A Guide to Preventing Pressure Ulcers – Best Practice
Incidences of Pressure Ulcers among patients who are confined to their beds for large portions of the day can have significant implications for both the patient and the clinical setting. They are painful for the patient and can lead to a considerably longer stay in hospital, thus increasing pressure on hospital beds and budgets. This is especially important with Spinal Cord Injury (SCI) patients who cannot move without considerable aid.
What are pressure ulcers?
Bony parts of the body are most susceptible to pressure ulcers, including the heel, hips and buttocks. They occur when there is sustained pressure on specific sections of the body or incidences of shearing or friction. Early indications of pressure ulcers include skin discolouration and, if not treated, these can deteriorate significantly and become open wounds. Depending on the severity of the ulcer, they can lead to a longer stay in hospital, lengthen the rehabilitation process or in the most critical cases lead to a patient’s death.
Diagram Courtesy of WebMD who explain the different stages in more detail.
Preventing Pressure Ulcers
If you have a patient who is susceptible to pressure ulcers, preventing them is significantly easier and cheaper than treating the damage. Pressure Ulcers can occur rapidly, making it essential that a care plan for prevention is established soon after the patient has been admitted.
This includes a schedule of regular checks and turning to reduce the risk of pressure ulcers developing. Preventing pressure ulcers needs to be a multi-disciplinary approach, involving all aspects of a patient’s care plan. The process should be adapted for individual patients, taking into account the severity of their injuries and risk factors.
Changing position on a regular basis is the simplest and most effective method for preventing pressure ulcers. For those with complex care needs, two-hourly turns should be instigated. Individual care plans can reduce this to every three or four hours if sufficient.
The way in which a patient is turned needs to cause minimal stress on the skin. A mechanical turning bed is particularly beneficial in cases where the patient has limited or no upper body strength, such as spinal cord injuries. This also reduces pressure on the nursing team, thus enabling them to move patients easier and limits manual handling injuries.
The position a patient is placed in has to minimise the pressure on certain areas of the body that are prone to ulcers. They should be positioned at an angle of no more than 30 degrees, an angle steeper than this may cause shearing.
Even with regular turning, patients can still suffer from pressure ulcers if the care team don’t carry out regular skin inspections. This needs to occur at least on a daily basis to check for areas that are prone to ulcers and spot early warning signs.
The patient’s skin should be cleaned and dried thoroughly and can be protected with talcum powder or moisturisers. Particular care needs to be shown to those patients with incontinence problems, with pads or catheters changed frequently to minimise moisture.
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