Evidence Based Practice Pressure Ulcer

Prevention Strategies: To Reposition or

Turn

By: Jeanette Caddell, RN

No Conflict of Interest

I have received no support or funding for this

presentation and bibliography will be provided at

the end of the presentation.

Objectives

At the completion of the presentation participants will:

Be able to identify EBP pressure ulcer prevention strategies.

Be able to verbalize the importance of a pressure ulcer prevention

program.

PICOT Question

How does repositioning or turning the client with

decreased mobility at frequent intervals as compared to

not repositioning or turning reduce the development of

pressure ulcers over a 90 day period?

Thesis Statement

Implementation of repositioning or turning will prevent

development of pressure ulcers along with providing

incontinent care, proper nutrition, and skin assessments.

BACKGROUND

Pressure ulcers (PU) common findings in healthcare

Occur when pressure is applied to an area for long periods of time

Staged from 1-4 with stage 1 being the least worst and 4 being the

worst

Measured in centimeters (cm)

Now called Pressure Injury

Stage 1

Non-blanchable erythema of intact skin

Skin is discolor or dark

Color doesn’t return when pressure is applied

Stage 1

Stage 2

Partial-thickness skin loss with exposed dermis

Similar to an abarasion

Top layer of skin isn’t present

May have a intact blister present

Stage 2

Stage 3

Full-thickness skin loss

Top layer of skin is removed

Fatty tissue is visible

Stage 3

Stage 4

Full-thickness skin and tissue loss

Worst of the worst

All layers of the skin are removed

Bone, ligament, or muscle may be visible

Stage 4

Pressure Ulcers/Injury

Significance

In critically ill infants and children is 18% to 27%

3.55 million hospital admissions in Australia each year 10% or

more will develop an ulcer

Estimated cost to treat full thickness PU is about $70,000

Yearly cost to treat PU in U.S. is about $11 billion

Proposed Interventions

Implemented at a skilled nursing home w/ licensed nursing staff

Repositioning or turning every 2 hours

Side to side to back

Even hours turn

90 day intervention

Complete head to toe assessment each shift

Incontinent care after each incontinent episode

Pressure reduction mattress

Proposed Intervention: Turn Schedule

Methods

Documentation of meal intake each meal

Offer supplement if refused meal or oral intake less than 50%

Documentation of fluid intake every shift

Skin assessment

Provide incontinence care

Ethical Considerations

Obtain signed consent forms

Privacy of clients

No harm to clients

Pressure Ulcer Module

Pressure Ulcer Module

Examples of Measurement

Examples cont.

Importance of Preventing Pressure Ulcers

It puts the client at risk for infection

Increases client’s length of stay

Decreases client’s life expectance

Perceives the facility as an unfit place of business

Increases costs at healthcare facility

Possibility of survey by Joint Commission or State

Bibliography Berloqwitz, D., VanDeusen Lukas, C., Parker, V., Niederhauser, A., Silver, J., Logan, C., Ayello, E., Zulkowski,

K. (2014). Preventing pressure ulcers in hospitals. Agency for Healthcare Research and Quality. https://www.ahrq.gov/professionals/systems/hospital/pressureulcertoolkit/index.html

Nancy Bergstrom, N. (2013). Repositioning as a pressure ulcer prevention strategy: a multi-site clinical trial. http://www.npuap.org/wp-content/uploads/2012/01/NPUAP.Keynote.2.2013.all_edits.2.3.13_1.pdf

Gillespie BM, Chaboyer WP, McInnes E, Kent B, Whitty JA, Thalib L. (2013) Repositioning for pressure ulcer prevention in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD009958. DOI: .10.1002/14651858.CD009958.pub2

Hall, K and Clark, R. (2016). A prospective, descriptive, quality improvement study to investigate the impact of a turn-and-position device on the incidence of hospital-acquired sacral pressure ulcers and nursing staff time needed for repositioning patients. Ostomy Wound Management 2016; 62(11):40–44. http://www.o-wm.com/article/prospective-descriptive-quality-improvement-study-investigate-impact-turn-and-position

Manzano F1, Colmenero M, Pérez-Pérez AM, Roldán D, Jiménez-Quintana Mdel M, Mañas MR, Sánchez-Moya MA, Guerrero C, Moral-Marfil MÁ, Sánchez-Cantalejo E, Fernández-Mondéjar E. (2013). Pressure ulcer prevention in ventilated patients using two repositioning regimens (PUPPAS). https://clinicaltrials.gov/ct2/show/results/NCT00847665?term=pressure+ulcers+and+turning&rank=3&sect=X01256

Rich, S. E., Margolis, D., Shardell, M., Hawkes, W. G., Miller, R. R., Amr, S., & Baumgarten, M. (2011). Frequent manual repositioning and incidence of pressure ulcers among bedbound elderly hip fracture patients. Wound Repair and Regeneration: Official Publication of the Wound Healing Society [and] the European Tissue Repair Society, 19(1), 10–18. http://doi.org/10.1111/j.1524-475X.2010.00644.x

Schindler, S, Mikhailov, T, Kuhn E, Christopher, J, Conway P, Ridling, D, Scott, A and Simpson, V. (2011). Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care. American Association of Critical-Care Nurses. http://ajcc.aacnjournals.org/content/20/1/26.full.pdf+html