Resident-Specific Turning & Positioning Schedules An F314 Essential

 

May 20, 2009
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Resident-Specific Turning & Positioning Schedules
An F314 Essential

  
Directors of Nursing are continuing to search for ways to minimize the potential for skin breakdown and the potential for an F314 deficiency.  Ineffective and/or generic risk assessment can (and often does)  lead to ineffective and generic care plan interventions including the ever popular 'turn and reposition q 2 hours.'  When every resident's care plan includes the same turning and positioning frequency, a nursing home is hard pressed to demonstrate that this is a resident-specific intervention.

So, how do we determine a resident-specific turning and position schedule? Having questioned many nursing homes, the answer is almost universally (dead silence).

Assesment of a resident's skin condition helps define prevention strategies.  The comprehensive skin assesment should include an evaluation of the skin integrity and tissue tolerance.  Tissue tolerance is the ability of the skin and its supporting structures to endure the effects of pressure without adverse effects after pressure to that area has been reduced or redistributed.

So, how do we evaluate tissue tolerance?  By using a Tissue Tolerance Test!  

Let's start with testing criteria, i.e. which residents should be tested:
 
  • Those who are unable to reposition themselves in chair and/or bed (includes extensive assistance and totally dependent);
  • Those who are physically able but DO NOT reposition themselves regularly without cueing.
  • Resident with current or recent skin breakdown.It is recommended that residents who meet the above criteria be tested in chair AND bed.

Ready...set..Let's Test:
Prior to the start of the Tissue Tolerance Test, observe and record any existing aread of redness or breakdown.  

Phase I:  Position the resident in chair or bed (note position on side or back) for a 1-hour interval.  Then:  
 
  • After the 1-hour interval, reposition the resident off the area exposed to pressure and observce/document any areas of redness.
  • Recheck the area after 30-45 minutes.
  • Did any redness resolve or is there persistent redness?
  • If redness has persisted, STOP the TEST.  Consider the area to be a Stage I, notify the MD and obtain applicable treatment orders.  The resident requires repositioning at an interval SHORTER THAN I HOUR! 
  • If there is no persistent redness continue to Phase II.
Phase II: Position the resident in chair or bed (same location as used in Phase I) for a 1 1/2 - hour interval.  Then:
 
  • After the 1 1/2 - hour interval, reposition the resident off the area exposed to pressure and observe/document any areas of redness.
  • Repeat steps as outlined above.
  • If redness has persisted, STOP the TEST!  Consider the area to be a Stage I, notify the MD and obtain applicable treatment orders.  The resident requires repositioning at an interval of NO MORE THAN EVERY 1 HOUR.
  • If there is no persistent redness continue to Phase III.

Phase III:  Position the resident in chair or bed (same location as used in Phase I and II) for a 2-hour interval.  Then:
 
  • After the 2-hour interval, reposition the resident off the area exposed to pressure and observe/document any areas of redness.
  • Repeat steps as outlined above.
  • If redness has persisted, consider the area to be a Stage I, notify the MD and obtain applicable treatment orders.  The resident requires repositioning at an interval of NO MORE THAN EVERY 1 1/2- hour.
  • If there is no persistent redness, the resident requires repositioning at an interval of EVERY TWO HOURS.
  • Test Over

Remember, a resident's tissue tolerance may be different when tested in chair versus bed.  It is, therefore, important to test in both settings and to communicate any differences in repositioning schedules to direct care staff.

With the assessment of tissue tolerance and determination of the resident-specific turning and positioning schedule, go directly to the Care Plan... do not pass Go and do not collect an F314 survey deficiency! 
About the Author:
The Edge is provided to members of the Leading Age Kansas in partnership with Life Services Network, the Illinois AAHSA affiliate. Authored by Dorrie J. Seyfried, Vice President of Method Management, Risk Management & LTC Consultants based in St. Charles, Illinois.
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