Download Keeping the Pressure Off - Minnesota Hospital Association

Pressure Ulcer
Prevention at North
Memorial
So what’s the big deal ?
Why We Practice Pressure Ulcer
Prevention

Maintenance of skin integrity and pressure
ulcer prevention is a nursing sensitive
indicator of quality nursing care (American
Nurses Association).
Why We Practice Pressure Ulcer
Prevention

It’s a community expectation.
Why We Practice Pressure Ulcer
Prevention

Pressure ulcers are a reportable
complication.
 www.health.state.mn.us/patientsafety
Patient Safety Link
 Adverse Health Events in Minnesota

 Avoidable
vs. Unavoidable
Why We Practice Pressure Ulcer
Prevention
It is more cost effective to prevent a
pressure ulcer than to treat one.
 Average cost per ulcer = $27,000
 Annual US healthcare costs are over $3.6
billion

Why We Practice Pressure Ulcer Prevention

It’s the right thing
to do !!!!
Components of a Pressure Ulcer
Prevention Program

A clear process for identifying a patient's
risk for developing pressure ulcers.

Strategies aimed at pressure ulcer
prevention for the patient at risk.
Components of a Pressure Ulcer
Prevention Program

Pressure ulcer prevention and treatment
initiatives should be:
 Evidence
based
ICSI (Institute for Clinical Systems Improvement)
Guidelines (2006) www.mnpatientsafety.org
 WOCN Clinical Practice Guideline (2003).
Prevention and Management of Pressure Ulcers.
www.wocn.org
 NPUAP (National Pressure Ulcer Advisory Panel)
www.npuap.org

Risk Assessment


Should be performed at the point of entry
to a health care facility and repeated on
a regularly scheduled basis or with any
change in condition.
At the time of patient "hand offs".
WOCN Guideline for Prevention and Management of Pressure Ulcers (2003).
Risk Assessment: Braden Scale

Intensity and
duration of pressure

Sensory perception
 Mobility
 Activity

Tissue tolerance for
pressure



Moisture
Nutrition
Friction/shear


Scoring 6-23
As scores become
lower, predicted risk
becomes higher.
 Mild
risk: 15-18
 Mod risk: 13-14
 High risk: 10-12
 Very high risk 9 or less
Risk Assessment: High Risk Groups







Peripheral Vascular
Disease
Myocardial Infarction
Stroke
Multiple trauma
Musculoskeletal disorders
GI bleed
Bariatric






Unstable and/or chronic
medical conditions
History of previous
pressure ulcer
Immunosuppression
Preterm neonates
Spinal cord injury
Neurological disorders
Risk Assessment: Skin Inspection


A head to toe inspection and palpation should be
done on every patient upon admission,
particularly over pressure points.
Repeat every 8-24 hours
 Inspect
 Palpate
 Ask
ICSI (2006)
Risk Assessment
Documentation
 Communication
 Patient Education

Skin Safety: Pressure Ulcer Prevention
Minimize or eliminate friction and shear.
 Minimize pressure
 Manage moisture
 Maintain adequate nutrition/hydration

Skin Safety: Friction and Shear
Friction:
 The force of two surfaces moving across
each other

Can cause superficial abrasions or blisters
Skin Safety: Friction and Shear
Shearing Force:
 Skin sticks to surface
 Deeper tissues move in opposite direction
 Capillaries kink
 Local ischemia
Skin Safety: Minimize Pressure
Schedule regular and frequent turning and
repositioning for bed and chair bound
individuals.
 Use support surfaces on beds and chairs
to reduce or relieve pressure.
 Relieve pressure to heels by using pillows
or other devices.

Skin Safety: Manage Moisture
Skin hydration issues

Dry skin
 Skin
with too little moisture 2.5 times more
likely to ulcerate than healthy skin.

Skin moist from incontinence

5 times more likely to ulcerate than dry
skin.
Skin Safety: Manage Moisture
Implement a toileting schedule
 Use ph-balanced cleansers
 Contain urine or stool
 Avoid chux, briefs, diapers.

Skin Safety: Maintain adequate
nutrition and hydration
Maintain adequate nutrition that is
compatible with the individual’s wishes or
condition.
 Consult a nutritionist in cases of suspected
or identified nutritional deficiencies.

Skin Safety
Documentation
 Communication
 Patient/Caregiver Education

 Causes
and risk factors
 Ways to minimize risk

Implementation
Is your process in place?
Risk assessment done on admission and
at appropriate intervals?
 Appropriate prevention strategies initiated
for patients at risk?
 Appropriate referrals initiated?
 Patient/caregiver education done?
 Document, document, document.

Questions ?