Clinical comment
It’s time to Stop the Pressure: importance of pressure ulcer prevention in community care Alison Pressler Promedica24 Regional Care Manager
W
ith research showing that between 80% and 95% of cases of pressure ulcers are avoidable (NHS England, 2015), the frequency of the development of pressure ulcers in the UK still remains high. The presence of pressure ulcers is one of the simplest indicators of the quality of nursing care provided to patients, and it is widely accepted that they can be avoided through a number of simple care practices. While health care assistants (HCAs) and nurses are in an ideal position to prevent problems, spot symptoms, and provide expert treatment, it is the duty of all health professionals across the wider team to work together to improve care for vulnerable patients. The NHS has led the way in terms of educating health professionals and encouraging employees to understand the importance of good prevention, management, and treatment. Campaigns such as ‘Stop the Pressure’ (held in November) (nhs. stopthepressure.co.uk) are a good way to increase awareness of the problem and get nursing and caring teams on board with the campaign’s educational messages and practical resources. Pressure ulcers are much easier to prevent than to treat, but that does not mean the process is easy or uncomplicated. Moreover, wounds may still develop with consistent, appropriate, preventive care. Pressure ulcers are estimated to occur in 4%–10% of patients admitted to hospitals in the UK, resulting in costs of £1.4–2.1 billion each year to the NHS (Dealey et al, 2012). New pressure ulcers are estimated to affect up to 30% of patients in the community, and 20% of patients in nursing and residential homes (NHS Institute for Innovation and Improvement, 2010).
Protect the skin Use talcum powder to protect the areas of skin vulnerable to excess moisture. Applying lotion to dry skin is also important as dry skin can also cause pressure ulcers (Thomas, 2008). Change bedding and clothing frequently, as dirty bedding and clothing will increase risk of infection.
Inspect the skin daily Inspect the patient’s skin daily to identify vulnerable areas or early signs of pressure ulcers. If the patient feels embarrassed, he/ she can check himself/herself with a mirror, if mobile enough.
Manage incontinence to keep the skin dry If the patient has urinary or bowel incontinence, take steps to prevent exposing the skin to moisture and bacteria. Care may include frequently scheduled help with urinating, diaper changes, applying protective lotions on healthy skin, or changing urinary catheters or rectal tubes.
Choose a healthy diet A healthy diet has a positive effect on patients’ health. For some patients living independently at home, it can be difficult to buy or prepare balanced and nutritious meals. Any support with daily chores can be helpful. If the patient has difficulty eating and this has been authorised by the GP, dietary supplements can also help to boost immunity in preventing development of pressure ulcers.
Drink enough to keep the skin hydrated Ensure the patient drinks water regularly and look for signs of poor hydration. These include decreased urine output, darker urine, dry or sticky mouth, thirst, dry skin, and constipation.
Tackling pressure ulcer development
Conclusion
Developing a good strategy with the patient is vital. Underlying all advice on prevention is the understanding that position changes are key to preventing pressure sores. Repositioning needs to avoid stress on the skin and body positions need to minimise pressure on vulnerable areas. With patients at risk, protecting and monitoring the condition of their skin is essential for preventing pressure ulcers, as is early identification of grade 1 ulcers so that they can be treated before they worsen. Guidance includes:
Patients are most at risk if they cannot move easily, have poor nutrition/dehydration, have additional health needs/complex conditions, are aged 70+ years, or are incontinent.While for some, pressure ulcers are an inconvenience that require minor care, for many others, they can be serious, leading to life-threatening complications, such as blood poisoning or gangrene. CWC
Clean the affected/vulnerable areas Clean the patient’s skin with mild soap and warm water/norinse cleanser. Gently pat the areas dry to reduce skin irritation.
