Training Resource Falls Prevention & Wound Care / UTI 13 Reducing... · management. Decide the need for pain relief well before scheduled dressings. 2. All new wounds must be reported

Training Resource Falls Prevention & Wound Care / UTI

Hand Washing Procedure

Hand Hygiene Step by Step

1. Wet Hands 2. Use the soap provided in the wall dispenser – one good squirt. 3. Take 30 seconds to rub all surfaces of your hands. 4. Special attention should be given to fingernails, the spaces between fingers

palms and backs of hands. 5. Rinse under the tap. 6. Use a dry paper towel to turn the tap off – beware bugs on the tap handles. 7. Dry with paper towel.

Hand hygiene stops sickness. Bugs on hands are “easy riders” to the next thing you

touch.

Hand Hygiene Is Required

a) After touching blood, body fluids, secretions, excretions and contaminated items, whether or not gloves are worn.

b) After touching your nose or sneezing! c) After removing gloves d) After touching other people e) Before touching, cooking and serving food f) Before giving out medication g) Before any kind of wound care. h) After touching animals i) After touching anything dirty

Wearing Gloves

a) When touching blood, body fluids, secretions, excretions and contaminated

items

b) All staff with cuts, abrasions or skin lesions on their hands must cover these

cuts before starting work.

c) Get help, as required if you cannot fix cuts & wounds yourself.

NB: Remove gloves before touching non-contaminated items and before going to

another person.

DO NOT USE GLOVES FORM PERSON TO PERSON, AREA TO AREA

ALL staff need to be assessed & signed off as competent hand washers!

Issue Number: 02 www.HH.NET.nz Issue Date: 01.08.08


POLICY: Residents / service users are assessed upon entry to the

Home for the likelihood of their sustaining injury through falling. Falls

are managed in a controlled and systematic way according to

Best Practice Guidelines.

REFERENCES: Alert sign on door & chart

of high risk fallers SNZ 8143: 2001 Health & Disability Sector Standards

SNZ HB 8163: 2005 Indicators for Safe Aged Care & Dementia Care for Consumers

DEFINITION [as described by Tinetti recognised falls researcher]:

Unintentionally coming to rest on the ground or at some lower level, not as the

result of a major intrinsic event [e.g. stroke or syncope] or overwhelming hazard

[one that would have caused a fit healthy person to fall].

EXCLUSIONS:

A catastrophic medical event – e.g. heart attack or stroke. This does not include

higher falls attributed to Parkinsons Disease or other debilitating medical condition.

[Medically unwell fallers should still be counted for the purposes of your statistics].

PROCEDURE / PREVENTION

Falls are a Quality Indicator of care with a threshold value of 6.38 falls per 1000

occupied bed days for Aged Care and 11.09 falls per 1000 occupied bed days for

Dementia Care. Falls are counted and reported at 3 monthly Service Review

Meetings. Falls are an integral part of the Benchmarking Stats Program. All residents

/ service users are assessed for risk of falling upon admission. Studies have shown

that “history of a fall” is the most reliable risk indicator. In other words, if a resident

has had a fall (at home, in hospital or in the Home) then the MUST be considered a

HIGH FALLS RISK. High falls risks residents must receive special care and attention,

otherwise they are likely to fall again and suffer harm.

High Falls Risk can be reduced by: Good Monitoring Regular & frequent

Involvement in regular activities - exercise

Thoughtful social management

An environment free of hazards.

