Why the admission skin assessment sets the baseline

An admission skin assessment checklist does two things. It finds skin problems while they are still small, and it records what the resident arrived with. A finding that was not documented at admission is hard to show later as present on arrival, and a prevention plan cannot address a problem nobody found.

Hospital paperwork is a starting point, not a substitute. Transfer summaries miss the discolored heel, the skin tear from the stretcher ride and the sacrum that was “pink” three days ago.

Before you start

  • Read the transfer summary and orders for known wounds, dressings, recent surgery and devices.
  • Explain what you are doing and why, and get the resident’s agreement.
  • Close the door and curtain, keep the resident covered between areas and use good light.
  • Bring a second staff member for turning and a measuring guide.
  • Remove socks, stockings, heel protectors and briefs. Look under existing dressings as the orders and your policy allow.

The head-to-toe checklist

Work in the same order every time so nothing depends on memory.

  1. Head and neck. The back of the head, the ears where oxygen tubing rests, the nostrils and lips if there is a tube, and the neck under a collar.
  2. Shoulders, back and arms. Shoulder blades, spine, elbows and forearms, where skin tears are common.
  3. Chest and abdomen. Folds under the breasts and abdomen, and the skin around feeding tubes, ostomies and incisions.
  4. Sacrum, tailbone and buttocks. Look into the cleft between the buttocks, and check the sitting bones.
  5. Hips and groin. Both hip bones, the groin folds and the perineal skin, including around a urinary catheter.
  6. Legs. Knees on both sides, shins and calves. Note swelling, color changes and weeping.
  7. Feet. Ankle bones, heels, soles, toe tips, between the toes and the nails.
  8. Under every device. Splints, braces, compression stockings, cast edges and tubing.

Give the sacrum and heels a second look. A heel resting on the mattress hides its own injury.

What to record for each finding

Write down normal findings too. “Skin intact, both heels intact and blanchable” is a finding. For anything abnormal, record:

  • The exact location, with side and landmark
  • What it looks like, described, not guessed: discolored intact skin, open area, blister, bruise, tear, rash or scar
  • Size in centimeters, and depth if it is open
  • Color, tissue, drainage and odor
  • The surrounding skin, and whether redness blanches
  • Pain or tenderness

Your policy decides who assigns a stage, and our review of pressure injury stages covers the terms. Moisture-associated skin damage and skin tears need their own plans, and mislabeling them sends the care plan in the wrong direction.

Findings that are easy to miss

On darker skin tones, early pressure damage may not look red. Compare the area with the skin around it. Look for a patch that is darker, purplish or shiny, feel for warmth, coolness, firmness or a boggy texture, and ask about pain.

Deep tissue injury can look like a bruise at admission and open days later. Document maroon or purple areas over bony places, tell the physician and recheck them daily through the first week.

Turn findings into a plan the same shift

Before the shift ends:

  • Complete the pressure injury risk assessment your facility uses.
  • Notify the physician of any wound or suspicious area and obtain treatment orders.
  • Tell the resident’s representative what was found on arrival.
  • Start the basics: a suitable support surface, heels off the bed, a repositioning plan and an incontinence plan.
  • Put the findings and interventions on the care plan and the CNA assignment sheet.
  • Request a dietitian review for anyone with a wound or poor intake.

Then look again. Many teams repeat the skin check within a day or two, because the first one happens when the resident is exhausted and the nurse has two other admissions waiting. Your pressure injury prevention program picks up from there.

When to ask for a wound clinician

Some admissions need more than the standard pathway: a Stage 3 or 4 pressure injury, a surgical wound that has opened, a negative pressure device, a diabetic foot wound or anything that looks infected. Raise a wound consult with the attending physician early.

Gateway arranges facility wound rounds and individual visits with partner clinicians for skilled nursing facilities across Greater St. Louis and the Metro East. Availability is confirmed by location. Call 314-325-0126 or send a referral request. For a resident who is acutely ill, call the physician or 911.

Common questions

How soon after admission should the skin assessment be done?

As soon as possible after arrival, within the time frame your facility’s policy sets. Many teams aim to finish within the first few hours, before the resident has spent a night on a new surface. A long gap makes it harder to show which findings came with the resident.

Should we remove hospital dressings during the admission skin check?

Follow the transfer orders and your policy. The admitting nurse generally needs to see and describe the wound under a dressing, unless the orders say to leave it in place, as with some surgical dressings or negative pressure devices. If you cannot look, document why and ask the physician when it may be changed.

What if a resident declines a full skin check on arrival?

Explain the reason again, offer to do it in parts, and offer a different staff member or a later time that day. Document the refusal, what was and was not seen, and each further attempt, and tell the supervisor and physician.

Does a return from the hospital need a new skin assessment?

Yes. Treat a readmission as a new admission for skin purposes. Residents come back with new pressure areas, device marks, skin tears and surgical sites. Compare what you find with the last assessment before they left, document the differences and update the care plan.

Related pages

Updated October 2026