Safe Patient Handling to Prevent Pressure Ulcer Development

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Safe Patient Handling to Prevent Pressure Ulcer
Development

• Linda Norton MSCH, OT Reg. (ONT)
• lnorton_at_shoppershomehealthcare.ca
• Jared Bespalko
• JBespalko_at_shoppershomehealthcare.ca

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What is a Pressure Ulcer?

• A pressure ulcer is localized injury to the skin
  and/or underlying tissue usually over a bony
  prominence, as a result of pressure, or pressure
  in combination with shear and/or friction.
• National Pressure Ulcer Advisory Panel
• (www.npuap.org)

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Skin Tear

• traumatic wounds due to separation of epidermis
  from the dermis (partial-thickness wound) or of
  the epidermis and dermis from underlying
  structures (full-thickness wound ). (Payne et al
  1993)
• 1 .5 million skin tears occur in the United
  States each year, (Bryant 2001)
• Where the cause is known 25 were caused by
  transfers (LeBlanc, 2008)

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The Burden of Pressure Ulcers
1 in 4

• In 2003, the CAWC funded a study to determine the
  extent of chronic wounds in Canada.
• Results of the study indicated the prevalence of
  pressure ulcers was
• 25 in acute care,
• 30 in non-acute care,
• 22 in mixed health-care settings, and
• 15 in community care
• The mean prevalence overall was 26.

Can you make a difference in this statistic?
- Woodbury MG, Houghton PE. Prevalence of
pressure ulcers in Canadian health-care settings.
Ostomy/Wound Management. 200450(10)22-38.
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PreventionFront line caregivers are essential
in the effort to prevent pressure ulcers.
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Pathway to Assessment/Treatment of Pressure Ulcers

• Keast DH, Parslow N, Houghton PE, Norton L,
  Fraser C. Best practice recommendations for the
  prevention and treatment of pressure ulcers
  Update 2006. Wound Care Canada. 20064(1)31-43.

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How do I inspect the skin?

• Head to toe
• Look for tears, scraps, areas of discoloration,
  redness, or patches where the skin looks or feels
  different

www.epuap.org
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Why are skin checks so important

• Redness/changes in the skin are usually stage 1
  pressure ulcers
• Immediate implementation of preventative measures
  e.g. pressure management devices, turning
  schedules etc. have been shown to resolve the
  skin changes, and prevent the progression of the
  ulcer

Reference VanderweeK., Grypdonck M., Defloor T.
Non-Blanchable erythema as an indicator for the
need for pressure ulcer prevention a
randomized-controlled trial. J Clin Nurs 2005 Aug
30(16)325-35)
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Pressure

• Use pressure management surfaces
• Encourage frequent repositioning

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Blood Flow

• When external pressure exceeds the mean arterial
  pressure blood flow ceases

If this is true, why is there an inverse
relationship between pressure and time?
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What do we know for sure?

• Minimize the use of incontinence pads. Use of an
  incontinence pad was shown to increase peak
  pressure values by 20 25. (Fader M, 2004)
• Leg elevation at 10 degrees in the 30-degree
  head-up position is effective for reducing body
  displacement at the acrominon it was not
  effective for reducing sacral interface
  pressures. (Harada C, 2002)
• Any pressure management surface is better than a
  standard hospital mattress (Callum et al 2006)

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What else do we know?

• Nothing replaces good client care
• Consider the impact of the support surface on bed
  mobility and transfers. The greater the
  immersion in the surface, the more difficult bed
  mobility and transfers will be for the client
• People are individuals, there is no one surface
  which works for everyone
• Friction and shear magnify the impact of pressure

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Friction and Shear

• Use devices which reduce friction and shear
• Lift, dont drag the patient

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Undermining
Courtesy of D. Keast

• Asymmetrical Undermining Shear
• Symmetrical Undermining
  Fluid

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Health Care Worker Injuries

• The health care sector in British Columbia
  accounts for more worker injuries than any other
  sector, including forestry, construction and
  transportation 14 .
• In British Columbia, patient handling activities
  account for almost 50 of MSK injuries in acute
  care and long term care settings 14 .

Handle with Care Patient Handling and the
Application of Ergonomics (MSI) Requirements"
from Worksafe BC.
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Safe Patient Handling Program

• Safe Patient handling Programs are typically
  composed of 5 key components.
• Policy Procedure,
• Assessment,
• Equipment,
• Training Education, and
• Program Monitoring.

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How can safe patient handling programs prevent
skin injuries?

• Reduces friction and shear forces
• Makes repositioning easier, so patients are more
  likely to get repositioned more frequently

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Transfer Boards
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Consider a more dependent transfer to reduce
friction and shear
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Apply the sling without rolling the patient
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One-way glides for repositioning
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Repositioning Sling in bed
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Multiglide
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4-Way Bed Management System
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Ergo Slide LT
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Final Thoughts

• Manage pressure, friction and shear forces
  everywhere all the time
• Encourage frequent changes in posture, to promote
  weight shifting
• Nothing replaces good client care

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Questions and Thank You