PI Prevention K-Card

HAC SPS Bundle Elements

Which department are you completing this survey for?

Name of the employee observed:

Patient MRN?

Was a full skin assessment performed within 24 hours of admission?
Was a pressure injury risk assessment (Branden QD) performed within 24 hours of admission?
Was the patient's skin reassessed every shift, with a change in patient condition, and/or upon arrival to the unit (i.e. transfer)?
Was the patient’s skin in contact with a medical device(s)?

A medical device is defined as any diagnostic or therapeutic device currently attached to the patient or transverses the patient’s skin/mucous membrane.
Was the skin in contact with the medical device(s) assessed at least every shift?
Were the devices rotated a minimum every 8 hours (respiratory devices, pulse ox, blood pressure cuff, etc.)?
Was the patient’s skin assessed under the c-collar every shift?

FOR PATIENTS ONLY WITH C-COLLAR:
Was skin care performed under the patient’s c-collar every shift?

FOR PATIENTS ONLY WITH C-COLLAR:
Were the c-collar pads changed every shift?

FOR PATIENTS ONLY WITH C-COLLAR:
Was the patient repositioned at least every 2 hours?

Repositioning includes patients sitting in a chair or other positioning devices, as well as off loading for critically ill patients.  If NICU, repositioning can be with timed cares.
Was the head of the bed less than or equal to 30 degrees?
Is the appropriate support surface being utilized?

Support surfaces include use of specialty mattresses, gel pads, fluidized positioners, and/or other pressure redistribution positioning aids to cushion bony prominences.
Can you confirm that the patient's skin is clean, dry, and appropriately hydrated to maintain its integrity?

Moisture barrier and wicking products are used to help keep skin dry.
Comments

If No is chosen above, please provide more details.