NDNQI IV CASE STUDIES QUESTIONS & ANSWERS

A 69 Y/O female with a right hip fracture was admitted to the orthopedic unit from the emergency department shortly after falling in her yard. Thirty-two hours later she underwent surgery to repair the hip and returned to the orthopedic unit post operatively. The pressure injury survey was conducted on day 4 of hospitalization and the survey team saw a Stage 2 pressure injury over the coccyx.Review of her hospital admission assessment record revealed incomplete assessment of this area due to difficulty turning the patient related to her level of pain and large size. Documentation during her 8 hour stay in the emergency department record was also incomplete. Initial documentation of the pressure injury on the coccyx was found in the patient's operating room record. For the pressure injury survey, this would be reported as: - ️️A Hospital Acquired Pressure Injury Only. A 72 Y/O male was admitted with pancreatitis to the surgical unit from home. His condition worsened after 24 hours and he was transferred to the ICU. The pressure injury survey was conducted on day three of hospitalization and the survey team saw a Stage 2 pressure injury over the sacrum. Review of his hospital admission assessment record revealed his skin was warm and dry with abrasions over both lower arms.The skin assessment documented on transfer to the ICU indicated a Stage 1 non blanchable area of redness at this site. For the pressure injury survey, this would be reported as: - ️️A Hospital Acquired Pressure Injury Only A 45 Y/O male patient is admitted to the trauma unit following a serious motor vehicle crash. Five days later he undergoes an 18 hour surgical procedure and is returned to the trauma unit postoperatively. The pressure injury survey was conducted on day seven of hospitalization and the survey team saw a Stage 4 pressure injury over his left malleolus.Review of his hospital admission assessment record revealed numerous abrasions, contusions and an 8 cm sutured laceration on his forehead, but no documentation of skin problems on the left malleolus. On day four of hospitalization, a Stage 1 pressure injury is documented on the left malleolus. For the pressure injury survey, this would be reported as: - ️️A Hospital Acquired and Unit Acquired Pressure Injury An 81 Y/O female was admitted to the oncology unit with metastatic cancer for pain control. On day 4 of hospitalization, she suffered circulatory complications and she was transferred to the step down unit. The pressure injury survey was conducted on day 5 of hospitalization and her family verbally consented to have her included in the pressure injury survey. The survey team found a large Stage 1 area of nonbankable redness over her right ischial tuberosity.Review of her hospital admission assessment record revealed her skin was warm, dry, and intact. The skin assessment documented on arrival to the step down unit noted a small Stage 1 pressure injury at this site. For thepressure injury survey, this would be reported as: - ️️A Hospital Acquired Pressure Injury Only A 78 Y/O female was admitted with heart failure to the ICU from home. By day 3 of hospitalization, she had improved and was transferred to the medical cardiac unit. The pressure injury survey was conducted on day 4 of hospitalization and the survey team saw a Stage 1 area of persistent, no blanchable redness on her right heel.Review of her hospital admission assessment record revealed that she had 4+ lower right leg edema and brown discoloration of the lower calf and ankle skin. A 2 cm by 4 cm wound with serous drainage also was also documented over her medial lower leg midpoint between her calf and ankle. The skin assessment documented on arrival to the medical cardiac unit noted a Stage 1 pressure injury at this site in addition to the wound, edema, and brown discoloration on her left lower leg as noted on the admission assessment. For the pressure injury survey, this would be reported as: - ️️A Hospital Acquired Pressure Injury Only An 81 Y/O female was admitted to the oncology unit with metastatic cancer for pain control. On day 4 of hospitalization, she suffered circulatory complications and she was transferred to the step down unit. The pressure injury survey was conducted on day 5 of hospitalization and her family verbally consented to have her included in the pressure injury survey. The survey team found a large Stage 1 area of nonblanchable redness over her right ischial tuberosity.Review of her hospital admission assessment record revealed her skin was warm, dry, and intact. The skin assessment documented on arrival to the step down unit noted a small Stage 1 pressure injury at this site. - ️️Hospital Acquired Pressure Injury Only RATIONALE: No pressure injury was identified at this site on the admission assessment record. Therefore, the pressure injury developed after the patient was admitted to the hospital and it is a hospital acquired pressure injury.Review of the patient's record on transfer to the step down unit revealed the presence of a Stage 1 pressure injury at this site. Therefore, the pressure injury was present upon arrival to the unit and it is not a unit acquired pressure injury even though the area was larger since arrival to the unit. RATIONALE: :The injury was present on admission to the hospital as documented on the admission assessment record; therefore, it is a community acquired pressure injury. An 88 Y/O male was admitted with urosepsis to the step down unit from a local long term care facility. On day 3 he was transferred to the medical-surgical unit. The pressure injury survey was conducted on day 4 of hospitalization and the survey team saw an unstageable pressure injury on the back of his head.Review of the hospital admission assessment record revealed his skin was very warm and dry with a pressure injury documented at this site. The skin assessment documented on arrival to the medical-surgical unit also noted a pressure injury at this site. - ️️Community Acquired Pressure InjuryA male infant was born at 29 weeks gestation and admitted to the neonatal ICU for care. He required a week of respiratory therapy with CPAP. The pressure injury survey was conducted on day 15 of life and the survey team found a Stage 3 pressure injury over his right cheekbone.Review of his hospital admission assessment record revealed his skin was warm, dry, and intact. For the pressure injury survey, this would be reported as: - ️️A Hospital Acquired and Unit Acquired Pressure Injury.