Regular Toileting

Good nutrition Nutritional assessments

Optimal medical management

Call bell handy Sensor mats

Adequate food and fluids

Attention to positional comfort

Assessment & care planning prevention

Keep in public area as much as possible

It is the care staff’s responsibility to know which residents are at risk of falling. Look for the sign in their rooms if in doubt:

www.HH.NET.nz


Use discrete sign to post on doors of our High Falls Risk people from page below.

www.HH.NET.nz


Falls / Skincare Guideline The best way to manage falls is to prevent them. See the guideline on the next

page. The best way to manage skin tears is to prevent them:

1. Stop

2. Assess the Risk 3. Get another person to help if you might not manage on your own. 4. Take time and care 5. Use suggested and supplied equipment [e.g. slide boards, high low beds, sheep skins]

6. Protect frail skin

- protective stockings [right size / not to tight or baggy]

- lotions to prevent dryness

- sheep skin

7. Never hold onto skin

8. Beware of dragging frail skin over sheets

9. Plenty of fresh fruit and vegetables to eat every day makes skin

healthier.

Falls Prevention Policy

1. Residents are assessed upon entry to the Home for the likelihood of their

sustaining injury through falling.

2. It is worth noting that studies have shown that “history of a fall” is the most

reliable risk indicator. In other words, if a resident has had a fall (at home, in

hospital or in the Home) then the MUST be considered a HIGH FALLS RISK.

3. High falls risks residents must receive special care and attention, otherwise

they are likely to fall again and suffer harm. Others need special care so as

not to scrape fragile skin, which easily tears.

www.HH.NET.nz


High Falls Risk can be reduced by:

Good Monitoring – Some people must be watches almost all the time!

Regular Toileting – decide how frequently and make sure everyone knows!

Adequate food and fluids

Sensible foot wear for that person.

Involvement in regular activities – Otago Uni Falls Prevention Program

Good nutrition

Attention to positional comfort

Thoughtful social management

An environment free of hazards.

Open channels of communication – call bell handy.

Keeping residents in a public area as much as possible (under supervision) has

been shown to reduce falls. Be aware that restraints carry RISK OF INJURY. Restraint injury risk (including psychological) must be weighed up against FALL INJURY RISK. It is the care staff’s responsibility to know which residents are at risk of falling. Look for the sign in their rooms if in doubt:

Use discrete sign to post on d ople from page below. oors of our High Falls Risk pe

Assessing Staff Knowledge

Staff can choose a resident who has been identified as a high falls risk. They should then fill in this person’s ‘Short Term Care Plan’ to reduce falls with the resident [and supportive family]. This should be discussed and marked by a registered clinician [RN Physio].

www.HH.NET.nz


Care of the Skin Policy DEFINITION: We define skin care as good assessment / adequate support and

ongoing monitoring. This helps our residents because skin becomes much more

frail with age.

REFERENCE:

Initial Assessment & Précis of Care / RN & Risk Assessment Form Falls Prevention Policy / Wound Care log / Wound Care Policy Individual Problem & Solutions Pages in Care Planning

GUIDELINES FOR CARE STAFF:

New Residents can bring infections into the Home on their skin. These include:

- Tinea

- Scabies

- Nits or head lice

- MRSA & other super bugs

- Strong bacteria like staphylococcus.

It is the referrer’s responsibility to tell us about any known infections. It is the RN’s

responsibility to question referrers AND to assess the new person [discretely]. Please

report anything like scratching or bad smelling toes to the RN straight away. These

minor infections can be easily passed to our other residents – and yet caught early

they are usually easy to manage.

Sunshine and passing years changes our skin. Where our residents have frail skin we

can help protect it, especially where the resident is prone to falls:

- Safe environment / assist with care as required

- Lotions and creams that our doctor will prescribe for that person

- Protective stockings

- Sheepskins on the bed or in comfortable chairs

- Staff no keep mails short and not wear jewellery at work

Where our frail residents cannot move around we must change their position

regularly so that pressure ulcers do not develop. Each resident has an

individualised Problem & Solutions Page of required care.

www.HH.NET.nz


Falls / Skincare Guideline The best way to manage falls is to prevent them. The best way to manage skin

tears is to prevent them:

1. Stop

2. Assess the Risk 3. Get another person to help if you might not manage on your own. 4. Take time and care 5. Use suggested and supplied equipment [e.g. slide boards, high low beds,

and sheep skins] 6. Protect frail skin with protective stockings [right size / not to tight or baggy] &

lotions to prevent dryness

7. Use of sheep skin or air mattresses

8. Never hold onto skin

9. Beware of dragging frail skin over sheets

10. Good hydration & nutrition is essential. Plenty of fresh fruit and vegetables to

eat every day, and lots of fluids are GREAT preventative action.

