Prevention in pressure ulcers

Jewelrmn · Feb 4, 2004

Hi Tam910

Your right about one thing, the key to preventing pressure ulcers is education, all involved in care processes from care assistants to managers need to be well versed in this subject. Throughout your research you will have ascertained that pressure ulcers are 95% preventable. With adequate pressure relieving surfaces, frequent repositioning, good nutrition and hydration, hygiene and generally good nursing care, they can be prevented. However, you must also think of that 5% that are not preventable. The skin is the body's largest organ and also one of its most active. In terminal care, we accept that patients could go into renal failure or heart failure etc. If these organs can 'fail', why can't the skin? You also need to acknowledge the presence of existing co-pathologies. In a healthcare setting, the patients are ill, otherwise they would not be in hospital! These co-pathologies, whether they are the ones which brought the patient into hospital or not, may make the patients more susceptible to tissue damage, and acknowledgement must be given to these. It is worthwhile for nurses to know what effects the patients disease process has on the patient and correlate these with their risk of developing pressure ulcers as a result. I find that in many instances that these are not taken into consideration. Also, think about pre-admission care. If a person is to be hospitalised for surgery, they generally know in advance of the admission date and many undergo a pre-op assessment clinic. Why can't info be disseminated to them of the risk of tissue breakdown due to surgery. Giving them this type of advice may help them 'build' themselves up a little, to help them tolerate the malnutrition experienced due to pre and post op fasting and catabolic states? You are right, much more should be and can be done. It is worth the while for trusts to look into these ideas. Research has shown, that across the NHS hospitals, that pressure ulcers can cost up to £30M per annum, and that is not counting litigation costs!

Good luck with your research.

mackrn · Jan 29, 2005

Hi Tam910
Your right about one thing, the key to preventing pressure ulcers is education, all involved in care processes from care assistants to managers need to be well versed in this subject. .

While it is true that most pressure ulcers are preventable in some cases there isn't much that can be done to stop the patient from developing them. One such case is the development of Kennedy Terminal Ulcer or in patient where the ability to releive the pressure is minimal. Have been doing wound care for over 20 years and there are some patient that are going to develop an ulcer no matter what you do in prevention.

alintanurse · Jan 29, 2005

Let's not forget that inadequate staffing also contributes to the development of pressure ulcers. Without enough staff to reposition,encourage/assist with hydrating,assess skin integrity and implement the interventions necessary to prevent breakdown----then pressure ulcers will develop.

CoffeeRTC, BSN, RN · Feb 1, 2005

Just gonna say something about staffing. In LTC that is not an excuse.. Yes understaffing is a major prob in LTC. It is an excuse I hear (and understand) from acute care. So many of our res come back with decubs mostly heel and buttocks. I know the units that they were on were understaffed and over worked. For the most part, what I teach my CNAs is the three basic. Feed them, Clean them and move them. If all of those parts are being done we are doing a big part for prevention.

cdf77414 · Feb 15, 2006

What is the best treatment for a heel ulcer 5 cm black.

Bird2 · Feb 15, 2006

What is the best treatment for a heel ulcer 5 cm black.

It would depend if it is stable or not. If the eschar is intact and the ulcer has no redness, warmth, or purulence then AHCPR guidelines recommend protecting the area and monitoring it. I would suggest getting a hold of the AHCPR guidelines. They are very useful for those questions that we often have regarding ulcers.

cdf77414 · Feb 16, 2006

How do I get a hold of the AHCPR guidelines?

Bird2 · Feb 16, 2006

How do I get a hold of the AHCPR guidelines?

Just do a search on YAHOO for AHCPR guidelines. I received mine at no cost from our wound care supply vendor. Although I believe they are under 20.00. Someone in you facility may have them sitting on a shelf and not even know what the book is.

nowhappywoundnurse · Feb 19, 2006

Go to the National Guideline Clearinghouse where you will find them posted. Also standards for neuropathic ulcers, burns, skin tears, etc. www.guideline.gov I found this on the AAWM website in the candidate handbook for CWS exam. They list it as a reference for studying.