Pressure ulcer prevention

Prevention strategies

By: Mölnlycke Health Care, April 25 2012Posted in: Pressure ulcer prevention

A pressure ulcer prevention strategy should always include risk and skin assessments, provision of correct nutritional support and pressure redistribution strategies. An emerging strategy is that of utilising a protective dressing such as Mepilex® border when used as part of a pressure ulcer prevention protocol.

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Learn more about prevention strategies

  • Prevention of pressure ulcers is a complex multifactoral process – evidence based recommendations should be followed which are applicable to the specific environment after careful consideration by the health care practitioner
  • Risk of litigation is discussed in a number of publications – importantly not only lack of prevention programmes but violation of recognised guidelines are reported
  • The Pressure Ulcer Prevention and Treatment Clinical Practice Guidelines developed by NPUAP/EPUAP
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Key elements in prevention

Key elements in prevention – adapted from National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009.1

  • Risk Assessment – not only should a risk assessment policy be implemented in a structured manner but importantly the health care team should be educated on both the use of the tool and the basics in pressure ulcer related issues. All risk assessment must be carefully documented and reassessments undertaken.
  • Skin assessment – condition of the skin such as moisture can increase the risk of damage; therefore a structured assessment as part of an overall risk assessment should be implemented and practical precautions initiated where needed
  • Nutrition – assessment of nutritional status, referral to dietician when required for nutritional support and assessment of hydration status are all key steps.
  • Repositioning – a key step in reducing the impact of pressure - frequency will depend upon individual's general health status, skin condition and support surface insitu. Repositioning should be undertaken in a manner that ensures pressure is relieved or redistributed whilst avoiding shear/ friction forces. Consider use of 30 degree tilted side lying position. Ensure documentation is meticulous and the health care team are educated correctly.
  • Support surfaces – select the appropriate device based on the individual's requirements – reassess frequently- pay particular attention to heels whereby they are relieved of pressure completely if possible by use of pillows correctly positioned. Note: The NPUAP has defined the characteristics of the various support surfaces.
  • Consider the implications of specialist groups – for example patients undergoing surgery, elderly, patients in critical care, paediatrics – all of whom may need additional care.
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Reducing the Risks of Shear Forces — using Mepilex Border

Mepilex® Border is an absorbent self adhesive dressing that is now indicated for the treatment and prevention of pressure ulcers - Mepilex Border through its unique 5 layer structure and patented soft silicone adhesive Safetac® technology has been demonstrated to add three way protection against the risk factors present in pressure ulcer formation and provide less pain during dressing change.

Safetac® technology allows you to lift and replace the dressing without adherent properties being lost. Therefore, you can check the skin condition on a regular basis to match many current pressure ulcer prevention protocols without having to change the dressing.

In-vitro test results demonstrate that Mepilex® Border can help decrease the effects of shear forces on tissue by up to 50% during wear time. Without Mepilex® Border, unprotected skin is exposed to the damaging effects of shear stress22.

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Managing the Skin Microclimate — using Mepilex Border

In-vitro testing reveals that Mepilex® Border has the best ability to absorb, retain and release moisture, maintaining proper moisture balance to keep skin dry, when compared to a range of other dressings – ensuring the skin remains in the optimal condition to help prevent pressure ulcer formation.23

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Clinical Evidence Demonstrating Positive Outcomes

Numerous healthcare practitioners have now added the use of Mepilex Border to their prevention protocols and have documented the impact in outcome improvement programmes.
15 case studies have now been documented involving almost 1000 high acuity patients.


Please note. The use of dressing’s with Safetac technology does not preclude the need for a comprehensive pressure ulcer prevention program (i.e. support surfaces, positioning, nutrition, hydration, skin care, mobility).

