Physical exam for pressure ulcers with people without risk factors

We had a pt that had developed a pressure ulcer a couple months ago, and the manager is pressure ulcer paniced now. I always ask if the pt has any sores or wounds, but she wants us to look between the buttocks of all the pts, even young people with no risk factors, and I am uncomfortable with this. Am I being to cautious, should I just get a aide to be there and do it, or what? How do yo uapproach this situation. If I were in that situation, I would refuse. How do other places handle this? Do you do a detailed physical exam for all pts?
What setting do you work in?In most hospitals, the standard of care is to do a complete skin assessment (exam) with a pressure ulcer risk scale (Braden, Norton) on admission. Usually in a hospital setting then, daily follow up skin assessments/exams are required. I think what your manager is asking you to do is pretty standard. If your facility has a skin care policy, this probably comes from that. It's quite possible that this has been the way it should have been done for awhile, but no one has been compliant with the policy. It's hard to say from your post --- not a lot of info is given.

Whether I've worked in a LTC setting or hospital setting, ALL patients get a thourogh skin check on admission, and in LTC, weekly. That means between the buttocks, under folds, even between the toes.The last thing any facility wants is an acquired pressure sore.You, as a nurse, are solely responsible for performing the skin assessment. You can have an aide in there to assist you with turning and such, but not to do the assessment.Any patient has the right to refuse, but make sure you document their refusal.While I can respect the fact that it makes you uncomfortable, you will be a lot more uncomfortable if a suit is brought against you and/or the facility because a pressure area was not noticed on admission.But, to answer your question, this is normal standard practice in every facility I've worked in.

At our hospital we do a complete skin assessment on ALL pts. We document anything found with the date and time. We also document old scars.. If a person on admission has no skin breakdown and later one was found, insurance will not pay for the care of it. Same as if a person comes in with a pressure ulcer that was not found on admission and later documented, insurance can refuse to pay and state that lack of proper care caused the ulcer..

At our facility we are required to check everyone's skin and do a complete skin assessment every shift. I work in a hospital, most of the population is elderly and does have some sort of skin issues. When I have a patient who is younger and I know they aren't a risk factor for breakdown etc. I usally just ask another nurse, usually the charge nurse if available to come in and look at the pts skin atleast for the admission assessment. This helps me atleast feel less uncomfortable. Also always explain to the pt why you are doing it and it will only take a few minutes. Hope that helps

I've been hospitalized twice in the past year, and I can guarantee that NO ONE did a total skin assessment on me! I am 58, and diabetic, and was in for CAD - received 2 stents each time.And I have some issues with my lower legs and my left heel. I actually asked one nurse to check my heel to see if there were any signs of breakdown. I would have welcomed a complete assessment.Also, I admit to not usually doing a total assessment on the mainly ambulatory patients, and those that can turn themselves easily in bed. Most of these people are aware of their skin status.

I use common sense. When I admit a NH or non-ambulatory patient, I do a very thorough skin assessment. When they are non-diabetic walkie-talkie I check all the exposed skin and ask them if they have any issues with the rest. It's easy for your manager to insist everyone else get these proctology type assessments. She's not the one who has to do it. I would feel like a weirdo asking someone my age to bend over and spread 'em.

I'm lucky, most of my pts come from surgery..and I'm able to turn them when getting them when getting into bed..and get a good look at elbows, bottom, heels, when they're out of it.

The patient may not be aware of a sore or a wound. Skipping a complete skin assessment will bite you in the butt sooner or later (pun intended).

Quote from systolyThe patient may not be aware of a sore or a wound. Skipping a complete skin assessment will bite you in the butt sooner or later (pun intended).

risk assessment anyone ? pressure risk scoresconsideration of bed rest etc if that is not in the pressure risk score you use ( it is in Waterlow, along with things like diabetes, steroid use , neuro deficeit)

It's the last item on my admission assessment routine to say "OK, let me check your tailbone to see how your skin is doing there; can you roll to the side?" and they always do. By doing it all the time, it'll become a normal, comfortable part of your assessment. Pts don't know if they should feel comfortable about something new or not, so they look at you to see if you're comfortable. That's why what's comfortable for you will be comfortable to your pt.

I for sure do this for people at risk, but at least there are a few people who think it is little invasive to check healthy 20, 30 yo's. I do not expect an aid to DO the assessment just be there to back me up in case someone ever said I touched them inappropraitly. I am trying to protect my patient and myself.