User Interface Name

Field Identifier

Definition

Data Display Format

Data Value Format (code or other value)

Value Sets

SNOMED CT

Guidelines for completion:
Please review patient handling assessment before completion of repositioning
Form to be completed by person competent to assess skin
Slide sheets to be used for all patients when repositioning

[TIP at the top of summary screen - Consider Purpose T Risk Assessment when PU Category has been entered or has changed since previous entry
 If the patient's recent reposition is the same as the last reposition recorded for the patient, then the recent entry will be highlighted in red bellow]

Date and Time of Assessment

Assessment_Date_Time

This is the date and time the assessment took place

Date and Time Picker

8 digit numeric, YYYY-MM-DD
4 digit numeric, hh:mm

Patient repositioned

Skin_inspection

This is to indicate that a new skin inspection and repositioning entry it to be created

Single Select Button

N/A

N/A

Patient Declined Repositioning

Patient_declined

This is to indicate whether the patient declined the repositioning

Single Select Button

N/A

N/A

Patient not at bedside

Patient_notatbedside

This is to indicate that the patient is not at the bedside

Single Select Button

N/A

N/A

Patient independently mobile

Patient_mobile

This is to confirm that the patient is independently mobile

Single Select Button

N/A

N/A

Was the patient’s skin wet?

Wet_skin

This is to indicate whether the patient’s skin was wet

Radio Button (Multiple options - Single select)

n1

1 - No
2 - Yes
3 - Patient Declined inspection

If yes, was it:

Wet_skin_reason

This is to indicate why the patient’s skin was wet

Radio Button (Multiple Options - Multi Select)

n1

1 - Faecal
2 - Urine
3 - Exudate
4 - Perspiration

Action

Wet_skin_action

This is to detail any actions taken if the patient was wet skin

Radio Button (Multiple Options - Multi Select)

n1

1 - Barrier product applied
2 - Patient hygiene needs met
3 - Other

Other

WetSkin_action_other

This is to detail what other action was taken if the patients skin was wet

Text Box

nvarchar(500)

N/A

Are patient's heels offloaded?

Heel_offloaded

This is to indicate whether the patients heels are offloaded

Radio Button (No No)

n1

1 - No
2 - Yes

Which heel was offloaded?

Which_heel_offloaded

This is to indicate which heel was offloaded

Radio Button (Multiple options - Single select)

n1

1 - Left Heel
2 - Right Heel
3 - Both Heels

723606006 |Structure of left heel (body structure)|
723607002 |Structure of right heel (body structure)|
Nothing for bilateral

Heel offload device used

Heel_device

This is to indicate which heel offload device has been used

Drop down list (Single select)

n1

1 - Pillow
2 - Boot
3 - Wedge
4 - Cast
5 - Other

Other

Heel_device_other

This is to provide details of the other heel offload device used

Text Box

nvarchar(500)

 N/A

Position patient left in

Patient_position

This is to indicate the position the patient was left in

Drop down list (Single select)

n1

1 - Sat up in bed
2 - Sat up with knee break
3 - Right side 30° tilt
4 - Left side 30° tile
5 - Prone
6 - Flat on back
7 - Sat out

Equipment patient left on

Equip_patient_lefton

This is to indicate what type of surface the patient was left on

Drop down list (Single select)

n1

1 - Static Mattress
2 - Active Mattress
3 - Trolley
4 - Chair

Surface Support Type patient left on

Surface_support_type

This is to indicate what type of surface support the patient was left on if they were on a static mattress

Look up

n2

1 - Pentaflex advanced
2 - Pentaflex
3 - Softform
4 - Dynaform HZ
5 - Aerospacer
6 - Mercury advanced foam
7 - Drive permaflex
8 - Invacare
9 - Hillrom NP100
10 - Repose overlay
11 - Trolley
12 - Renray Noodles
13 - UH Trinity Plus
14 - Drive Lullaby Paediatric
15 - Drive
16 - Soft Form Premier
17 - Sleep angel
18 - Select selmed edge
19 - Karomed enterprise
20 - Direct H/C Maximus
21 - Pentaflex paediatric
22 - Drive Memaflex
23 - UH Active Foam
24 - Drive Permaflex Plus
25 - Autologic
26 - Alfa Active 4
27 - Duo 2
28 - Herida Lothian 2
29 - Herida Grampian II
30 - Lothian II
31 - Nimbus
32 - Nimbus 3
33 - Nimbus 4
34 - Nimbus professional
35 - Drive Hybrid
36 - Dolphin
37 - Bariatric Saphire
38 - Primo
39 - Promat and pump
40 - Promat
41 - Mercury Advance
42 - Drive Elite
43 - Drive Artemis
44 - Tamora Plus
45 - Squirel Dormir
46 - HC Active Air
47 - Talley
48 - Repose  companion
49 - Arjo Bi flex
50 - Stryker
51 - SM Selmed
52 - Repose cushion
53 - Repose lite cushion
54 - Atmos Air cushion
55 - Aura Logic cushion
56 - Aura cushion
57 - Carefree cushion
58 - Duo form cushion
59 - Flex foam cushion
60 - Herida Berkshire cushion
61 - Roho cushion
62 - Valley cushion
63 - Viola cushion
64 - Trinity Plus cushion
65 - Equazone cushion
66 - Drive Memaflex cushion
67 - Drive Elite cushion
68 - Hybrid Power cushion
69 - Essential Visco cushion
70 - Reactive Air cushion
71 - Transflo cushion
72 - Mercury Adavance cushion
73 - Viola 2 cushion
74 - Active Air cushion
75 - Reflect HFC130 cushion
76 - EHOB cushion
77 - Lozone cushion
78 - Tilt and space chair
79 - No cushion' will appear
80 - Other

Other

Surface_supporttype_other

This is to detail the other surface support type if different to those already listed

Text Box

nvarchar(500)

N/A

Has there been any changes to the patient's skin condition?

