Pressure ulcers, also known as bedsores or pressure injuries, are localized damage to the skin and underlying tissue, usually over bony areas, from prolonged pressure or pressure and shear. They are a big problem in healthcare, resulting in increased morbidity, extended hospital stays, and higher care costs. However, with good prevention and management, healthcare providers and caregivers can reduce the incidence and severity of pressure ulcers by managing pressure ulcers.
Risk Factors
The first step in prevention is to identify who’s at risk for managing pressure ulcers.
Who’s at risk?
- Immobility: Patients in bed or wheelchairs are at risk due to prolonged pressure on specific body areas.
- Sensory Impairment: Conditions that reduce sensation, such as spinal cord injuries, prevent individuals from feeling discomfort and prompt repositioning.
- Poor Nutrition and Hydration: Inadequate intake can compromise skin integrity and delay healing.
- Moisture: Incontinence or perspiration can make skin more vulnerable.
- Age: Elderly have thinner skin and reduced blood flow, making them more susceptible.
Prevention Strategies
- Risk Assessments: Use structured tools like the Braden Scale to assess the patient’s risk level upon admission and periodically thereafter. This will guide the development of an individualized care plan.
- Skin Care
- Daily Inspections: Do skin assessments at least once a day, focusing on high-pressure areas such as the sacrum, heels, and hips.
- Cleanliness and Moisture Balance: Clean the skin immediately after incontinence episodes using pH-balanced cleansers and moisturizers to keep the skin hydrated.
- Repositioning and Mobilization
- Scheduled Repositioning: Encourage patients to change position frequently, at least every 2 hours for those in bed and every hour for those in chair. Use equipment to assist if needed.
- Proper Positioning: Don’t position patients directly on bony areas, and use pillows or foam wedges to offload pressure.
- Support Surfaces
- High-Spec Foam Mattresses: For high-risk patients, use high-spec foam mattresses to redistribute pressure.
- Cushions and Overlays: Use pressure-redistributing cushions for chairs and overlays for mattresses to offload pressure on vulnerable areas.
- Nutrition and Hydration
- Nutritional Assessment: Do a comprehensive dietary assessment and supplement to address deficiencies.
- Hydration: Ensure adequate fluid intake to maintain skin turgor and overall health.
- Education and Training
- Staff Training: Provide regular education sessions for healthcare providers and caregivers on pressure ulcer prevention, identification, and management.
- Patient and Family Education: Educate patients and their families on mobility, nutrition, and skincare to prevent pressure ulcers.
Existing Pressure Ulcers
If a pressure ulcer develops, management must be prompt and proper:
- Assessment and Documentation
- Staging: Classify the ulcer based on its severity, from Stage 1 (non-blanchable erythema) to Stage 4 (full-thickness tissue loss).
- Measurement: Document the size, depth, and appearance of the wound to monitor healing.
- Wound Care
- Debridement: Remove necrotic tissue to promote healing, use method appropriate to the patient’s condition and ulcer type.
- Dressings: Use dressings that maintain a moist wound environment, control exudate, and prevent infection. Options are hydrocolloids, foams, and alginates.
- Infection Control
- Monitoring: Monitor for signs of infection, such as increased redness, warmth, swelling or purulent discharge.
- Antibiotics: Use antibiotics judiciously, only for confirmed infection or cellulitis.
- Pain Management
- Assessment: Assess pain regularly and provide analgesia as needed to keep the patient comfortable.
- Adjunctive Therapies
- Negative Pressure Wound Therapy (NPWT): Consider NPWT for deep exudative wounds to promote healing.
- Electrical Stimulation: Some evidence support electrical stimulation to enhance wound healing, more research needed.
Summary – Managing Pressure Ulcers
Pressure ulcer prevention and management requires a whole system approach. By using evidence-based practice in risk assessment, skin care, repositioning, support surface use, nutrition, and education, healthcare providers and caregivers can reduce the incidence and severity of managing pressure ulcers and improve patient outcomes and quality of life.
We recommend you review our Wound Prevention Certification Prep Course and Wound Certification Prep Course.