The next template which is unique to the Nursing Home Suite of Templates is Skin Lesions. The full name of the template is “Clinically Unavoidable Skin Lesions.”
Skin lesions are common in long-term care facilities, and often are unavoidable. This template helps identify the patients who are at risk of unavoidable skin lesions.
The template is organized into three vertical sections.
The left-hand section has two columns.
Risk Factors – 22 conditions are listed which contribute to the patient’s being at risk for “Clinically Unavoidable Skin Lesions.” These should be reviewed and any risk factors which apply to the patient should be documented by checking the box next to it. These are in demographic fields, which means that once they are checked, they remain checked in subsequent visits until they are unchecked.
Laboratory Results –
There are six laboratory results here which impact the ability of the patient to heal wounds and/or which indicate the presence of chronic malnutrition which would prevent wound healing. There is a button entitled Check for New Lab which allows you to import the most recent lab values on this patient. Additional information on the patient’s nutritional status can be found on the Nutrition Template. To learn more about the Nutrition template, visit the Nutrition tutor. To review the tests necessary to evaluate the patient’s nutritional status, see the Lab Charge Posting template
This section addresses 6 skin-care options and 3 Mobility options for improving skin care. However, in the presence of the above mentioned Risk Factors and in the presence of clinically unavoidable malnutrition, maintaining the integrity of the skin is not possible.
At the very bottom of this left-hand section is a button entitled Care for Dry Skin. When launched 8 options for caring for dry skin appear. There are boxes which allow the selecting of certain options which will then appear on the chart note.
Middle Section of Clinically Unavoidable Skin Lesions Template
Skin Condition – this provides the opportunity to document 10 skin conditions which contribute to Clinically Unavoidable Skin Lesions.
Right-hand section of Clinically Unavoidable Skin Lesions Template
NH Master – this is a navigation button back to NH Master Template
Wound Protocol – this launches the Wound Protocol pop-up which gives treatment guidelines for Stage II wounds and for Stage III/IV Wounds. This is a different guideline than that for the Skin Tear Guidelines
Call to Family – this launches the Call to Family Record. For details see below.
Document – this creates a document for the chart from the evaluation of Clinically Unavoidable Skin Lesions.
Beneath this are two functions
- Waterlow Risk Assessment -- this is a standardized risk assessment from 11 categories which indicates whether or not the patient has a clinically unavoidable skin lesion risk.
- Norton Risk Assessment – this is the Norton Risk Assessment Clinically Unavoidable Skin Lesions which assesses the patient from 5 categories. A score is produced and indicates the patient’s risk for clinically unavoidable skin lesions.
- Braden Risk Assessment – Baden Scale Clinically Unavoidable Skin Lesions. This is based on 6 categories of evaluation and gives a score which indicates whether or not the patient is susceptible to clinically unavoidable skin lesions.
Note: On the Braden Assessment there is a pop-up entitled Friction and Shear which expands on this risk factor.
- Skin Care in Elderly Patients – this document gives more detail about skin care in the elderly.
- Skin Integrity – this is an excellent discussion with pictures of the integrity or lack of integrity of the skin.
- Skin Care Glossary – this defines 16 terms commonly used in evaluating the skin.