Dealey C, Posnett J, Walker A (2012) The cost of pressure ulcers in the United Kingdom. J Wound Care 21(6): 261–66 NHS England (2015) Stop the pressure. http://bit.ly/1jjDSxR (accessed 24 November 2015) NHS Institute for Innovation and Improvement (2010) The high impact actions for nursing and midwifery 4: your skin matters. http://bit.ly/1l7Blbi (accessed 19 November 2015) Thomas S (2008) The role of dressings in the treatment of moisture-related skin damage. World Wide Wounds. http://bit.ly/1N6XY8f (accessed 24 November 2015)
© 2015 MA Healthcare Ltd
S6
Community Wound Care December 2015
sh Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on January 4, 2016. For personal use only. No other uses without permission. . All rights rese
It’s time to Stop the Pressure: importance of pressure ulcer prevention in community care Alison Pressler Promedica24 Regional Care Manager
W
ith research showing that between 80% and 95% of cases of pressure ulcers are avoidable (NHS England, 2015), the frequency of the development of pressure ulcers in the UK still remains high. The presence of pressure ulcers is one of the simplest indicators of the quality of nursing care provided to patients, and it is widely accepted that they can be avoided through a number of simple care practices. While health care assistants (HCAs) and nurses are in an ideal position to prevent problems, spot symptoms, and provide expert treatment, it is the duty of all health professionals across the wider team to work together to improve care for vulnerable patients. The NHS has led the way in terms of educating health professionals and encouraging employees to understand the importance of good prevention, management, and treatment. Campaigns such as ‘Stop the Pressure’ (held in November) (nhs. stopthepressure.co.uk) are a good way to increase awareness of the problem and get nursing and caring teams on board with the campaign’s educational messages and practical resources. Pressure ulcers are much easier to prevent than to treat, but that does not mean the process is easy or uncomplicated. Moreover, wounds may still develop with consistent, appropriate, preventive care. Pressure ulcers are estimated to occur in 4%–10% of patients admitted to hospitals in the UK, resulting in costs of £1.4–2.1 billion each year to the NHS (Dealey et al, 2012). New pressure ulcers are estimated to affect up to 30% of patients in the community, and 20% of patients in nursing and residential homes (NHS Institute for Innovation and Improvement, 2010).
Protect the skin Use talcum powder to protect the areas of skin vulnerable to excess moisture. Applying lotion to dry skin is also important as dry skin can also cause pressure ulcers (Thomas, 2008). Change bedding and clothing frequently, as dirty bedding and clothing will increase risk of infection.
Inspect the skin daily Inspect the patient’s skin daily to identify vulnerable areas or early signs of pressure ulcers. If the patient feels embarrassed, he/ she can check himself/herself with a mirror, if mobile enough.
Manage incontinence to keep the skin dry If the patient has urinary or bowel incontinence, take steps to prevent exposing the skin to moisture and bacteria. Care may include frequently scheduled help with urinating, diaper changes, applying protective lotions on healthy skin, or changing urinary catheters or rectal tubes.
Choose a healthy diet A healthy diet has a positive effect on patients’ health. For some patients living independently at home, it can be difficult to buy or prepare balanced and nutritious meals. Any support with daily chores can be helpful. If the patient has difficulty eating and this has been authorised by the GP, dietary supplements can also help to boost immunity in preventing development of pressure ulcers.
Drink enough to keep the skin hydrated Ensure the patient drinks water regularly and look for signs of poor hydration. These include decreased urine output, darker urine, dry or sticky mouth, thirst, dry skin, and constipation.
Tackling pressure ulcer development
Conclusion
Developing a good strategy with the patient is vital. Underlying all advice on prevention is the understanding that position changes are key to preventing pressure sores. Repositioning needs to avoid stress on the skin and body positions need to minimise pressure on vulnerable areas. With patients at risk, protecting and monitoring the condition of their skin is essential for preventing pressure ulcers, as is early identification of grade 1 ulcers so that they can be treated before they worsen. Guidance includes:
Patients are most at risk if they cannot move easily, have poor nutrition/dehydration, have additional health needs/complex conditions, are aged 70+ years, or are incontinent.While for some, pressure ulcers are an inconvenience that require minor care, for many others, they can be serious, leading to life-threatening complications, such as blood poisoning or gangrene. CWC
Clean the affected/vulnerable areas Clean the patient’s skin with mild soap and warm water/norinse cleanser. Gently pat the areas dry to reduce skin irritation.
Dealey C, Posnett J, Walker A (2012) The cost of pressure ulcers in the United Kingdom. J Wound Care 21(6): 261–66 NHS England (2015) Stop the pressure. http://bit.ly/1jjDSxR (accessed 24 November 2015) NHS Institute for Innovation and Improvement (2010) The high impact actions for nursing and midwifery 4: your skin matters. http://bit.ly/1l7Blbi (accessed 19 November 2015) Thomas S (2008) The role of dressings in the treatment of moisture-related skin damage. World Wide Wounds. http://bit.ly/1N6XY8f (accessed 24 November 2015)
© 2015 MA Healthcare Ltd
S6
Community Wound Care December 2015
sh Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on January 4, 2016. For personal use only. No other uses without permission. . All rights rese