Note: It is NOT best practice to rub pressure areas. Please refrain from rubbing

pressure areas. This can cause further damage.

Assessing Staff Knowledge

Look at a wound [on a resident or a picture of a wound Practice filling in the wound care log below This should be discussed and marked by a registered clinician [RN Physio].

www.HH.NET.nz


Wound Care Policy DEFINITION: Wounds will be assessed adequately and fill heal optimally

REFERENCE:

Falls Prevention Policy / Wound Care log Skin Tear Policy / Individual Problem & Solutions Pages in Care Planning

GUIDELINES FOR CARE STAFF:

1. Pain assessment and treatment is an essential part of effective wound

management. Decide the need for pain relief well before scheduled dressings.

2. All new wounds must be reported to the RN immediately.

3. Only designated people who have had a written and practical assessment of

knowledge may dress Skin Tears

4. All skin tears no matter how minor are documented on an Incident Form

- One copy in the resident notes

- One copy in the Exception Reports Folder

5. The objective of wound care is to

- Maximise healing opportunity

- Minimise the risk of infection

6. Wounds heal best in warm moist environment – please see Skin Tears Policy to

guide you step by step

7. Do not swab a new wound with an antiseptic like Betidine - it slows healing.

8. Betidine will only be used by the RN on infected wounds.

9. It is not necessary to change a new dressing daily – uncovering it cools it and

slows the healing. Swabbing can wipe away the first stages of healing and

delay the process. Provide the body the opportunity to heal itself undisturbed

under a well sealed dressing.

10. Monitor to see that the dressing has not been picked or pulled off, that there is

no ooze or signs of infection [smell, heat, swelling, pain]

11. Well nourished residents will heal better – dietary assessment is advised if the

resident is frail and has a wound.

12. Document and review care in the resident's:

- Problems and Solutions Page

- Wound Care Log

www.HH.NET.nz


Skin Tear Repair

SKIN TEAR 1. ASSESS THE RISK

RISK: - Amount blood - Do I need gloves? - Make resident comfortable - Reassure resident

2. GET A SKIN TEAR BOX FROM THE TREATMENT ROOM

Skin tear boxes stocked up and ready. Stays with the resident until healed

3. CLEAN THE WOUND

- Work on something clean - It will stop bleeding itself - Bleeding is cleansing too - Mop away excess blood - Use gauze from skin tear box

4. PULL BACK SKIN FLAP & IRRIGATE

Use a clean forcep Use saline supplied Wash well under the skin flap

4. CAREFULLY ARANGE SKIN BACK IN PLACE

This can be difficult Sometimes the edges roll under It is important to get all the skin back in place if you can.

5. ONLY SERISTRIP IF VERY LARGE TEAR

Steristrip will hold large skin tears Not needed on little ones Steristrips sweat and healing under them may be less

6. COVER WITH PARANETTE GAUZE

Careful that the skin stays in place Paranette seals and protects Gives the body a chance to heal

7. PLACE TELFA OR MELANIN ON TOP

Padded for protection Only just cover the wound

8. SEAL WITH TEGADERM Use a tegaderm large enough to cover all of the dressing

9. WRITE THE DATE Use a felt tip 10. LEAVE AS LONG AS POSSIBLE

Don’t get dressing wet Check every day for signs of infection Leave until falls off – HEALED!!!!!!! Check no signs infection – heat / pain / swelling / ooze

www.HH.NET.nz


Skin Tear Repair Assessment of Knowledge

SKIN TEAR 1. ASSESS THE RISK

RISK: - Is there b _ _ _ _ ? - Do I need g _ _ _ _ _? - Make resident comfortable - Reassure resident

