clinical reports An Ounce of Prevention
EDWARD M. BERGER, BS, and PATRICIA DeGREGORIE, BS
The purpose of this article is to describe a team approach to the prevention and treat ment of decubitus ulcers in patients in a 168bed acute care facility. Decubitus ulcers, in sidious and pervasive conditions, are being seen more frequently in our facility than ever before. Our hospital population reflects a current demographic trend toward an everincreasing geriatric population. Among the most common problems of this age group are metabolic diseases, peripheral vascular dis eases, and malnutrition. This triad provides an ideal breeding ground for the formation of decubitus ulcers. We find that once started, a decubitus ulcer can take up to six months to heal despite ideal management. Physical therapists are being requested to apply their skills in the treatment and healing of these ulcers. Our experience shows that 15 minutes of preventive care three times a day can avoid six months of curative care. We have devised a simple yet effective approach to the prevention of decubitus ulcers through the early recognition of the patients most sus ceptible to decubitus ulcers. PROGRAM
Nurses are customarily responsible for skin observation and care. We have instituted a formal program aimed at the prevention of breakdown of the skin, however, for all per sonnel concerned with skin care. We have Mr. Berger is Director of Physical Therapy, Yonkers Professional Hospital, 27 Ludlow St, Yonkers, NY 10705. Ms. DeGregorie is Senior Physical Therapist, Yonkers Professional Hospital, 27 Ludlow St, Yonkers, NY 10705.
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found this formalized program is effective when it is instituted and followed through by the doctors, the nurses, and the physical therapists. An in-service education program was de veloped to orient the nursing staff to our de cubitus ulcer prevention program. This pro gram deals with the anatomical and physio logical causes of breakdown and is followed by a discussion of preventive procedures. Subsequent lectures given on a regularly scheduled basis alert all new staff to the pro gram. Decubitus ulcer rounds are conducted bi weekly by the members of the decubitus ulcer prevention team. This team consists of the head nurse on each floor, the physiatrist, the patient care coordinator, and the chief physi cal therapist or senior physical therapist or both. All newly admitted patients are evalu ated to determine which of them might be susceptible to skin breakdown or might have a decubitus ulcer. The patients chosen for the program have a decubitus ulcer alert sticker with a notation of the area to be treated af fixed to the front of their charts. The physia trist orders the necessary gel pads and band ages for the protection of the patients' bony prominences and requests that bandages be changed daily. One layer of linen is used to cover the gel pad to prevent direct body con tact of the patient with the latex cover of the gel pad. The patient must be turned as or dered with gel pads placed under all bony pressure points. Any need for debridement is noted and a recommendation is made as to whether the debridement should be perPHYSICAL THERAPY
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Decubitus Ulcers
TREATMENT In addition to the conventional methods for the treatment of decubitus ulcers (infrared, ultraviolet, hydrotherapy), we have found that three factors have been valuable adjuncts to our program. The first of these factors is a silastic flotation pad used under all bony
Volume 56 / Number 12 December 1976
prominences. Next, chemical debridement by an enzyme ointment provides safe and fast cleansing of necrotic areas when used with proper technique and conditions. This oint ment is particularly effective when used in conjunction with daily hydrotherapy to facili tate debridement and promote the growth of new granulation tissue. Finally, a prepack aged antiseptic gauze pad saturated with povidine iodine is placed over open ulcers. This pad allows serous seepage yet does not adhere to the wound and provides a halogen barrier against external invading organisms.
CONCLUSION Based on the number of patients who have been placed on this treatment regimen (an average of 20% of our total hospital census), we conclude that a definite need exists for the prophylactic program. In very large institu tions, a program following these basic out lines can be instituted where there is ade quate manpower. The prime factors in the success of this program are the followthrough by the physicians and the nursing staff. Several other health care facilities have adopted this program with great success. In summary, we believe that a prophylactic pro gram is feasible and practical in the preven tion of decubitus ulcers and their concomi tant problems.
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Downloaded from https://academic.oup.com/ptj/article-abstract/56/12/1374/4568205 by Iowa State University user on 27 January 2019
formed surgically or chemically using enzy matic ointments. Only paper tape is used with dressings that require attachment to the skin. Plastic-lined dressings are never used di rectly on the skin. When a patient is placed on the treatment regimen, the physical therapist records all pertinent information about the patient's skin condition and any recommended treatment procedures. This record is made part of the patient's chart and is updated weekly. After the weekly rounds, a memo is sent to the Director of Nursing with copies to the Direc tors of Medicine and Surgery, the Chief of Staff, the Hospital Administrator, the Supervi sor of Central Supply, and the Social Service Department. The circulated memo lists the names, room numbers, and physicians for those patients selected for the program and indicates which patients already have decubi tus ulcers. Central Supply maintains a current indica tor master board of all patients with gel pads and reconditions and sterilizes the pads when required.
