Risk-based prevention
Recommendations
| Identify and Treat the Cause | ||
|---|---|---|
| 1 | Implement a positioning or turning schedule immediately for patients at risk of pressure ulcer development. | Level of Evidence Not Assessed |
| 2 | Use an interdisciplinary approach to develop an individualized strategy to prevent pressure ulcers for each patient, based on risk factors and degree of risk. | Level of Evidence Not Assessed |
| 3 | Consider pain, protective sensation, nutrition, maintenance of tissue integrity, use of pressure-relieving surfaces and appropriate devices and frequency of reassessment in developing a prevention strategy. | Level of Evidence Not Assessed |
| Address Patient-Centered Concerns | ||
|---|---|---|
| 4 | Educate patients about the risk and prevention of pressure ulcers. | Level of Evidence Not Assessed |
| Provide Local Wound Care | ||
|---|---|---|
| 5 | Follow TREATMENT recommendations | Level of Evidence Not Assessed |
| 6 | Implement a rehabilitation program if the potential for improving mobility and activity exists. | Level of Evidence Not Assessed |
| Provide Organizational Support | ||
|---|---|---|
| 7 | Empower and educate an interprofessional team to assess risk and prevent pressure ulcers | Level of Evidence Not Assessed |
Background
Pressure ulcer prevention requires a systematic approach and begins at admission to a healthcare facility or home care. Patient evaluation using the activity subscale of a validated tool, such as the Braden Scale, can determine the need for a full risk assessment. The patient should be reassessed 48 hours later, whenever the condition changes significantly, such as an acute illness, and at periodic intervals.To develop an effective individualized pressure ulcer prevention strategy, it is first necessary to identify specific patient risk factors and the patient degree of risk, based on assessment and clinical judgment, and to understand patient goals. Existing preventive protocols specify appropriate preventive strategies by patient risk level. It is advisable for institutions to either adapt existing protocols to their needs or develop protocols that better reflect their care environment. Consultation with an occupational therapist and/or physiotherapist can assist in identifying optimal transfer and positioning techniques and devices to minimize pressure, friction and shear and maximize patient mobility and independence.
Relevant considerations in developing individualized risk reduction strategies include the following:
• Immediate implementation of a positioning or turning schedule for patients at risk.
• The impact of pain on mobility and activity and on local tissue perfusion. It is important to monitor pain levels and to implement appropriate pain control, including pharmacologic and non-pharmacologic measures.
• Assessment of protective sensation and ability to perceive pain and respond effectively, as loss is associated with pressure ulcer development
• Prevention of skin breakdown
o Maintenance of adequate hydration of the stratum corneum
o Reduction of force and friction during cleansing
o Use of protective barriers or padding to prevent friction injuries
o Protection of skin from excessive moisture by effective management of incontinence, wound exudate, perspiration and saliva
• Avoidance of massage over bony prominences.
• Replacement of a standard mattress by one with a low interface pressure
• Use of a pressure-relieving surface intraoperatively for patients undergoing surgery
• Implementation of appropriate nutritional interventions, including supplementation and physical support for eating as necessary
• For individuals restricted to bed or chair, use of an interdisciplinary approach to planning care, including weight-shifting and positioning, appropriate devices to relieve pressure and/or enable independent positioning and transfers
• Potential for rehabilitation to increase mobility and activity
• Appropriate frequency of reassessment.
References
| Essential Publications |
|---|
| 1 | Pressure ulcer prevention and treatment |
Quality Indicator
|
Type: Systematic review |
| Keast DH, Parslow N, Houghton PE. Best practice recommendations for the prevention and treatment of pressure ulcers: update 2006. Adv Skin Wound Care. 2007 Aug;20(8):447-60; quiz 461-2. Review. | |||
| This paper is a systematic review of other systematic reviews and guidelines. As such, it does not present new results, but rather summarizes other relevant papers into one useful algorithm or enabler. | |||
| 2 | Dimethyl Sulfoxide Massage |
Quality Indicator
|
Type: RCT |
| Duimel-Peeters,I.G.P., Halfens,R.J.G., Ambergen,A.W. The effectiveness of massage with and without dimethyl sulfoxide in preventing pressure ulcers: a randomized, double-blind cross-over trial in patients prone to pressure ulcers. Int.J.Nurs.Stud., 2007, 44, 8, 1285-1295 | |||
| This publication examines the effect of massage with and without dimethyl sulfoxide in the prevention of pressure ulcers. Statistically insignificant results are obtained, indicating that this area requires further research. | |||