2. GET A SKIN TEAR BOX FROM THE TREATMENT ROOM

Skin tear boxes stocked up and ready. Stays with the resident until healed

3. CLEAN THE S _ _ _ T _ _ _

- Work on something c_ _ _ _ - It will stop bleeding itself - Bleeding makes the wound c _ _ _ _ - Mop away excess b _ _ _ _ - Use g _ _ _ _ from skin tear box

4. PULL BACK SKIN FLAP & IRRIGATE

Use a clean forcep Use s_ _ _ _ _ or w _ _ _ _ to cleanse Wash well under the s _ _ _ flap

4. CAREFULLY ARANGE S _ _ _ BACK IN PLACE

This can be difficult Sometimes the edges roll under It is important to get all the skin back in place if you can.

5. ONLY SERISTRIP IF VERY LARGE TEAR

S _ _ _ _ _ _ _ _ _ will hold large skin tears Not needed on little ones Steristrips sweat and healing under them may be l _ _ _ _

6. COVER WITH PARANETTE GAUZE

Careful that the skin stays in place P_ _ _ _ _ _ _ _ _ seals and protects Gives the body a chance to heal

7. PLACE TELFA OR MELANIN ON TOP

Pad for p _ _ _ _ _ _ _ _ _ Only just cover the wound

8. SEAL WITH TEGADERM Use a t _ _ _ _ _ _ _ large enough to cover all of the dressing

9. WRITE THE D _ _ _ Use a felt tip 10. LEAVE AS LONG AS POSSIBLE

Don’t get dressing wet Check daily for signs of I _ _ _ _ _ _ _ _ Leave until falls off – HEALED!!!!!!! Signs infection – h _ _ _ / p _ _ _ / s _ _ _ _ _ _ _ / ooze / bad s _ _ _ _ .

www.HH.NET.nz


Skin Tear Box List

It is a very good idea to have more than one Skin Tear Box. This can be quite small

and should NOT be overstocked.

Recommended:

o Sterile saline o 2 forceps [plastic is OK] o steristrips o sharp scissors o small gauze squares o sofra tulle in a small square tin o telfa or melalin [what you have is fine] o tegaderm [small and medium sized] o paper bag for rubbish [or plastic or both] o gloves [only for lots blood]

Make one person responsible for checking that everyone is restocking the boxes

after use, so that the dressing can be done without having to run off and ‘get

something’ half way through. Check the box BEFORE you start.

Once in use, a Skin Tear Box can stay with that person until their tear is healed, thus

drastically reducing chances of cross – infection. Once healed sterilise the

container and stock it up with clean equipment.

Training:

1. Learn Standard Precautions first please.

2. Observe skin tear being treated by a trained person

3. Dress a skin tear under supervision [trained trainer]

4. Continue under supervision until signed off as proficient.

www.HH.NET.nz


Safe Nail Care

SAFE NAIL CARE POLICY: Offering podiatry treatment to residents.

1. Toe nails DO rip frail skin. Keeping nail short reduces the risk of skin tear.

2. Toenails and toes are a common place for bacteria and fungal

infections.

Check every new resident and monitor everyone else closely.

PROCEDURE

Our Podiatrist visits on a regular and ongoing basis.

Look at toe nails on admission and decide care – document in care

planning.

Residents who wish to use the podiatrist services are placed on her list.

Diabetic residents should be assessed carefully and treatment reserved for

family or podiatrist.

Each visit is documented in the resident progress notes:

- podiatrist describes problems

- podiatrist logs progress

Caregivers are responsible for checking toe nails and feet while assisting with

personal cares. Long nails or any problems are reported to the RN.

The RN is responsible for seeing that nails are cut and that podiatrist is

offered when needed.

Report these things to the RN:

Painful feet Lack of sensation / discolouration of feet. Very hard or thick nails that are difficult for staff to cut. Obvious ingrown toenail Bad smelling areas between toes Obvious corns – often painful Foot deformities Anything that does not quite look right – if in doubt, report.

