Pressure Ulcer Prevention at North Memorial So whats

Pressure Ulcer Prevention at North Memorial

So what’s the big deal ?

Why We Practice Pressure Ulcer Prevention n 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 n It’s a community expectation.

Why We Practice Pressure Ulcer Prevention n Pressure ulcers are a reportable complication. ¨ www. health. state. mn. us/patientsafety Patient Safety Link n Adverse Health Events in Minnesota n ¨ Avoidable vs. Unavoidable

Why We Practice Pressure Ulcer Prevention It is more cost effective to prevent a pressure ulcer than to treat one. n Average cost per ulcer = $27, 000 n Annual US healthcare costs are over $3. 6 billion n

Why We Practice Pressure Ulcer Prevention n It’s the right thing to do !!!!

Components of a Pressure Ulcer Prevention Program n A clear process for identifying a patient's risk for developing pressure ulcers. n Strategies aimed at pressure ulcer prevention for the patient at risk.

Components of a Pressure Ulcer Prevention Program n Pressure ulcer prevention and treatment initiatives should be: ¨ Evidence based ICSI (Institute for Clinical Systems Improvement) Guidelines (2006) www. mnpatientsafety. org n WOCN Clinical Practice Guideline (2003). Prevention and Management of Pressure Ulcers. www. wocn. org n NPUAP (National Pressure Ulcer Advisory Panel) www. npuap. org n

Risk Assessment n n 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 n Intensity and duration of pressure Sensory perception ¨ Mobility ¨ Activity ¨ n Tissue tolerance for pressure Moisture ¨ Nutrition ¨ Friction/shear ¨ n n 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 n n n n Peripheral Vascular Disease Myocardial Infarction Stroke Multiple trauma Musculoskeletal disorders GI bleed Bariatric n n n Unstable and/or chronic medical conditions History of previous pressure ulcer Immunosuppression Preterm neonates Spinal cord injury Neurological disorders

Risk Assessment: Skin Inspection n n 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 n Communication n Patient Education n

Skin Safety: Pressure Ulcer Prevention Minimize or eliminate friction and shear. n Minimize pressure n Manage moisture n Maintain adequate nutrition/hydration n

Skin Safety: Friction and Shear Friction: n The force of two surfaces moving across each other n Can cause superficial abrasions or blisters

Skin Safety: Friction and Shearing Force: n Skin sticks to surface n Deeper tissues move in opposite direction n Capillaries kink n Local ischemia

Skin Safety: Minimize Pressure Schedule regular and frequent turning and repositioning for bed and chair bound individuals. n Use support surfaces on beds and chairs to reduce or relieve pressure. n Relieve pressure to heels by using pillows or other devices. n

Skin Safety: Manage Moisture Skin hydration issues n Dry skin ¨ Skin with too little moisture 2. 5 times more likely to ulcerate than healthy skin. n Skin moist from incontinence ¨ 5 times more likely to ulcerate than dry skin.

Skin Safety: Manage Moisture Implement a toileting schedule n Use ph-balanced cleansers n Contain urine or stool n Avoid chux, briefs, diapers. n

Skin Safety: Maintain adequate nutrition and hydration Maintain adequate nutrition that is compatible with the individual’s wishes or condition. n Consult a nutritionist in cases of suspected or identified nutritional deficiencies. n

Skin Safety Documentation n Communication n Patient/Caregiver Education n ¨ Causes and risk factors ¨ Ways to minimize risk n Implementation

Is your process in place? Risk assessment done on admission and at appropriate intervals? ü Appropriate prevention strategies initiated for patients at risk? ü Appropriate referrals initiated? ü Patient/caregiver education done? ü Document, document. ü

Questions ?