impact of the Braden Scale, the table below, and implemented

treatment plans efficacy. This will hopefully lead to improved outcomes for the residents

and ultimately reduce the cost of preventable changes in skin integrity leading to the

SNF saving money that can be allocated elsewhere.

Table. 1

Resident Pressure Ulcer Ulcer Skin Treatment Picture

Room # Ulcer Stage Measurem Team Plan Taken

Location ent (cm) Consulted

 The wound care team will have their rounds every Tuesday and Thursday and

will be created by the OT manager. Additional responsibilities of the manager include

ensuring appropriate and adequate training of said wound care team members,

implementation of wound care program, and ensuring all needed equipment and

materials are at the clinic for the team. The team lead position will be held by a wound

care OT specialist who will either be an existing employee or an outside hire. Their

responsibilities include administering the Braden Scale and measuring all skin changes

to ensure standardization of assessment administration. Other responsibilities include

training wound care team members, cleaning wounds, analyzing data collected,

creating a treatment plan for the resident’s wounds, and educating residents and team

members on the importance of adhering to the treatment plan. The physical therapist,

nurse, and aides will all help with the positioning of residents during the wound care

rounds. The nurse will also perform routine skin checks and ensure routine checks by

aides during showers and dressing. In order to ensure that skin integrity is maintained in

every resident, not just those at risk, the aides will be required to document the skin

checks after every shower with every resident. In addition, the aides will help with

gathering supplies for wound care. There will also be a caseworker present for all

rounds where they will fill in the table above for each resident. Lastly, it will be all team

members’ responsibility to communicate and document any changes in skin integrity

throughout the week to ensure proper documentation and adherence to treatment

plans.
 The wound care program will need a certified wound care specialist which will be

done by 12/21. Creating and training all other members does not require certification

and will also be completed by 12/21, where training resources will be free and

downloadable online. The tentative date of implementation of the wound care program

is 01/22. Overall, as OT managers, we feel the best way to address changes in skin

integrity is to form a wound care team where the wound care specialist will educate and

train the wound team members stated above, and implement biweekly rounds to collect

data on residents changes in skin integrity to track preventive measures and treatment

plans efficacy. However, we are open to any changes or improvements to this program

to ensure the best overall outcome for our residents and reduce costs for the SNF.

References

Armour-Burton, T., Fields, W., Outlaw, L., & Deleon, E. (2013). The Healthy Skin
 Project: Changing Nursing Practice to prevent and treat hospital-acquired

pressure ulcers. Critical Care Nurse, 33(3), 32–39.

https://doi.org/10.4037/ccn2013290

Braden, B., & Bergstrom, N. (1988). Braden scale for predicting pressure sore risk.

Retrieved November 9, 2021, from

https://www.in.gov/health/files/Braden_Scale.pdf.

Hall, C. (2013). Occupational therapy toolkit: treatment guides and handouts for

physical disabilities and geriatrics (6th ed.).

Internet Brands. (2021). Functions of the skin. Wound Care Centers. Retrieved

November 8, 2021, from

https://www.woundcarecenters.org/article/wound-basics/functions-of-the-

skin#:~:text=Skin%20Functions.%20Skin%20has%20four%20main%20functions

%2C%20as,the%20first%20physical%20barrier%20to%20withstand%20any

%20pressure%2C.

Padula, W. V., & Delarmente, B, A. (2019). The national cost of hospital-acquired

pressure injuries in the united states. Retrieved November 8, 2021, from The

national cost of hospital-acquired pressure injuries in the United States - PubMed

(nih.gov)

Virginia Department of Behavioral Health & Developmental Services. (n.d.). Promoting

Skin Integrity and Preventing Pressure Sores. Office 365 login. Retrieved

November 8, 2021, from

https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F

%2Fdbhds.virginia.gov%2Flibrary%2Foih%2Foih%2520programs
 %2Feducational%2520resources%2Fpowerpoint%2520forpromoting%2520skin

%2520integrity%2520and%2520preventing%2520pressure

%2520sores.pptx&wdOrigin=BROWSELINK.

Park-Lee, E., & Caffrey, C. (2009). Pressure Ulcers Among Nursing Home

Residents: United States, 2004. Centers for Disease Control and Prevention.

Retrieved November 8, 2021, from

https://www.cdc.gov/nchs/products/databriefs/db14.htm.