Please make sure the podiatrist logs and signs work done each visit. File this in the residents Integrated Notes.

www.HH.NET.nz


www.HH.NET.nz

Podiatrist Treatment Log Name:________________________________________________ Problems: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Date Comment Sign

Please see next page for Wound Care Log – this is used to assess / monitor & log larger wounds and ulcers

Wound Care Log Resident: _________________________

www.HH.NET.nz

Date / Time Re-Assessment due [Leave as long as possible]

Wound shape (sketch) Please draw the skin tear / ulcer / problem area.

Actual size ½ size ¼ size



Surrounding skin Please highlight Best description

Puffy with fluid Dry / scaly Red & swollen / blisters Good surrounding skin / Healthy



Discharge

None Colourless Small Blood in it Moderate Pus Large Green colour



Smell

None Not nice Bad

None Not nice Bad

None Not nice Bad

Pain at wound site

0 –1– 2– 3– 4– 5– 6– 7– 8- 9- 10 none max

0 –1– 2– 3– 4– 5– 6– 7– 8- 9- 10 none max

0 –1– 2– 3– 4– 5– 6– 7– 8- 9- 10 none max

RED HOT SWELLING SORE Infected?

Yes No Yes No Yes No

Action taken for infection: Local treatment / swab to lab Observation / oral antibiotic

Local treatment / swab to lab Observation / oral antibiotic

Local treatment / swab to lab Observation / oral antibiotic

Wound cleansed with Saline

Cleansed Not required



Wound was dressed with: Remember the aim is to keep the wound moist & protected.

Please print name & designation


www.HH.NET.nz

Wound Assessment Form - Female Mark each wound location on the body map with a

cross and a number Name:________________________________________ Date of Birth_________________ Room Number________________ GP: ________________________

Relevant History Type of wound

Medications: Steroids anti-inflammatory anti-coagulants chemotherapy antibiotics Conditions: Diabetes Peripheral vascular disease Anaemia Elderly Frail Cancer Mobility: Good Limited Poor Confined to bed Nutrition: Good Limited Poor Incontinence: Nil urinary faecal Allergies: Other:

1. Skin Tear: MINOR 0 –1– 2– 3– 4– 5– 6– 7– 8- 9- 10 BAD 2. Ulcer 3. Burn Degree: 1 2 3 4. Surgery wound 5. Cancer ulceration 6. Large bruise & contusion 7. Sinus / fistula 8. Other wound

Date of onset:__________________ Assessed by: ____________________Designation ________________

Issue 01


www.HH.NET.nz

Wound Assessment Form - Male Personal Details Please mark wound location on the body map

Name:________________________________________ Date of Birth_________________ Room Number________________ GP: ________________________

Relevant History Type of wound

Medications: Steroids anti-inflammatory anti-coagulants chemotherapy antibiotics Conditions: Diabetes Peripheral vascular disease Anaemia Elderly Frail Cancer Mobility: Good Limited Poor Confined to bed Nutrition: Good Limited Poor Incontinence: Nil urinary faecal Allergies: Other:

1. Skin Tear: MINOR 0 –1– 2– 3– 4– 5– 6– 7– 8- 9- 10 BAD 2. Ulcer 3. Burn Degree: 1 2 3 4. Surgery wound 5. Cancer ulceration 6. Large bruise & contusion 7. Sinus / fistula 8. Other wound

Date of onset:__________________ Assessed by: ____________________Designation ________________

Training Resource Falls Prevention Skin & Wound Care

www.HH.NET.nz

Continence Policy INCONTINENCE POLICY: The aim is that all residents feel clean and comfortable and dignified at all times.

REFERENCES: Falls Policy RN & Risk Assessments and Care Planning

PROCEDURE: 1. Registered Nurse Assessment benchmarks each new resident’s incontinence status, upon

admission. All incontinent residents are offered a retraining program. Other special

support may be needed. This is decided at ongoing review meetings.

