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CASE STUDY: Mr Smith is a 76-year-old male and a recent widower. He has been referred to Emergency Department (ED) by his General Practitioner (GP) for treatment of a skin infection on his right leg. On inspection right lower leg is visibly swollen/oedematous and severe pain in this leg is affecting his mobility. He suffers from breathing problems, joint pain (gout) and has had recent spinal surgery for a prolapsed disc. Mr Smith had to wait in the ED for 12 hours and another 24 hours in Short Stay Unit, before a bed was available on Medical Ward. During his stay in Short Stay Unit, he experienced urinary incontinence and was embarrassed to share this with staff. He developed a sore bottom and reported it to the staff. The staff told him this was due to the old mattress, and that he would be more comfortable when he got to the ward. On the ward, Mr Smith’s mobility further decreases due to a flaring of pain in the joints of his lower limbs and wrists. He complains of back pain and is given pain relief and a heat pack. No skin assessment is done. He passes urine in the bottle, sometimes nurses are very busy and forget to empty the bottle. Day 4 post admission, you realise this patient needs assistance with ADLs. You observe broken skin on the sacrum, and your preceptor suggests a stage 1 pressure ulcer. She then discusses it with the ward educator, who suggests that your preceptor deliver an in-service to promote awareness of pressure injuries. Question: How do you determine, document and communicate further priorities, goals and outcomes with the relevant persons?

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