Pressure ulcer prevention

Successful treatment

By: Mölnlycke Health Care, December 8 2011Posted in: Pressure ulcer prevention

Patients at high risk of developing pressure ulcers can be identified before ulcers occur if risk is assessed – however it is now recognised that there are situations whereby a pressure ulcer is unavoidable. Review the key elements of pressure ulcer treatment.

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Learn more about Treatment Strategies

Patients at high risk of developing pressure ulcers can be identified before ulcers occur if risk is assessed – whilst it is now recognised that there are situations whereby a pressure ulcer is unavoidable.

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Key elements in treatment

Key elements in treatment – adapted from National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009.1

  • Classify the ulcer – use a validated tool, educate the health care team as to specific techniques required when caring for dark pigmented patients and to differentiate from other wounds
  • Assess and monitor healing – assess ulcer at a minimum weekly – monitor healing using a validated healing tool – modify treatment protocols when progress is not as expected
  • Ensure nutritional requirements are assessed and met with nutritional support and dietician referral
  • Assess pain – pain can occur both during procedures and at rest- use a validated pain assessment tool such as a visual analogue score
  • Ensure adequate pain relief strategies are implemented
    Note pain assessment tools can be accessed in the pain awareness zone of
    www.less-pain.com
  • Choose a suitable support surface and take care when positioning patients –be aware of the special requirements of patients in critical care or those with spinal cord injury and obesity
  • Dressing selection – base selection upon specific nature of the individual wound – consider exudate level, condition of wound bed, infection, location and   condition of surrounding skin. Adopting a moist environment is essential for optimal healing. Also consider choosing dressings which offer minimisation
    of pain and trauma such as soft silicone dressings
  • Assess and treat infection
  • Consider use of specialist therapies – such as NPWT
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Assessment of Pressure Ulcers

Various characteristics of a pressure ulcer are important, both in understanding the depth and degree of tissue damage and defining principles of care including dressing selection.

The following elements should be assessed:

  • Stage
  • Location
  • Size (length, width, depth)
    (photography may be prove useful)
  • Is undermining present?
  • Sinus tract/ tunneling
  • Necrotic tissue/slough presence
  • Granulation tissue presence
  • Exudate
  • Pain – has pain assessment be conducted and pain relief strategies implemented
  • Peri wound skin condition

References

  1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009
  2. Bibliometric Analysis of Pressure Ulcer research. JWOCN; 37(6); 627-632; Hong-Lin Chen et al; 2010
  3. Medical Device related pressure ulcers in hospitalised patients. International Wound Journal; 7(5); 358-365; Black J M et al; 2010
  4. WOCN Society. Professional Practice Manual 3rd Edition, Appendix D Prevalence and Incidence: A Toolkit for Clinicians, Mt. Laurel NJ; 2005 3. Dressing related pain in patients with chronic wounds: an international patient perspective. Price P et al. International Wound Journal; 2008
  5. International Guidelines: Pressure ulcer prevention: prevalence and incidence in context. A consensus document. London: MEP Ltd, 2009
  6. Pressure Ulcer Prevalence Monitoring Project: Summary report on the Prevalence of Pressure Ulcers. EPUAP Review; Volume 4, Issue 2, 2002
  7. Results of nine international pressure ulcer surveys: 1989-2005. Ostomy Wound Management; 54(2). Vangilder C et al; 2008
  8. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy/Wound Management. 50(10):22-38. Woodbury MG, Houghton PE; 2004
  9. Prentice JL, Stacey MC. Pressure ulcers: the case for improving prevention and management in Australian health care settings. Primary Intention 2001; 9: 111-12027
  10. A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China Zhao G, Ostomy Wound Manage. 2010 Feb;56(2):38-42
  11. Factors affecting healing of Pressure ulcers in Korean Acute Hospital. Sung Y.H et al. WOCN January 2011
  12. Description of pressure ulcers pain at rest and at dressing change. Szor JK. JWOCN. 26(3):115–120; 1999
  13. Pressure ulcer pain suffering; issues in a multi centre pain prevalence, Nixon J et al. Oral presentation at EPUAP Annual Conference, Birmingham, UK. 2010
  14. Reaching for the moon: achieving zero pressure ulcer prevalence. J Wound Care 18(4): 137–44 Bales I, Padwojski A ;2009
  15. The cost of pressure ulcers in the UK: Age and Ageing; 33: 230–235; Bennett G et al; 2004
  16. Legal Issues in the Care of Pressure Ulcer Patients: Ket Concepts for Healthcare Providers – A Consensus Paper from the International Expert Wound Care Advisory Panel. 23(11):493-507, November; Fife C et al; 2010
  17. Centers for Medicare & Medicaid Services. Proposed Fiscal Year 2009 Payment, Policy Changes for Inpatient Stays in General Acute Care Hospitals. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3045&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500. Accessed May 13, 2008.
  18. Centers for Medicare & Medicaid Services. Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians; Proposed Rule. Federal Register. 2008;73(84):23550. Available at: http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf
  19. Hospitalisation related to pressure ulcers among adults 18 years and over. Agency for Healthcare Research and Quality; Statistical Brief #64. 2006
  20. Interprofessional Management of Complex Continuing Care Patient Admitted with 18 Pressure Ulcers. Baker T et al. Ostomy Wound Management; Feb 2011
  21. Pressure Ulcer Classification; Differentiation between pressure ulcers and moisture lesions. EPUAP Review 6(3); Defloor T., et al ;2005
  22. Wound Dressing Shear Test Method (Bench) Providing Results Equivalent to Humans.Bill B et al. Poster Presentation at the EPUAP Congress, Oporto, 2011
  23. Wound Dressings, Measuring the Microclimate They Create, Call E. Oral Presentationat the EPUAP Congress, Oporto, 2011
  24. Dressings can prevent pressure ulcers :fact or fallacy? The problem of pressure ulcer prevention. Wounds UK;5(4) pg 61-64; Butcher M et al; 2009
  25. Journal of Wound, Ostomy and Continence Nursing: May/June 2007 - Volume 34 - Issue 3S - p S67 doi: 10.1097/01.WON.0000271036.00057.f8 Scientific and Clinical Abstracts From the 39th Annual Wound, Ostomy and Continence Nurses Annual Conference, Salt Lake City, Utah, June 9-13, 2007:Research Abstracts: Wound-Evidence-Based Interventions
  26. Shear A contributory factor in pressure ulceration. A presentation aimed at clinicians and associated professional. www.npuap.org; accessed 14/12/09
  27. Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil. 76(7):666-73; Kokate J.Y et al; 1995
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