Pressure Ulcer Prevention at North Memorial

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Pressure Ulcer Prevention at North Memorial

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So whats the big deal ?
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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).

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Why We Practice Pressure Ulcer Prevention

• Its a community expectation.

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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

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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

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Why We Practice Pressure Ulcer Prevention

• Its the right thing to do !!!!

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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.

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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

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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).
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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

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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

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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)
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Risk Assessment

• Documentation
• Communication
• Patient Education

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Skin Safety Pressure Ulcer Prevention

• Minimize or eliminate friction and shear.
• Minimize pressure
• Manage moisture
• Maintain adequate nutrition/hydration

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Skin Safety Friction and Shear

• Friction
• The force of two surfaces moving across each
  other
• Can cause superficial abrasions or blisters

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Skin Safety Friction and Shear

• Shearing Force
• Skin sticks to surface
• Deeper tissues move in opposite direction
• Capillaries kink
• Local ischemia

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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.

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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.

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Skin Safety Manage Moisture

• Implement a toileting schedule
• Use ph-balanced cleansers
• Contain urine or stool
• Avoid chux, briefs, diapers.

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Skin Safety Maintain adequate nutrition and
hydration

• Maintain adequate nutrition that is compatible
  with the individuals wishes or condition.
• Consult a nutritionist in cases of suspected or
  identified nutritional deficiencies.

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Skin Safety

• Documentation
• Communication
• Patient/Caregiver Education
• Causes and risk factors
• Ways to minimize risk
• Implementation

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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.

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Questions ?