2. If the new resident is using any artificial device e.g. catheter we consider eliminating it for

ongoing infection control, falls and safety reasons. There may need to be input from

external multi-disciplinary team [urologist recommendation / specialist opinion].

3. Those who are incontinent, or use pads or other product, have this noted on the RN

Assessment. These people are offered the use of an assisted [reminded] visit to the toilet

regularly. As time goes on, successful routine should become established. Usually, after all

meals and before bed, and possibly again late at night.

4. All staff need to be aware of the new resident’s needs as described in their Problem &

Solutions page / as handed over at change of shift / as discussed at staff meetings. See

the Précis of Care for this information also.

5. All staff are responsible for the ongoing monitoring of our success in keeping each

resident clean, smelling nice and comfortable.

6. Where there is incontinence from the bowel, this is managed similarly.

7. Special diet & Medications may be used for clear urine. Examples include: Cranberry

juice, Citravescent, & Antibiotics: but we try to avoid using these unless our resident is

symptomatic of a Urinary Infection according to standard definitions of infection. They

must be charted by a doctor.

8. Medications for constipation may be charted for residents and these might include

lactulose, or laxatives like senna. Staff need to be aware that laxatives should be with

held if they are working too well.

9. Where resident incontinence is difficult to manage, please fill in a challenging behaviour

form so that management will be alerted to support care staff in this difficult area.


www.HH.NET.nz

Prevention & Treatment of Urinary Tract Infections DEFINITION: Bacteria or yeast in the urine, which is normally sterile. There may be

symptoms or there may be none.

REFERENCE:

Indicators for Safe Aged Care & Dementia Care for Consumers SNZ HB 8163:2005 Residential Service Delivery Manual: Pgs 11 – 13 [Antimicrobial Policy].

RISK FACTORS: a) Use of indwelling catheters b) Incontinence c) Reduced mobility

SURVEILLANCE: 1. We do not routinely test urines for bacteria

2. Symptomatic infections are recorded on the Infection Report Form.

3. This data is inputted into spreadsheets monthly [Quick and Easy Stats] by the Infection

Program Coordinator or their deputy.

4. Benchmarking Stats through Healthcare Help measures the infection rate against the

known threshold rate [1.51 / per 1000 occupied be days]. This is discussed at Service

Review Meetings as an agenda item.

STANDARD DEFINITION: [Please look in Resource folder in staff room for Standard Definitions]

Considered to have Urine Tract Infection if:

Need three of the following four signs or symptoms: 1. Fever OR chills

2. Flank pain OR suprapubic pain OR tenderness OR frequency OR urgency

3. Worsening of mental status/functional status

4. Changes in urine: bloody urine, foul smell, increased sediment

AND urinalysis or culture not done.

B. At least two of the four above signs or symptoms AND at least one of the following: 1. Urinalysis with positive nitrite and/or positive leukocyte esterase

2. Presence of organisms by culture at laboratory


www.HH.NET.nz

For our Infection Control Surveillance, please count as an infection if the above criteria

are met. Where considered to have an infection, but not given antibiotics, treated

instead conservatively with extra fluids please also record so that we can count this

separately.

CAREFUL HANDWASHING Staff, allied health professionals [doctors, laboratory staff] visitors and residents all need to

practice careful hand washing. Hand washing is taught at Induction, knowledge is assessed,

and silent audits may be conducted at any time. Residents need supervision and ongoing

support in this area.

Support Factors Responsibility

A Managed Program This is an arm of the Infection Control Program

The RN manages the Incontinence Program supported by

the GP, Diagnostic Medlab, and other providers such as

Bugs control & Healthcare Help.

Adequate training and

education of Staff

Staff are trained in the use of Incontinence Products & in

the Prevention & Management of UTI’s.

Knowledge is assessed to ensure understanding.

Education extends to residents and family as appropriate

at a practical level.

Assessing the Risk All residents are assessed at entry. Those at higher risk of

infection are identified using the Norton Scale.

