Need advice, preventing shear force/friction

[Yosemite, RN, ASN, EMT-I]

Help! I need advice on treating pressure ulcers from shear force/friction in a couple of my patients. Both have limited mobility, both are obese, both have limited recourses. Shear force during transfers are tearing up the buttocks and or posterior thighs. I have tried hydrocolloid under transparent dressings; when no drainage is present, transparent dressings alone. Inevitably, the dressings roll/pull away/shred and the adhesive remnants further cause friction. Of course, I have used skin protectant products. I have bordered the dressings with Hypafix. Same results. Using just barrier creams alone is not an option, either (lack of resources). Keeping skin clean and dry is as good as it's going to get. Both have COPD, so powders are ill advised, especially one of the 2.

I have consulted as many wound care/ostomy nurses as I have available to me. Transfer methods are NOT going to change in either of them (again, lack of resources).

My wits end is approaching!

[Davidaugustyn]

What kind of bed? If there is moisture involvement you may want to implement a low air loss mattress.

I have seen these patients before, with skin that just literally just shears off. but it's rare. Have you had these before? For you to have 2 at once you might want to consider that you have a bad process at your facility. Just a thought.

Otherwise, the mattress.

What type of draw sheet are you using? Are you using one?

I get the impression your staff is not very willing to make a change for these residents. Will they adjust to changes in the plan of care or will they need monitoring for providing it?

If they're a sling lift, they may need to be bed bound for awhile. idk, depends on the severity.

Overall, make sure you are not negligent. If the patient needs the right product or device, make sure it's provided.

Make the patient a L+R turn only. No back time except if eating. At that, only 45 degrees.

Boost only when on their side, not back.

Less layers. No hydrocolloids or dressings at all is usually the case. Thin layer of thin zinc based cream usually the best with my experience. Even better, if continent or get a foley, leave the chux off and use just a draw sheet.

msg me if any questions.

More info would be helpful

[Yosemite, RN, ASN, EMT-I]

Thanks, Mon...

This was a Home Health patient, no care giver, no Hoyer lift, not incontinent and NOT willing to consider assisted living facility or board & care. Fairly obese, mobility impaired, living alone, and wheelchair bound, I got roped into fixing the situation. I called in every reserve I had open to me... Physical Therapy, Medical Social Worker, etc. I changed dressings 5 to 6 days a week and FINALLY got them healed and bailed from the case. Within 2 weeks, PCP wanted us/me to reopen the case. Thankfully, no openings available. A MASSIVE revenue loss for non-billable dressing supplies.

Some things you just cannot fix. Thanks for the reply, though.

[Davidaugustyn]

That's true. Tough situation. I would suggest to him a mattress if he doesn't have one, (something he can't be noncompliant with) and let him be. Those are tough....