Skin Check:

Recognize It. Report it. Document it.

A skin change is an ALC change (Looks). Anything new or worse than the client’s usual baseline gets reported live to your CSS/office.

WHERE TO LOOK: Pressure Points

1. Back of head

2. Ears (side-lying, O₂ tubing)

3. Shoulder blades

4. Elbows

5. Tailbone/lower spine

6. Hips (side-lying)

7. Buttocks & sitting bones

8. Inner knees

9. Ankles

10. Heels

ALWAYS check skin in areas where moisture gets trapped:

  1. Skin folds (under breast, belly, groin)
  2. Areas of incontinence or excessive sweat
  3. Covered skin in areas with poor air circulation (under briefs, braces, shoes, or tubing)

WHEN TO LOOK: During Usual Care

Look during bathing, toileting, dressing, repositioning.

  • Ask first and protect privacy.
  • Clients in bed/wheelchair all day are highest risk.

WHAT TO LOOK FOR

Changes can look different on different skin tones.

Red, raw skin in damp areas

Red, raw, shiny, or peeling skin in folds, groin, or buttocks.

Note in ALC. Call if it opens.

MILD Incontinence rash on buttocks:

Source: AI-generated

Call the office.

SEVERE Incontinence rash on buttocks:

Source: AI-generated

Redness that stays

A red area that does not fade, often over a bony spot.

Note in ALC. Call the office if it opens.

Red patch over tailbone:

Red patch over heel:

Source: AI-generated

Darker or purple patch

Purple, maroon, bluish, or darker than the client’s usual skin.

Not sure? Call the office.

Red patch over tailbone on dark skin tone:

Source: AI-generated

Red patch over heel on dark skin tone:

Source: AI-generated

Open or broken skin

Any break: scrape, crack, crater, or bleeding (even small)

Call the office.

Small open area over tailbone:

Small open area over heel:

Dressing or wound area change

Dressing wet, dirty, loose or off. New leaking or smell. Redness spreading.

Call the office.

Soaked, redness spreading around a wound dressing:

Dirty, loose, leaking dressing:

Blister or skin tear

Fluid bubble, or thin torn skin on arms or shins. Bruises too.

Bleeding or open? Call the office.

Skin tear with flap:

Heel blister:

Source: AI-generated

HOW TO DO: Skin Checks

1. Protect. Reposition the client as the care plan allows. Don’t rub the area or add creams or dressings.
2. Call live, during the visit. Report new or worse skin to your CSS or the office. Report even if the nurse or family already knows.
3. Document. Document what you saw, where, the time, and who you told in the ALC note.
4. Follow through. Follow the updated care plan. Report again if it gets worse.
5. If you cannot see the at-risk area or wound. Document what tasks were NOT done and what areas you could not see in the ALC note.

When you see a change, call the office.

Give the facts: CLOSE-UP

C
Colour
What colour is the wound?

L
Location
Where is the wound?

O
Odour (Smell)
Does the wound smell?

S
Size
How big is the wound, compared to a coin? (e.g. dime, quarter, toonie)

E
Exudate (Leaking)
Is there any oozing? Is it a blister wound? Is it bleeding?

U
Update
Is the wound new? Open? Worse since last visit?

P
Pain
Does the wound hurt? Itch? Burn?

 

The following is NOT in PSW Scope:

  • DO NOT diagnose or evaluate the severity of a wound
  • DO NOT remove a dressing to look at a wound
  • DO NOT choose creams or dressings for a wound
  • DO NOT provide instructions on how to change a wound dressing

You should be doing skin checks during usual care and reporting any changes. Your CSS will arrange a clinical assessment.