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    Ulcer Qs Checklist

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    mike rosen
    1) The document provides a checklist of 37 questions for evaluating risk factors and management of decubitus ulcers. 2) The checklist addresses issues like ulcer stage and location, risk assessments, positioning, nutrition, monitoring, documentation, staff training, and review of prior incidents. 3) It is intended to be used when developing or reviewing risk plans, for educational training, and to evaluate contributing factors after incidents occur.

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    Ulcer Qs Checklist

    Uploaded by

    mike rosen
    59 views1 page
    1) The document provides a checklist of 37 questions for evaluating risk factors and management of decubitus ulcers. 2) The checklist addresses issues like ulcer stage and location, risk assessments, positioning, nutrition, monitoring, documentation, staff training, and review of prior incidents. 3) It is intended to be used when developing or reviewing risk plans, for educational training, and to evaluate contributing factors after incidents occur.

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    Ulcer Qs Checklist

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    1) The document provides a checklist of 37 questions for evaluating risk factors and management of decubitus ulcers. 2) The checklist addresses issues like ulcer stage and location, risk assessments, positioning, nutrition, monitoring, documentation, staff training, and review of prior incidents. 3) It is intended to be used when developing or reviewing risk plans, for educational training, and to evaluate contributing factors after incidents occur.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    59 views1 page

    Ulcer Qs Checklist

    Uploaded by

    mike rosen
    1) The document provides a checklist of 37 questions for evaluating risk factors and management of decubitus ulcers. 2) The checklist addresses issues like ulcer stage and location, risk assessments, positioning, nutrition, monitoring, documentation, staff training, and review of prior incidents. 3) It is intended to be used when developing or reviewing risk plans, for educational training, and to evaluate contributing factors after incidents occur.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Instructions: DECUBITUS ULCER CHECKLIST

    Proactive Risk Management: If a person receiving services/supports has this identified risk factor, this checklist can be utilized when
    developing and/or reviewing/revising a risk plan.
    Educational Tool: Training curriculum, both general and individual-specific, can incorporate the information on this checklist.
    Addressing Specific Incidents: As an incident occurs, the team can work through the variables that could have been contributing factors and
    ensure appropriate actions are taken to reduce the likelihood of a future incident of a similar manner.
    Issue # GENERAL QUESTIONS
    1 What is the stage of the ulcer (stage I, II, III, IV)?
    2 Is there a diagnosis that can contribute to ulcer development (e.g., spina bifida, terminal cancer, etc.)?
    Was there a decline in functional status prior to ulcer development? If so, include the reason for decline (e.g., stroke, worsening
    3 dementia, heart failure, etc.).
    4 Was a Braden Scale of Pressure Ulcer Risk Assessment completed? If so, include the date of assessment.
    When was the ulcer first discovered? When was the most recent head-to-toe assessment completed prior to discovery of a decubitus
    5 ulcer? What was the date of the last document indicating skin had no signs of injury (no decubiti noted)?
    6 Is there a written positioning schedule?
    If appropriate to the location of the ulcer, what type of mattress has been used (name, brand, description)? How long has it been in
    7 use for this person?
    8 What is the level of mobility (e.g., ambulatory, chair bound, bed bound, quadriplegic)?
    9 Are any devices (e.g., wedges, heel protectors, etc.) used to relieve pressure at that body site and/or other sites?
    10 Are there any positioning aids (e.g., trapeze, bed rails, etc.) being used?
    11 If there is a wheelchair, is it being used? Are footrests being used?
    12 Is there a bowel and bladder toileting program?
    13 What is the date of the last physical therapy assessment?
    14 What is the date of the last occupational therapy assessment?
    15 What is the date the decubitus ulcer is considered healed?
    16 Is there a history of prior decubiti? If so, indicate date of onset, stage and location.
    17 Describe the type of dressing being utilized.
    18 Have there been any complications (e.g., abscess, cellulitis, sepsis, osteomyelitis)?
    19 Was a wound clinic/wound specialist consulted?

    RELATED TO HOSPITAL STAY


    20 If the person returned from the hospital with a decubitus ulcer:
    a. Was an ulcer present prior to transfer to the hospital?
    b. Is a copy of the transfer packet of information sent to the hospital available?
    c. Was a skin assessment completed prior to transfer to the hospital?
    d. Was a skin assessment completed upon return from the hospital?
    e. What was the stage upon the return from the hospital (include location(s), dimension(s), etc.)?

    NUTRITIONAL ISSUES
    21 What is the date of the last nutritional assessment?
    22 Are dietary supplements (e.g., formula, zinc, vitamins) provided?
    23 Is intake recorded? If so, who reviews this intake log? What is the frequency of the review?
    24 What is the most recent albumin level (along with date)? (or other lab values followed by agency)

    MONITORING AND DOCUMENTATION


    25 What are the monthly weights for the past six months?
    26 Include the temperature record for the past 30 days.
    27 Is pain monitored? How is it recorded? What treatment is provided?
    28 Are serial photographs used to document change in the decubitus ulcer?
    29 Is there a measuring tool in the photographs?
    30 Is there a decubitus tracking/monitoring log? How is the decubitus ulcer monitored?
    31 Include the dates of all team meetings within the past six months about decubitus care and progress.

    STAFF TRAINING ISSUES


    Note: Training should be competency-based (hands-on implementation of procedures to ensure staff understand and can perform)
    32 Have direct support staff been formally trained on decubitus care/prevention?

    MONITORING BY MANAGEMENT
    33 Have other individuals in this home experienced decubitus within the past 12 months?

    PERTINENT DOCUMENTATION
    34 Copy of person’s risk plan relative to decubitus ulcers
    35 Copy of person's positioning plan/schedule
    36 Copy of person's Braden Scale of Pressure Ulcer Risk Assessment
    37 Staff training records regarding decubitus care/prevention (ALL settings - home and day programs)
    Note: Training should be competency-based (hands-on implementation of procedures to ensure staff understand and can perform)

    Name:
    Date:

    3/15/2011

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