One thing you might see while reviewing home care records and consulting with home care agencies and in doing some legal nurse consulting is that you don't always cover your basis. And so in your OASIS-C, if you mark that your patient has been identified as being at risk for pressure ulcers, what a hope that you're going to develop.
But what you've got to do right off the bat either in that admission on the very first visit after that is get a support surface for bed and chair. Now there's a lot of variability. And so it's important that you'd be an advocate for your patient. As you're selecting a durable medical equipment company or a bed company to bring in a support surface, you want to advocate for your patient.
Our expert mentioned in a CMS OASIS session that a pressure ulcer prevention mattress is always going to be better than an overlay. If your patient has a hospital bed frame that prevention mattress is going to do a great job will fit right on that bed frame and go a long way. You can even do some treatment on these surfaces.
If your patients are sitting in a chair, they've got to have a pressure reduction cushion. Sadly Medicare had changed their regulations for providing chair cushion. It's a little more difficult.
So that you can prevent pressure ulcers that then you're going be charged with the agency acquired pressure ulcer. And then you're going to be charged with the task of caring for it. So that $22 investment in a four-inch foam chair cushion goes along way really towards saving money.
Remember that positioning is important. It is so important to note how your patient is lying when you arrive at home. It's very important to make sure that they understand how to turn and position, how the alter turns and tilts and then how to float heels. There's more and more information coming out that it is essential to float heels, not just reduce pressure to heels.
Nutrition assessment and to have a nutritional plan is very important. A 24-hour diet recall is so important. You've got to do a better job of teaching our patients how to meet their protein needs, how to make sure, how to understand when they're drinking enough fluids.
Your patients probably don't know how much protein they need. So if you can calculate their body, if you can get their body weight, change it to kilograms, then you can tell them not only how much protein they need but get some packages from the kitchen and show him how to read. Put a light food package labeling. And then certainly with your wounded patient, this is vitally important.
You’ve got to be careful with overhydration because they have CHF or maybe renal failure. But suppose many of your patients are chronically dehydrated. If they're chronically dehydrated, the capillaries in their dermal layer are going to be clamped down. There is going to be sort of constricted to try to conserve energy or conserve the flow that's there.
Therefore, you're going to have reduced oxygen, nutrition and hydration in the tissues. And they're not going to be able to defend against pressure. So nutrition is important.
And then incontinence management, we have our responsibility to help our patients who are incontinent, understand how to keep their skin clean, dry and protected. Our expert mentioned it in a home health conference that when it comes to incontinence management, a lot of our patients struggle with how to pay for product a good skin barrier ointments that they can take up from the drug store or Wal-Mart is always useful. But there are some incontinence wipes that contain a product called Dimethicone.
Now Dimethicone is a palmer. That's even found in some barrier creams. It's a very popular ingredient and it's included in some incontinence skin cleansing wipes. And when you clean with this wipes, not only do you clean and wipe the incontinence but you paint on a breathable layer of plastic. It's very useful in protecting the skin from moisture and friction.
Again there is a wipe because you are home care audience, the Pampers brand baby wipes. If your patient can't afford the adult incontinence wipes that contain Dimethicone, those wipes actually do contain some Dimethicone. And that might be something that they can afford and that might help them because if we can protect the skin and keep it intact, we're going a long way towards preventing pressure ulcers.
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