Children's Hospitals Today - Fall 2024 - 17

IMPROVEMENT / FEATURE
GETTING STARTED
More than skin deep
A job guide created by nurses at Seattle Children's calls for
providers to follow these steps when assessing patients' skin.
Ask the patient's
family or caregiver
about skin changes.
Use touch to identify
temperature, feel
textural differences,
observe skin response to
pressure, and examine
tissue consistency.
Perform bilateral
examinations to
compare skin tone
across the body.
Prioritize symptoms that
affect everyone equally,
such as how it looks when
compared to the patient's
regular skin or how the
patient reports it feels
(e.g. itchy, warm, dry).
Having a productivity target in place
also supports growth plans as demand
for music therapy continues to grow at
the hospital. " Music therapy is still a
somewhat new modality to our country,
and I think in five to 10 years, it will
look incredibly different. It's going to be
a lot more common, and departments
are going to be a lot larger, " Rahenkamp
said. " Our hope is this can move our
country just one step in the right direction
to help us get there. "
Finding the right words
Many health care educational materials
use " pink " to describe signs of diaper
rash, " blue " for cyanosis, and " red " for
erythema. Though exact, these colors
only describe how the conditions appear
on white skin. Symptoms may look or
feel different on other skin tones.
Without precise descriptions of
symptoms on brown or black skin, providers
could miss subtle changes. For
example, darker skin may mask redness
and blanching, both indicators of
early-stage pressure injuries.
A nursing-led initiative at Seattle
Children's sought to describe how skin
symptoms look on patients of varying
skin tones instead of making broad
generalizations. " We wanted people to
know that simply using race or ethnicity
as an assumption of somebody's skin
tone wasn't the most inclusive way to
go about it, " said Mari Moore, MSN, RN,
NPD-BC, RNC-NIC, manager of nursing
professional development.
An interdisciplinary group worked
to describe specific symptoms on all
skin tones. Over 18 months, the group
may be subtle on the skin but more obvious
on the sclera of the eye.
Along with the job aid, the hospital's
EMR now offers more ways to describe
skin tone. Pink was removed as the default
option for " normal skin " and more
We had to balance being sensitive to the team's needs
while pushing for progress. -Kelsey Rahenkamp
collaborated with a dermatologist, consulted
the hospital's Family Advisory
Committee, and conducted a literature
review. The results were a job aid for
inclusive language for skin symptoms
and updates to the clinical documentation
function.
" We wanted to be as descriptive as
possible, using evidence-based ways
to assess skin that take into account
people with differing skin tones, "
Moore said. " We didn't want to provide
a long list of dos and don'ts but instead
give some high-level guidelines while
being very objective. "
Seattle Children's inclusive-language
job aid offers condition-specific examples.
For cyanosis, the aid instructs
nurses to look for a blue or gray tinge
on the lips, tongue, and gums-areas
where the condition may be easier to
identify on patients of all skin tones.
For jaundice, the guide states yellowing
color descriptors were added. Instead
of " appropriate for ethnicity " as a skin
color choice, the EMR now includes " appropriate
for usual tone. "
Moving forward, Seattle Children's
will continue to incorporate inclusive
language around skin tone into dayto-day
work. Many staff members have
requested a photo library showing
how dermatological conditions appear
on various skin tones. That project is
on the hospital's long-range plan; in
the interim, staff use the Skin Deep
Project, an open-access photo bank of
skin conditions.
" Our organization prioritizes this
work because we know it's important
to people who work here, and we
know it's important to patients and
families, " Moore said.
Send questions or comments to
communications@childrenshospitals.org.
CHILDREN'S HOSPITALS TODAY Fall 2024
17
Children's Hospitals Today - Fall 2024

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