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Safety Matters: Preventing pressure ulcers

According to the U.S. Department of Health and Human Services, pressure ulcers affect an estimated three million adults in the United States, with notable variations in incidents depending on the medical care setting.

Pressure ulcers are defined by the National Pressure Ulcer Advisory Panel as a 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.

“Many co-morbid conditions make it more likely [for] a patient to develop a pressure ulcer, said Molly Dyer, nurse manager at Baptist Memorial Hospital-Memphis. “Anyone with the inability to offload pressure from tissue over a bony prominence can develop a pressure ulcer.”

While patients who are bed bound or wheelchair bound are more at risk for developing pressure ulcers, other factors make one more vulnerable to these ulcers.

“A few examples of contributing factors are diabetes, malnutrition, immobility, circulatory and oxygenation deficiencies,” said Dyer. “Even lengthy surgical procedures can contribute to the development of a pressure ulcer.”

Patients with a history of previous pressure ulcers are at increased risk of subsequent pressure ulcer development.

For those with pressure ulcers, treatment begins by relieving the pressure from the affected area. Dressings, topical agents, as well as debridement are other treatment options.

“Look at your patient’s skin daily and perform a daily risk assessment such as the Braden Score for pressure ulcer development,” said Dyer. “Be sure to assess the heels and sacral areas as these are common sites of pressure ulcer development.”

One of the best ways to prevent the development of pressure ulcers is to turn the patient every two hours to offload the pressure to various tissues, said Dyer.

Another way to avoid the development of these ulcers is to keep the patient well-hydrated and nourished. Supplements are also available to maximize the patient’s nutritional status. Special support surfaces such as mattresses with low air loss or microclimate control functions and pressure redistribution cushions are helpful in prevention but do not replace turning and repositioning the patient.

“If excessive moisture is an issue, incorporate moisture management such as moisture wicking under-pads or materials designed for moisture management in the skin folds,” said Dyer. “We have partnered with Smith & Nephew to provide specific products to combat dry skin and to maintain the healthy pH balance of skin.”

Complications associated with pressure ulcers can include pain, infection, amputation, and in some instances, death.

“Baptist has led a campaign for many years to help prevent pressure ulcer development,” said Dyer. “In addition, many of the hospitals offer four to eight hour courses on pressure ulcer prevention and treatment.”

Baptist also started the Save Our Skin team in 1997 at two of Baptist’s metro area hospitals. Today, the project has grown to include all 14 hospitals in the Baptist system, striving to address this patient safety risk and to reduce the occurrence of pressure ulcer development.

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