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New Guidelines Developed For Treating Pressure Ulcers

Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization.

The Agency for Healthcare Research and Quality has developed new guidelines to assist hospital staff in implementing effective pressure ulcer prevention practices through an interdisciplinary approach to care.

One approach that has been successfully used is a care bundle, which incorporates those best practices that if done in combination are likely to lead to better outcomes. It is a way of taking best practices and tying them together in a systematic way.

The pressure ulcer bundle incorporates three critical components in preventing pressure ulcers:

1. Comprehensive skin assessment.
2. Standardized pressure ulcer risk assessment.
3. Care planning and implementation to address areas of risk.

Comprehensive skin assessment is a process by which the entire skin of every individual is examined for any abnormalities. It requires looking and touching the skin from head to toe, with a particular emphasis over bony prominences.

As the first step in pressure ulcer prevention, comprehensive skin assessment has a number of important goals and functions. These include:

• Identify any pressure ulcers that may be present.
• Assist in risk stratification; any patient with an existing pressure ulcer is at risk for additional ulcers.
• Determine whether there are other lesions and skin-related factors predisposing to pressure ulcer development, such as excessively dry skin or moisture-associated skin damage (MASD).
• Identify other important skin conditions.
• Provide the data necessary for calculating pressure ulcer incidence and prevalence.

While there is no consensus about the minimum for a comprehensive skin assessment, usual practice includes assessing the following five parameters: temperature, color, moisture level, turgor and skin integrity.

After a comprehensive skin examination, pressure ulcer risk assessment is the next step in pressure ulcer prevention. Pressure ulcer risk assessment is a standardized and ongoing process with the goal of identifying patients at risk for the development of a pressure ulcer so that plans for targeted preventive care to address the identified risk can be implemented.

Risk assessment does not identify who will develop a pressure ulcer. Instead, it determines which patients are more likely to develop a pressure ulcer, particularly if no special preventive interventions are introduced. In addition, risk assessment may be used to identify different levels of risk.

Knowing which patients are at risk for a pressure ulcer is not enough; health care professionals must do something about it. Care planning provides the guide for what will be done to prevent pressure ulcers. Once risk assessment has helped identify patient risk factors, it is important to match care planning to those needs.

Care plans must address the pain and how patients will be encouraged to reposition. Some tips to incorporate in the care plan:

• Explain why you need to reposition the person. Try having several pillows placed under the patient’s shoulder and back.
• Sit the person in a chair. This maintains the more elevated position and allows for small shifts in weight every 15 minutes.
• Try having patients turn toward their stomach at a 30 degree angle. They can be propped up or leaning on pillows.
• Ask the patient what his or her favorite position is. All of us have certain positions we prefer for sleep. After surgery or injury, the favorite may not be possible. For example, after knee replacement surgery the person cannot bend that leg to curl up. Try to find an alternative that the patient will like.
• Frequent small repositioning shifts can help prevent pressure ulcers. Care plans should acknowledge the need for patients to shift their weight a little each time you area there.
• Dehydration is a common problem predisposing patients to pressure ulcers. Care plans may suggest offering a sip of a beverage each time you enter the room.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.




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