Editor's note: This tip was originally published in May 2009. It has been updated with the latest clinical information and online resources.
Consistent assignment of caregivers in nursing homes can help prevent pressure ulcers. Inspecting residents' skin regularly -- checking for any changes -- is vital in making sure skin stays intact and pressure ulcers do not develop. Caregivers who are more familiar with residents are more likely to notice even subtle changes in the skin. Consistent assignment paves the way toward this familiarity.
In the Consistent Assignment model, residents see the same caregivers (nurses, med techs, and nursing assistants) at least 85% of the time. Because staff see residents more frequently, subtle changes in the skin are more likely to be noticed and reported. Caregivers are more likely to catch small changes, like Stage 1 pressure ulcer formation, before they worsen.
When employees are given rotating assignments, it is more difficult for them to build relationships with residents and coworkers. Consistent assignment, by contrast, can strengthen relationships between caregivers and residents, allowing residents to become more comfortable with intimate aspects of care like skin assessment. The model also strengthens organizations: staff turnover is lower in homes using consistent assignment, and quality of life is higher.
Consistent assignment is not just a good thing; it’s possible! To learn how, first go to page 2 of "Change Ideas for Consistent Assignment" for a process to easily change from rotating to consistent assignments.
Then visit pages 8-15 of "Improving Consistent Assignment of Nursing Home Staff Implementation Guide" to walk through the process of implementing consistent assignment at your nursing home.
Action Steps:
- Target one group of residents to test the consistent assignment model with.
- Build a team that will regularly work together to care for these residents.
- Ask staff members for their preferred schedule. Assign shifts based on care needs and personal relationships with residents.
- Ask team members to back each other up and fill in when their teammates need to change schedules or call in.
- If the consistent assignment model is new to the home, discuss pros and cons with staff. Explain how and why this helps the residents. Some people might be concerned how the new model affects them -- encourage these people to share what barriers they feel they might face. Look for ways to overcome these barriers.
- Identify a set of staff members who like to float. This is often a matter of preference. Having floaters on staff empowers the team and helps ensure residents are cared for.
November 2012
Tip 5: PUP Digs Consistent Assignment 