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Pressure ulcers are a growing problem in the health care setting. As a healthcare provider, you know that treating pressure ulcers requires time and resources. This adds to your workload and puts an increased financial burden on facilities. Most important, pressure ulcers cause pain and slow patient recovery. For these reasons, it’s vital to help prevent pressure ulcers with attentive care and speed healing with proper treatment.
Pressure ulcers are localized injuries to the skin or underlying tissue due to unrelieved pressure. This puts patients with immobility issues at greatest risk of developing pressure ulcers. Other health problems can also dramatically increase their risk. Yet even under such challenging conditions, pressure ulcers can be prevented if proper steps are taken. The single most important issue regarding pressure ulcers is prevention. Once a deep pressure ulcer forms it is very hard to heal.
Assess each patient’s pressure ulcer risk upon admission and throughout the patient’s stay.
Document your findings in detail.
Prevent ulcers by limiting time patients spend in one position.
Involve family members in prevention efforts from the start.
Evaluate an existing pressure ulcer to determine its stage.
Treat pressure ulcers quickly and properly to speed healing.
Reduce risk of infection by using gloves and practicing the proper handwashing technique.
Every patient requires an initial risk assessment upon admission. This involves performing a thorough skin assessment and gathering the patient’s information. The patient’s risk factors for pressure ulcers should also be listed in the assessment. Use the risk assessment tool, such as the Braden Scale or Norton Scale, approved by your facility. Be sure to document whether your patient is any of the following:
Immobile or inactive
Underweight or overweight
Malnourished or dehydrated
Ill with systemic disease, such as diabetes or anemia
Recovering from surgery
Medicated with steroids or sedatives
Sensory impaired or has an altered level of consciousness
Thorough assessment and proper documentation are vital for monitoring patient progress. Both should be performed during each shift. Assessment and documentation also show that you and others at your facility are taking all the appropriate steps to prevent, manage, and treat pressure ulcers.
Assess with care: Properly assess each patient for pressure ulcer stage. Be particularly mindful when examining for pressure ulcers in patients with dark skin tones. It can be difficult to determine changes in skin color.
Document with care: Once you’ve assessed the patient and staged the ulcer, document your findings. Remember to be thorough and descriptive. Doing so gives a clear account of the wound’s state and progress. Document the following:
The patient’s level of pain using your facility’s pain scale.
The length, width, and depth of the pressure ulcer.
The type of wound tissue present, such as slough or granulation.
If any exudate is present and its characteristics, such as if it is serosanguineous fluid. Also note the amount, color, consistency, and odor of drainage.
The presence of a tunnel or sinus tract. Also note undermining. It is extremely useful to place your gloved finger into the wound and probe. This way you can assess the depth of the wound and discover tracks that were previously not seen with a simple surface exam.
The condition of surrounding skin. Note any signs of infection, such as redness or warmth of skin, or injuries due to pressure, tape, or other causes.
Caution: Never reverse stage or “backstage” a healing pressure ulcer. For example, do not list a healing Stage IV as a Stage III. Instead, continue documenting the ulcer’s characteristics relative to its initial stage.
A variety of professional resources are available to help you care for and prepare your patients for discharge. Your facility may even have a skin care team that makes “skin care rounds.” Be sure to take advantage of all the resources available for preventing and treating pressure ulcers. Follow your facility’s protocol for referring patients to other specialists. Some of these specialists include:
Occupational therapist or physical therapist
Physician or surgeon
Infectious disease specialist