Outside expertise utilised for problem people.

Preventative Measures Adequate fluids

- Nice fluids

- Enjoyable social opportunity when offered

- Fluids available at all times

- Fluids readily available

- Assistance to take the fluids if required

- Encouragement to take fluids

- Fluids not too strong nor acid

- Cranberry available [drinks / tablets]


www.HH.NET.nz

Extra Help - Practical Assistance with Hygiene

Help with moving / mobilising

Toileting Regimes put in place where needed

Exercise encouraged

Regular repositioning of anyone who is unable to get up.

Good bowel management & monitoring

Promote wellness and happiness

Keep clean and smelling nice

Extra Help - Nutritional Nutritional Assessment all residents within 6 weeks of entry

to the Home.

- optimise Health Status

- individualised menu planning within reason

Monitoring Fluid balance Chart used for very frail people whose fluid

input is low.

Record of incontinence for those having problems.

Good reporting of each individuals progress

Problems reported to the RN at once.

Treatment

[See also antimicrobial policy]

Follow our doctors guideline:

1. No symptomatic UTI is left untreated

2. Try conservative treatments first

3. Review medication as appropriate

Cross Infection Prevented Clean environment

Safe techniques

Good Hand washing

Short Term Care Plan to Reduce Falls NHI No: ________________ Resident Name: _____________________________________________ Date: ________________________ Preferred Name:_____________________________________________ Date of Admission: ____________________ Please tick the most appropriate care listed below.

Diagnosis: Environmental Good Monitoring

Needs to be watched all the time Safe from hazards & clutter Must be assisted to walk Encourage to be in public area

Needs ________ people to walk / transfer

Toileting Check regularly while in bed. Every: Assist after meals & at bed time ½ hour 1 hour 2 hours

Assist in the night. State times / frequency:

Beware UTI: Report confusion, wandering

Use sensor mat when in bed

Always have call bell handy

Beware! May not use the call bell

Encourage to be in lounge [supervised] Any different behaviour. Allocate 1 care staff available as needed

Exercise:

Passive exercises in bed

Exercise from sitting position

Walks with care staff / physio

2 hourly every shift for toileting & meals

daily

Falls prevention program of exercises

Frequency:

Walks unaided:

Overcoming Disabilities:

Ensure walking frame within reach not

parked out of the way

Ensure other aids available [state]:

Pain managed by:

Poor balance managed by:

Wanders:

Poor gait:

Injury Prevention Strategies

Footwear

Sensible shoes Orthotics

Preferred Footware: Beware of resident wearing socks

Too long so trips risk Help with good fitting shoes or slippers Help to put on or tie laces

Other:

Family well informed & sharing care planning

Hip Protectors

Special diet:

Encourage fluids Small frequent meals High protein High calorie Supplementary liquid food [state]:

e.g. Arginaid Ensure

Extra staff as needed:

Special Instructions [Doctor / other]:

Resident / Family Sign:______________________ Date:______________

Issue: 02 Date of Issue: 01.02.08

Staff Sign:________________________ Date:______________ www.hh.net.nz

http://www.hh.net.nz/

Training Signing Sheet

Topics: Falls Prevention Care of the Skin Preventing Skin Tears Wound Care Date:___________ Trainer: _____________________________ PLEASE PRINT CLEARLY We have discussed the topics, above. I have been shown and understand what was demonstrated. Anything that I did not understand, I asked for and received adequate explanation.

First Name Surname Signed Employee

Training Signing Sheet

Topics: Managing Incontinent People Preventing Urine Infections Date:___________ Trainer: _____________________________ PLEASE PRINT CLEARLY We have discussed the topics, above. I have been shown and understand what was demonstrated. Anything that I did not understand, I asked for and received adequate explanation.

First Name Surname Signed Employee

Documents

Training Resource Falls Prevention & Wound Care / UTI 13 Reducing... · management. Decide the need for pain relief well before scheduled dressings. 2. All new wounds must be reported