pressure ulcer prevention at north memorial

Pressure Ulcer Prevention at North Memorial

So what’s the big deal ?

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).

Why We Practice Pressure Ulcer Prevention

It’s a community expectation.

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

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

Why We Practice Pressure Ulcer Prevention

It’s the right thing to do !!!!

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.

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

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).

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

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

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)

Risk Assessment

Documentation Communication Patient Education

Skin Safety: Pressure Ulcer Prevention

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

Skin Safety: Friction and Shear

Friction: The force of two surfaces moving across

each other

Can cause superficial abrasions or blisters

Skin Safety: Friction and Shear

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

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.

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.

Skin Safety: Manage Moisture

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

Skin Safety: Maintain adequate nutrition and hydration

Maintain adequate nutrition that is compatible with the individual’s wishes or condition.

Consult a nutritionist in cases of suspected or identified nutritional deficiencies.

Skin Safety

Documentation Communication Patient/Caregiver Education

Causes and risk factorsWays to minimize risk

Implementation

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.

Questions ?