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Welcome to lesson three, prevention and skin maintenance, prevention of of pressure injuries requires multiple steps. It requires identification, documentation, tracking, reporting, developing and implementing policies and being aware of the skin safety task force guideline and video to help you through these steps, documentation properly, documenting skin integrity checks is the first step to demonstrating patient safety and it is one of your top priorities. The form to the right is only a sample of a skin integrity check sheet used for longterm eeg monitoring. The important pieces of information include the following. Number one, verification of any preexisting conditions and their location. Number two, documentation of all applied leads. Number three, documentation of condition of skin at each subsequent check and any applied treatments and for documentation of communication with providers. Please keep in mind if you don't document, you didn't do it. Tracking, tracking is important because it helps us tell what commonalities might be leading to skin breakdown in our area. We want to note what patient, the percentage of skin breakdown, whether they had some or didn't a rating scale for the skin breakdown. According to the NP of pressure ulcers, the location of the skin breakdown, the age of the patient, the approximate time that the electrodes had been on their head. We want to know what their average Braden score was. We also want to know what type of electrodes were on their head, whether they had a head wrap, what skin prep was used? What conductive the adhesive used and how many days they were monitored as well as their highest impedance value reporting is important reporting helps not just our department track this but other areas as well. When we report to the Mius or other anonymous web-based reporting tools for critical incidents, we are able to help provide information to a much larger database and then help worldwide to reduce pressure ulcers, nursing staff, physicians in wound care, teams also help in order to provide care when pressure ulcers happen, policies are only useful if they're developed and then implemented and strictly adhered to. It is also important that as time goes by those policies are adjusted to fit evidence based medicine under development, we need to look at the scope of our audience, we need to look at the purpose. Why is this policy being created the procedure? How should it be carried out? Every policy needs an effective date and a review date when that policy is applicable. It is important when implementing a policy to make sure that tracking is used for the education of the policy relaying to that audience and making sure that that policy is strictly adhered to adjustment every review date. The team should review the policy, any incidents or concerns that have occurred since the policy was implemented. To determine if that policy requires change. In order to develop a policy, we must look at our audience sometimes that is strictly your department. Other times that may reach outside of your department to aides nursing staff providers. If you're part of a large system, it may be your specific role to reach out and find out who the players are. The policy title can be part of your L TM or C EEG Policy. The purpose goals you hope to achieve specific to the policy in this particular lesson, we're dealing with the policy of skin safety. So our purpose is to accurately prepare patients for continuous eeg monitoring, maintain electrode integrity and prepare patient data for neurologist review, interpretation and archiving the procedure. You need to make sure to include equipment, patient setup and communication with staff. If part of an L TM or C EEG policy, clarify which portions are related to the ongoing process and include the frequency of the tasks. A technologist will check impedances. Daily technologist will follow process on electrode assessment process and scheduling form. The technologist will document skin integrity checks on the electrode assessment process and scheduling form and in the electronic medical record under wound care, this process may be different at your facility. However, it is important to provide all of these components. Once the skin study is complete in that second paragraph, remove electrodes with water, perform skin integrity assessment with the nurse and document on electrode assessment process and scheduling form. And in the EMR assist patient with additional cleanup, it is important to go through all of these steps. You'll need to read through your entire procedure. Have a newer tech, read it to ensure that everything is clear. Many times those of us who are experienced will write a policy and certain things have become so commonplace. We forget to include them. However, a new set of eyes on the process will help us make sure that all steps are covered. Don't forget to include documentation, tracking and reporting in your policy. The example seen here is merely an example. Yours may be a very different process in our process for documentation. We included editing with daily samples and video clips as appropriate. We included the patient visit is documented by entry in the eeg electronic and paper logbook that billing is completed once the patient is discharged and document skin integrity check in the EMR is is provided of screenshots of each step of documenting the skin integrity check in the EMR snapshots are a valuable tool. They help people to be able to see the steps as they move through the process under documentation. It is important to note what medical device or supplies were used. What location the skin breakdown was seen, any symptoms that were felt by the patient were seen by the healthcare team, any treatment that was applied and who the skin breakdown was reported to on this particular EMR, you will see that there are boxes for each of those except for who it was reported to and that would be under the comment or notes section. The end of the policy, you want to make sure to include any links to forms. If that is an option also include key words that help to make that policy useful, searchable and very specific a summary table. At the end of the policy often provides things like a title and ID number, the author contact information for the author of the policy. Any contributors, administrator contacts and effective date. The next expected review date, the date the document itself went into effect and any revision history. This is a quick check for anyone who wants to evaluate the document in case there is a need to change things. The skin safety task force guideline and video are a great resource to help you develop your policy. It will walk you through step by step. The process used to develop a healthy policy for skin safety. Feel free to use those guidelines and the video to educate your group and to determine your policy in developing your policy. You're going to determine your scope. Who does your policy apply to your purpose? A summary of your intent and your procedure the most effective manner to safely deliver services. Procedural items that you will need to develop your policy include supplies, staff and charting. You want to make sure to include communication roles and documentation for your staff, electronic charting paper, charting and any device charting that is necessary. This is another sample of a policy that was prepared for longterm video eeg. It includes all patient preparation, all equipment supplies and the longterm recording process. A very effective safe policy is one that is clearly written, has screenshots included to not leave any doubts as to the next step of the process. When you consider safety first, we need to consider the equipment and document within the procedural sections. Any steps taken to prevent injury such as taping down cords, the environment and does a patients is a patient sitter required a cooler room to prevent humidity under the leads that micro environment we've spoken of earlier and patient wellbeing diligently document all steps taken to prevent monitor and report skin injuries. In wrap up, summary statements should include keywords, keywords enable users to find the document quickly, keywords, link related documents together. The dates are effective dates, review dates and revision dates. Those are critical for joint commission. They're also important for general safety purposes and legal purposes that all policies are dated properly in regards to the date they were established, made effective or changes occurred or the policy was revised. This is a brief sample to walk you through developing a continuous eeg monitoring procedure including skin safety, the supporting at the at the end of this will help you to develop your policy, which is a requirement of finishing lesson three.