Skin Risk Card- A tool for identifying an individual patient's risk for skin breakdown

Purpose:To provide a tool for  recognition of skin risk breakdown by staff and allied health care workers in an acute care setting .This  provides a guide  when the Braden skin risk score is less than 18 .Heightened awareness of pressure ulcer prevention have become the mantra of national healthcare groups .Daily Braden scores are documented and policy and procedure reflect nursing measures that should be included . But how do we relate this to the individual patient's needs ? This tool with check boxes  reflects  areas of importance related to the six areas of measurement on the Braden scale .  The tool  is initiated by the nurse when the Braden score is less than 18. The staff may participate in identifying and checking the various icons. The icons include fragile skin, nutrition (a plate to  encourage patient to eat 75 % of meals and supplements ),time to turn( clock with arrows ),rain and puddle for incontinence , heels reddened with arrow up to keep heels off mattress, and a picture of a support surface to remind staff to avoid plastic underpads and document the use .Nursing staff and other departments were inserviced to the purpose and meaning. The laminated tool was placed at the head of the bed on a bar .Erasable china pencils were used for marking. Monthly audits were completed by the wound committee to identify appropriate documentation based on the individual patient's needs . Improved documentation occurred when the PCA's (patient care assistants)were able to document their care. Previously only the  RN and LPN charted on the Meditech ADL (activies of daily living ) screen. The PCA's  also took pride in their work and documentation.The  design of the ADL screen also helped to reflect the areas of nursing care related to the icons .All  documentation could be on one screen except for the nutrition.This has provided an opportunity to focus on early interventions for pressure ulcer prevention.