I was wondering if nurses know the value of a good skin assessment with a new admit to your unit? 

If a patient comes as a new admit to your unit following a procedure, of ANY sort, (knee replacement, hip replacement, tonsillectomy, breast augmentation, repair of heel spurs............any procedure at all, and if a decubitus is found, requires treatment........medicare can deny payment to the facility. 

The same rule might even apply to someone who did not have surgery, maybe an illness of any sort from MS, MI, CHF, pneumonia.........anything, if a decubitus is found that did not exist prior to the admisssion........medicare will probably deny payment.  If the hospitals do not get payment, how can we get a pay raise?    If they came in to the hospital with an MI (or whatever), was treated for it with a stent............develops a bed sore, they will not pay for any of that stay including payment for the admitting diagnosis.  Stents cost a fortune! 

From what has been being drilled into our heads lately the best way to avoid the hospital getting saddled  with the bill is a complete head to toe skin assessment upon admission, make sure its documented.  If its not documented, it wasnt done.  When shift change occurs and you do your assessments........repeat that complete assessment.  A patient was brought into our unit, normal med/surg unit at around 10pm from recovery after an emergent total knee replacement.  I arrived for shift change the next shift at 6:45 the next morning, the nurse giving me report stated she was just told by the patient that she had a 'tender' spot on her bottom and it burnt, none of that was documented. When I did my assessment, I found it was a stage 2 decubitus to right and left buttocks.  We think it occured because she would 'scoot' across the bed to get to the side for toileting using the bedside commode, pulling herself with her arms, and pushing with her 'good leg'.......the whole time  dragging her butt and getting massive friction.  Also, after her postop stay, and then  on the floor, her foley catheter was pulled.....she was on lasix <one of her home meds>, and she's bad diabetic.  These last 2 things are huge issues probably with her wounds.

According to the ER report, the only wound she had when arriving to the hospital was the injury to the knee obtained by a fall that brought her in by EMS.   Our unit is screwed!!  Between 10pm and 7am.....2 stage 2 decubitus ulcers were 'grown' by scooting across the bed.  I documented my assessment, also the fact that I saw the 'scooting'.  I educated her and her husband on 'scooting and friction'.  They verbalized understanding of the importance of not creating friction  (by the way.........the surgical site was doing great!).  By noon that day, the WOCN was there starting her wound care protocol.  At 2pm, the patient was on her cpm for knee therapy and doing the pressure to her butt for 3 hours.  At 5pm, I took her off the cpm, she said she had to go to the bathroom........and here she goes just 'scooting'!  Once again, I told her to press the call light to help her get to the bedside commode.  I educated her and her husband AGAIN about this..........they verbalized understanding yet again.  The physical therapists had done some teaching with her about moving in bed to avoid friction as well prior to the cpm being applied.   I documented the noncompliance with the scooting and not asking for help to toilet!  

Anyhow, like I said............these bedsores occured between 10pm and 7am.   Her risk factors were diabetes, limited immobility due to her knee injury.   She had a very expensive surgical procedure due to a fall at home, and everything will be written off the bill by medicare probably because of poor documentation or lack of.      I'm feeling bad for the nurse whose watch this occured under..........but I'm glad I'm not that nurse. 

Im the bar code!