How can the CNA help spot skin breakdown?

OK, so a big part of the CNA’s job involves butt-wiping.  There, I said it!  Although both nurses and unlicensed assistive personnel (uh, aides and CNAs) will often receive derision from others not working in health care concerning this aspect of providing patient care, perineal care butt-wiping ain’t no joke, friends and neighbors.  Allow me to trot out the evidenced-based, well, evidence:

In *Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Chapter 12 discusses Pressure Ulcers: A Patient Safety Issue:

Pressure ulcers remain a major health problem affecting approximately 3 million adults.1 In 1993, pressure ulcers were noted in 280,000 hospital stays, and 11 years later the number of ulcers was 455,000.2 The Healthcare Cost and Utilization Project (HCUP) report found from 1993 to 2003 a 63 percent increase in pressure ulcers, but the total number of hospitalizations during this time period increased by only 11 percent. Pressure ulcers are costly, with an average charge per stay of $37,800.2 . . .Given the aging population, increasingly fragmented care, and nursing shortage, the incidence of pressure ulcers will most likely continue to rise.

Preventing pressure ulcers has been a nursing concern for many years. In fact, Florence Nightingale in 1859 wrote, “If he has a bedsore, it’s generally not the fault of the disease, but of the nursing”4 (p. 8). Others view pressure ulcers as a “visible mark of caregiver sin”5 (p. 726) associated with poor or nonexistent nursing care.6 Many clinicians believe that pressure ulcer development is not simply the fault of the nursing care, but rather a failure of the entire heath care system7—hence, a breakdown in the cooperation and skill of the entire health care team (nurses, physicians, physical therapists, dietitians, etc.).

CNAs are on the front lines of this battle in long-term care facilities everywhere, and while we are outnumbered by RNs in the acute-care setting, our role in detecting skin abnormalities is no less vital.  So how can we best help our residents/patients avoid developing pressure ulcers?

  1. Be vigilant about skin issues when caring for patients with:  diabetes mellitus, peripheral vascular disease, cerebral vascular accident, sepsis, and hypotension.
  2. There’s no “one and done” – a pressure ulcer, according to this source, can develop in 2-6 hours – so keep watching out for skin changes at each peri-care session and/or brief change.
  3. Avoid using hot water, and use only mild cleansing agents that minimize irritation and dryness of the skin.
  4. During skin care, avoid vigorous massage over reddened, bony prominences because evidence suggest that this leads to deep tissue trauma. Skin care should focus on minimizing exposure of moisture on the skin.
  5. Follow turning/repositioning schedules as delegated.

This publication also addresses the incidence of pressure ulcers in more darkly pigmented skin: 

**The Stage I pressure ulcer may be more difficult to detect in darkly pigmented skin. A quality improvement study in several nursing homes found that by empowering the nursing assistants with education (skin assessment), use of pen lights to assess darker skin, mirrors, and financial reward, the researchers were able to reduce the Stage I pressure ulcers in residents with darkly pigmented skin.

So how about it?  Share your comments, including your skin integrity promotion techniques below!

*Hughes, R. G. (Ed.). (2008). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: US Department of Health and Human Services Agency for Healthcare Research and Quality.

 **Rosen J, Mittal V, Degenholtz H, et al. Organizational change and quality improvement in nursing homes: approaching success. J Healthc Qual. 2005;27(6):6–14. 21, 44. (41 ref) [PubMed: 17514852]

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4 thoughts on “How can the CNA help spot skin breakdown?

    1. @Steam Mops – thank you for your commment – could you be more specific concerning the items you question? Don’t forget your peer-reviewed references!

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