Independent wound consultant Rachael Lee offers an update of pressure ulcer prevention and management strategies
A pressure ulcer can be defined as: ‘Localised damage to the skin and/or underlying tissue, usually over a bony prominence (or related to a medical or other device), resulting from sustained pressure (including pressure associated with shear). The damage can be present as intact skin or an open ulcer and may be painful.’
All people, regardless of their age, are potentially at risk of developing pressure ulcers. However, there are certain risk factors that make people more susceptible, or increase the risk of existing pressure ulcers deteriorating. Prevention and management strategies are therefore required across a variety of health and social care settings. These include acute care, community services, primary care, hospices, care homes and home care services.
This learning module will explore the risk factors around pressure ulcers and consider the latest assessment, prevention and management techniques.
- Most pressure ulcers are preventable but, despite extensive programmes of work to reduce their occurrence, their treatment accounts for more than two-thirds of NHS spend on wound care
- Nutrition and hydration are vitally important to maintaining skin elasticity to help prevent pressure ulcers
- The risk of pressure ulcer development should be assessed using a validated tool alongside clinical judgement
- Skin assessment involves more than what the eye can see. Changes in skin colour, temperature, texture, visible swelling and reports of pain are all potential indicators of underlying pressure damage
- Support surfaces, such as mattresses and cushions, should be chosen based on individual need, and at-risk patients should be encouraged to change position at least every six hours, or four hourly for those at high risk
Although most pressure ulcers are preventable, and despite extensive programmes of work to reduce their occurrence, a national audit found overall prevalence across 36 hospitals in England was still 9.04%. Pressure ulcers are a substantial burden on people’s quality of life, often resulting in pain and distress. They also negatively impact the allocation of valuable health and care resources, accounting for approximately 71% of total NHS spend on wound care. Consequently, pressure ulcers remain a challenge to health and care practitioners as well as for patients.
Finding ways to improve prevention and management should be a priority for policymakers, managers and health and care practitioners alike. This article will explore and explain best practice according to the aSSKINg framework, which has evolved from guidance and standards relating to pressure ulcer prevention, management and education.
Rachael Lee is an independent wound consultant and clinical implementation lead for the National Wound Care Strategy Programme.
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