med/surge nurse with a ?

  1. I work on a med/surge floor with a small SCU and we are currently rewriting our pressure ulcer prevention polices to comply with the new HEN guidelines. We are reviewing our best practice for wound care and prevention. Something some of the staff currently does is apply mepilex boarders to reddened pts buttocks/coccyx areas. I have done alot of research but can't find anywhere this is recommended or condemed. I cant find any information that states this should be placed on intact skin for protection. My thought is that it could trap moisture on incont patients ; they tend to roll on the edges with the "wiggley" confused types and I would just like some input from some nurses with more knowledge regarding this area of nursing then I.
  2. 1 Comments

  3. by   CWONgal
    There is actually a lot of literature out there. I just read a study where the intervention was placing the "PUP" dressing in the ER prior to the patient getting to the floor. The author reported a decreased rate of HAPU's when this was done (one study though!). I would suggest you go to the Molnlyke website where they should have literature you can reference. They have a sacral foam dressing that seems to be "the" popular product used. PUP dressings aren't for everyone...if your patient is incontinent and the dressing is getting soiled then that's not the right product choice. The PUP dressings actually do best w/ preventing shear/friction. The size of the foam dressing also disburses pressure. What I have noticed in the past are nurses placing small 2x2 foam dressings over an ulcer or an area w/ some erythema and then later when you go to take the dressings off you actually see a square indentation in the skin. Personal view, that can't be good. I haven't noticed the indentation w/ the larger dressing. With respect to moisture I believe we cause more harm by placing patients on a draw sheet and multiple pads not allowing circulation to the tissue. Additionally when you get to the nitty gritty of it we just need to turn our patients! I do agree the edges of the silicone dressings are a pain. The rep demonstrated rolling the edges back and then rolling them back into place to preserve the dressing. Check out these links:

    Use of a sacral silic... [J Wound Ostomy Continence Nurs. 2012 Mar-Apr] - PubMed - NCBI
    The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial - Santamaria - 2013 - International Wound Journal - Wile

    Hope this helps you!