References

  1. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009
  2. Bibliometric Analysis of Pressure Ulcer research. JWOCN; 37(6); 627-632; Hong-Lin Chen et al; 2010
  3. Medical Device related pressure ulcers in hospitalised patients. International Wound Journal; 7(5); 358-365; Black J M et al; 2010
  4. WOCN Society. Professional Practice Manual 3rd Edition, Appendix D Prevalence and Incidence: A Toolkit for Clinicians, Mt. Laurel NJ; 2005 3. Dressing related pain in patients with chronic wounds: an international patient perspective. Price P et al. International Wound Journal; 2008
  5. International Guidelines: Pressure ulcer prevention: prevalence and incidence in context. A consensus document. London: MEP Ltd, 2009
  6. Pressure Ulcer Prevalence Monitoring Project: Summary report on the Prevalence of Pressure Ulcers. EPUAP Review; Volume 4, Issue 2, 2002
  7. Results of nine international pressure ulcer surveys: 1989-2005. Ostomy Wound Management; 54(2). Vangilder C et al; 2008
  8. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy/Wound Management. 50(10):22-38. Woodbury MG, Houghton PE; 2004
  9. Prentice JL, Stacey MC. Pressure ulcers: the case for improving prevention and management in Australian health care settings. Primary Intention 2001; 9: 111-12027
  10. A Cross-sectional Descriptive Study of Pressure Ulcer Prevalence in a Teaching Hospital in China Zhao G, Ostomy Wound Manage. 2010 Feb;56(2):38-42
  11. Factors affecting healing of Pressure ulcers in Korean Acute Hospital. Sung Y.H et al. WOCN January 2011
  12. Description of pressure ulcers pain at rest and at dressing change. Szor JK. JWOCN. 26(3):115–120; 1999
  13. Pressure ulcer pain suffering; issues in a multi centre pain prevalence, Nixon J et al. Oral presentation at EPUAP Annual Conference, Birmingham, UK. 2010
  14. Reaching for the moon: achieving zero pressure ulcer prevalence. J Wound Care 18(4): 137–44 Bales I, Padwojski A ;2009
  15. The cost of pressure ulcers in the UK: Age and Ageing; 33: 230–235; Bennett G et al; 2004
  16. Legal Issues in the Care of Pressure Ulcer Patients: Ket Concepts for Healthcare Providers – A Consensus Paper from the International Expert Wound Care Advisory Panel. 23(11):493-507, November; Fife C et al; 2010
  17. Centers for Medicare & Medicaid Services. Proposed Fiscal Year 2009 Payment, Policy Changes for Inpatient Stays in General Acute Care Hospitals. Available at: http://www.cms.hhs.gov/apps/media/press/factsheet.asp?Counter=3045&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500. Accessed May 13, 2008.
  18. Centers for Medicare & Medicaid Services. Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians; Proposed Rule. Federal Register. 2008;73(84):23550. Available at: http://edocket.access.gpo.gov/2008/pdf/08-1135.pdf
  19. Hospitalisation related to pressure ulcers among adults 18 years and over. Agency for Healthcare Research and Quality; Statistical Brief #64. 2006
  20. Interprofessional Management of Complex Continuing Care Patient Admitted with 18 Pressure Ulcers. Baker T et al. Ostomy Wound Management; Feb 2011
  21. Pressure Ulcer Classification; Differentiation between pressure ulcers and moisture lesions. EPUAP Review 6(3); Defloor T., et al ;2005
  22. Wound Dressing Shear Test Method (Bench) Providing Results Equivalent to Humans.Bill B et al. Poster Presentation at the EPUAP Congress, Oporto, 2011
  23. Wound Dressings, Measuring the Microclimate They Create, Call E. Oral Presentationat the EPUAP Congress, Oporto, 2011
  24. Dressings can prevent pressure ulcers :fact or fallacy? The problem of pressure ulcer prevention. Wounds UK;5(4) pg 61-64; Butcher M et al; 2009
  25. Journal of Wound, Ostomy and Continence Nursing: May/June 2007 - Volume 34 - Issue 3S - p S67 doi: 10.1097/01.WON.0000271036.00057.f8 Scientific and Clinical Abstracts From the 39th Annual Wound, Ostomy and Continence Nurses Annual Conference, Salt Lake City, Utah, June 9-13, 2007:Research Abstracts: Wound-Evidence-Based Interventions
  26. Shear A contributory factor in pressure ulceration. A presentation aimed at clinicians and associated professional. www.npuap.org; accessed 14/12/09
  27. Temperature-modulated pressure ulcers: a porcine model. Arch Phys Med Rehabil. 76(7):666-73; Kokate J.Y et al; 1995
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