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Pressure Ulcer Prevention at North Memorial
So what’s the big deal ?
Why We Practice Pressure Ulcer Prevention
Maintenance of skin integrity and pressure ulcer prevention is a nursing sensitive indicator of quality nursing care (American Nurses Association).
Why We Practice Pressure Ulcer Prevention
It’s a community expectation.
Why We Practice Pressure Ulcer Prevention
Pressure ulcers are a reportable complication.www.health.state.mn.us/patientsafety
Patient Safety Link Adverse Health Events in Minnesota
Avoidable vs. Unavoidable
Why We Practice Pressure Ulcer Prevention
It is more cost effective to prevent a pressure ulcer than to treat one.
Average cost per ulcer = $27,000 Annual US healthcare costs are over $3.6
billion
Why We Practice Pressure Ulcer Prevention
It’s the right thing to do !!!!
Components of a Pressure Ulcer Prevention Program
A clear process for identifying a patient's risk for developing pressure ulcers.
Strategies aimed at pressure ulcer prevention for the patient at risk.
Components of a Pressure Ulcer Prevention Program Pressure ulcer prevention and treatment
initiatives should be:Evidence based
ICSI (Institute for Clinical Systems Improvement) Guidelines (2006) www.mnpatientsafety.org
WOCN Clinical Practice Guideline (2003). Prevention and Management of Pressure Ulcers. www.wocn.org
NPUAP (National Pressure Ulcer Advisory Panel) www.npuap.org
Risk Assessment Should be performed at the point of entry
to a health care facility and repeated on a regularly scheduled basis or with any change in condition.
At the time of patient "hand offs".
WOCN Guideline for Prevention and Management of Pressure Ulcers (2003).
Risk Assessment: Braden Scale
Intensity and duration of pressure Sensory perception Mobility Activity
Tissue tolerance for pressure Moisture Nutrition Friction/shear
Scoring 6-23 As scores become
lower, predicted risk becomes higher. Mild risk: 15-18 Mod risk: 13-14 High risk: 10-12 Very high risk 9 or less
Risk Assessment: High Risk Groups
Peripheral Vascular Disease
Myocardial Infarction Stroke Multiple trauma Musculoskeletal disorders GI bleed Bariatric
Unstable and/or chronic medical conditions
History of previous pressure ulcer
Immunosuppression Preterm neonates Spinal cord injury Neurological disorders
Risk Assessment: Skin Inspection
A head to toe inspection and palpation should be done on every patient upon admission, particularly over pressure points.
Repeat every 8-24 hours Inspect Palpate Ask
ICSI (2006)
Risk Assessment
Documentation Communication Patient Education
Skin Safety: Pressure Ulcer Prevention
Minimize or eliminate friction and shear. Minimize pressure Manage moisture Maintain adequate nutrition/hydration
Skin Safety: Friction and Shear
Friction: The force of two surfaces moving across
each other
Can cause superficial abrasions or blisters
Skin Safety: Friction and Shear
Shearing Force: Skin sticks to surface Deeper tissues move in opposite direction Capillaries kink Local ischemia
Skin Safety: Minimize Pressure
Schedule regular and frequent turning and repositioning for bed and chair bound individuals.
Use support surfaces on beds and chairs to reduce or relieve pressure.
Relieve pressure to heels by using pillows or other devices.
Skin Safety: Manage Moisture
Skin hydration issues Dry skin
Skin with too little moisture 2.5 times more likely to ulcerate than healthy skin.
Skin moist from incontinence 5 times more likely to ulcerate than dry
skin.
Skin Safety: Manage Moisture
Implement a toileting schedule Use ph-balanced cleansers Contain urine or stool Avoid chux, briefs, diapers.
Skin Safety: Maintain adequate nutrition and hydration
Maintain adequate nutrition that is compatible with the individual’s wishes or condition.
Consult a nutritionist in cases of suspected or identified nutritional deficiencies.
Skin Safety
Documentation Communication Patient/Caregiver Education
Causes and risk factorsWays to minimize risk
Implementation
Is your process in place?
Risk assessment done on admission and at appropriate intervals?
Appropriate prevention strategies initiated for patients at risk?
Appropriate referrals initiated? Patient/caregiver education done? Document, document, document.
Questions ?
