PRESSURE ULCERS By: Emily Ebright

DEFINE THE PROBLEM Cause:

Prolonged pressure on skin and tissue especially bony points, decreases blood flow to these areas.

Affected skin and tissue are deprived of nutrients and oxygen and start to die.

Contributing factors: Immobility, mental and physical impairments,

excess weight, increased age, dehydration, poor nutrition, bowel and bladder incontinence, smoking, and poor perfusion.

DEFINE THE PROBLEM CON’T Complications: Infection and sepsis, loss

of quality of life, decreased life expectancy, cellulitis, bone and joint infection, and a form of cancer caused by wounds that heal slowly.

Scope of problem: National Avg: 5 %Local avg: 1.6%- 5%

(Ayello, E. and Sibbald, G., 2012)

(IMayo Clinic , 2015)

DISCUSS IMPLICATIONS For the Patient

Longer healing times Weakened immune system Loss of quality of life Longer stays in a facility

For the Institution Decrease in the amount of reimbursement Wasted resources Poor statistics and ratings (possible loss of business)

For healthcare resources Wasted on preventable condition Increased spending (Nationwide 11 billion a year to

treat)(Reddy, M., Gill, S., Rochon, P., 2006)

RECOMMENDATIONS For patient care:

Ensure proper nutrition and hydration Monitor and measure ulcers Record progression of healing

For prevention/prophylaxis: Ensure turning schedule is enforced Skin checks Keep patient dry- bowel and bladder program Position with bony parts padded and reduce pressure

on high risk parts Initiate pressure sore prevention protocol for high

risk patients. Staff and patient education on ulcers. Prevent and reduce sheering to the skin.

NURSING ROLE Assess:

Skin Checks Identify high risk patientsAddress skin concerns early Initiate interventions early

PlanChange position q2Keep clean and dryPosition off bony parts Increase hydration and nutritional intake (protein)

NURSING ROLE CON’T Intervene

Dressings to cover risk areas Protect bony prominences Increase Protein and caloric supplementation (snacks and

shakes) Specific plan of care for turning (turn sheet) Create bowel and bladder program Special weight distribution bed Frequent skin assessment Encourage as much independence and mobility as

possible Evaluate

Measure and evaluate healing and thoroughly document Evaluate need for change in current plan. Frequently assess skin for risk areas

INITIATIVES AND EDUCATION Initiatives

Skin check with 2 nurses on admission to the unit.

Braden daily skin assessment Hyperbaric Chamber

Education Informational Pamphlets

Online:National Pressure Ulcer Advisory PanelMayo Clinic

REFERENCESAyello, E. and Sibbald, G.( 2012). Hartford Institute

for Geriatric Nursing, Nursing standard of practice protocol: Pressure ulcer prevention & skin tear prevention. Retrieved from: http://consultgerirn.org/topics/pressure_ulcers_and_skin_tears/want_to_know_more#item_4

Mayo Clinic. (2015). Diseases and Conditions: Bedsores, Retrieved from: http://www.mayoclinic.org/diseases-conditions/bedsores/basics/complications/con-20030848

Reddy, M., Gill, S., Rochon, P. (2006) The Journal of American Medical Association. Preventing pressure ulcers: A systematic review. Retrieved from: http://jama.jamanetwork.com/article.aspx?articleid=203227