EDWARD M. BERGER, BS, and PATRICIA DeGREGORIE, BS
The purpose of this article is to describe a team approach to the prevention and treat ment of decubitus ulcers in patients in a 168bed acute care facility. Decubitus ulcers, in sidious and pervasive conditions, are being seen more frequently in our facility than ever before. Our hospital population reflects a current demographic trend toward an everincreasing geriatric population. Among the most common problems of this age group are metabolic diseases, peripheral vascular dis eases, and malnutrition. This triad provides an ideal breeding ground for the formation of decubitus ulcers. We find that once started, a decubitus ulcer can take up to six months to heal despite ideal management. Physical therapists are being requested to apply their skills in the treatment and healing of these ulcers. Our experience shows that 15 minutes of preventive care three times a day can avoid six months of curative care. We have devised a simple yet effective approach to the prevention of decubitus ulcers through the early recognition of the patients most sus ceptible to decubitus ulcers. PROGRAM
Nurses are customarily responsible for skin observation and care. We have instituted a formal program aimed at the prevention of breakdown of the skin, however, for all per sonnel concerned with skin care. We have Mr. Berger is Director of Physical Therapy, Yonkers Professional Hospital, 27 Ludlow St, Yonkers, NY 10705. Ms. DeGregorie is Senior Physical Therapist, Yonkers Professional Hospital, 27 Ludlow St, Yonkers, NY 10705.
1374
found this formalized program is effective when it is instituted and followed through by the doctors, the nurses, and the physical therapists. An in-service education program was de veloped to orient the nursing staff to our de cubitus ulcer prevention program. This pro gram deals with the anatomical and physio logical causes of breakdown and is followed by a discussion of preventive procedures. Subsequent lectures given on a regularly scheduled basis alert all new staff to the pro gram. Decubitus ulcer rounds are conducted bi weekly by the members of the decubitus ulcer prevention team. This team consists of the head nurse on each floor, the physiatrist, the patient care coordinator, and the chief physi cal therapist or senior physical therapist or both. All newly admitted patients are evalu ated to determine which of them might be susceptible to skin breakdown or might have a decubitus ulcer. The patients chosen for the program have a decubitus ulcer alert sticker with a notation of the area to be treated af fixed to the front of their charts. The physia trist orders the necessary gel pads and band ages for the protection of the patients' bony prominences and requests that bandages be changed daily. One layer of linen is used to cover the gel pad to prevent direct body con tact of the patient with the latex cover of the gel pad. The patient must be turned as or dered with gel pads placed under all bony pressure points. Any need for debridement is noted and a recommendation is made as to whether the debridement should be perPHYSICAL THERAPY
Downloaded from https://academic.oup.com/ptj/article-abstract/56/12/1374/4568205 by Iowa State University user on 27 January 2019
Decubitus Ulcers
TREATMENT In addition to the conventional methods for the treatment of decubitus ulcers (infrared, ultraviolet, hydrotherapy), we have found that three factors have been valuable adjuncts to our program. The first of these factors is a silastic flotation pad used under all bony
Volume 56 / Number 12 December 1976
prominences. Next, chemical debridement by an enzyme ointment provides safe and fast cleansing of necrotic areas when used with proper technique and conditions. This oint ment is particularly effective when used in conjunction with daily hydrotherapy to facili tate debridement and promote the growth of new granulation tissue. Finally, a prepack aged antiseptic gauze pad saturated with povidine iodine is placed over open ulcers. This pad allows serous seepage yet does not adhere to the wound and provides a halogen barrier against external invading organisms.
CONCLUSION Based on the number of patients who have been placed on this treatment regimen (an average of 20% of our total hospital census), we conclude that a definite need exists for the prophylactic program. In very large institu tions, a program following these basic out lines can be instituted where there is ade quate manpower. The prime factors in the success of this program are the followthrough by the physicians and the nursing staff. Several other health care facilities have adopted this program with great success. In summary, we believe that a prophylactic pro gram is feasible and practical in the preven tion of decubitus ulcers and their concomi tant problems.
1375
Downloaded from https://academic.oup.com/ptj/article-abstract/56/12/1374/4568205 by Iowa State University user on 27 January 2019
formed surgically or chemically using enzy matic ointments. Only paper tape is used with dressings that require attachment to the skin. Plastic-lined dressings are never used di rectly on the skin. When a patient is placed on the treatment regimen, the physical therapist records all pertinent information about the patient's skin condition and any recommended treatment procedures. This record is made part of the patient's chart and is updated weekly. After the weekly rounds, a memo is sent to the Director of Nursing with copies to the Direc tors of Medicine and Surgery, the Chief of Staff, the Hospital Administrator, the Supervi sor of Central Supply, and the Social Service Department. The circulated memo lists the names, room numbers, and physicians for those patients selected for the program and indicates which patients already have decubi tus ulcers. Central Supply maintains a current indica tor master board of all patients with gel pads and reconditions and sterilizes the pads when required.