Skin_changes

This is to confirm whether there have been any changes to the patients skin condition

Radio Button (Multiple options - Single select)

n1

1 No
2 Yes
3 Unable to assess

Comments

Skin_changes_comments

This is to provide any further comments on the changes to the patients skin condition

Text Box

nvarchar(500)

N/A

Detailed skin assessment to be completed by a person competent to assess skin, using their own Nadex login

Skin Assessment - Current detailed skin assessment - For each skin site tick applicable column. This is not intended to replace the Purpose T Risk Assessment, if skin condition has deteriorated complete a new Purpose T Risk Assessment and update care plan.

Skin Site

Skin_site

This is to indicate which skin site the patient has pain

Radio Button (Multiple Options)

n2

1 Sacrum
2 L Buttock
3 R Buttock
4 L Ischial
5 R Ischial
6 L Hip
7 R Hip
8 L Heel
9 R Heel
10 L Ankle
11 R Ankle
12 L Elbow
13 R Elbow
14 Other as applicable

699698002 |Structure of sacrum (body structure)|

723979003 |Structure of left buttock (body structure)|

723980000 |Structure of right buttock (body structure)|

722755001 |Structure of ischiogluteal bursa of left hip (body structure)|

722754002 |Structure of ischiogluteal bursa of right hip (body structure)|

287679003 |Left hip region structure (body structure)|

287579007 |Right hip region structure (body structure)|

723606006 |Structure of left heel (body structure)|

723607002 |Structure of right heel (body structure)|

51636004 |Structure of left ankle (body structure)|

6685009 |Structure of right ankle (body structure)|

368148009 |Left elbow region structure (body structure)|

368149001 |Right elbow region structure (body structure)|

Other

Skin_site_other

This is to detail the other skin site where the patient has pain if not listed above

Text Box

nvarchar(500)

N/A

Normal Skin

Normal_skin

This is to indicate whether the skin at the identified skin site is normal

Tick Box

N/A

N/A

Vulnerable Skin [i info button]

Vulnerable_skin

This is to indicate whether the patient has vulnerable skin at each of the identified skin sites

Tick Box

n1

1 - Blanchable redness that persists
2 - Dryness
3 - Paper thin
4 - Moist

PU Category [i button]
NPUAP / EPUAP Pressure Ulcer
Classification System (2014)

PU_Cat

This is to indicate which category the patients pressure ulcer is

Pick List

n1

1 - Cat 1 Non-blanchable redness of intact skin
2 - Cat 2 Partial thickness skin loss or clear blister
3 - Cat 3 Full thickness skin loss (fat visible / slough present)
4 - Cat 4 Full thickness tissue loss (muscle / bone visible)
5 - Cat U (Unstageable / Unclassified): full thickness skin or tissue loss - depth unknown
6 - Cat SDTI (Depth Unknown) Purple localised area of discoloured intact skin or blood filled blister

Moisture Leision

Moisture_lesion

This is to indicate whether the patient has a moisture lesion.

Tick Box

N/A

N/A

Not seen

Notseen

This is to indicate whether the patient was not seen and reason why

Radio Button (Multiple Options – single select)

n1

1 - Covered by medical device
2 - Covered by dressing
3 - Pain
4 - Patient declined
5 - Other

Other

Notseen_other

This is to detail the other reason why the patient was not assessed

Text Box

nvarchar(500)

N/A

[A user cannot select field id 'normal_skin', 'vulnerable_skin', 'pu_cat', 'moisture_lesion' and 'notseen' for one skin site]

Does the patient require further repositioning?

Further_reposition

This is to indicate whether the patient requires further repositioning

Radio Button (No Yes)

n1

1 - No
2 - Yes

Further repositioning required in (hours)

Reposition_time

This is to indicate how long it is before the patient is to be repositioned

Drop down list

n2

1 - 1 hourly
2 - 2 hourly
3 - 3 hourly
4 - 4 hourly
5 - 5 hourly
6 - 6 hourly
7 - 7 hourly
8 - 8 hourly
9 - 9 hourly
10 - 10 hourly
11 - 11 hourly
12 - 12 hourly

Other

Reposition_time_other

This is to indicate the time in which the patient should next be repositioned if different to those hourly times listed

Text Box

nvarchar(500)

N/A

Comments

Repositioning_comments

This is to include any further comments on the activity status of the patients reposition

Text Box

nvarchar(500)

N/A