This paper focuses on how to reduce pressure ulcer rates and the tools and strategies to be used to improve the quality of the service provided. Pressure ulcers can mostly be prevented and using initiatives to prevent pressure ulcers from developing can improve the health care process and reduce the rates of pressure ulcers developing (Sullivan & Schoelles, 2013). According to Lyder (2003, p. 223), “pressure ulcers develop when persisting pressure on a bony site obstructs healthy capillary flow, leading to tissue necrosis.” Preventing pressure ulcers is important because it protects patients as well as reduces the cost of care for patients (Sullivan & Schoelles, 2013).
Since pressure ulcers can develop in as little as 2 hours, preventing pressure ulcers depends on accurately identifying those patients that are at-risk for pressure ulcers so that preventative steps can be taking (Lyder, 2003). First, the aim is to identify the primary risk factors for those that would develop pressure ulcers and use tools to predict levels of risk. Risk factors include diabetes mellitus, sepsis, hypotension, peripheral vascular disease, cerebrovascular disease and a pressure ulcer prediction tool such as Braden Scale or Norton Scale can be used at this stage (Lyder, 2003).
Second, major preventative interventions to be implemented must be identified (Lyder, 2003; Sullivan & Schoelles, 2013). One, removing or regularly redistributing pressure-sensitive areas of the body is needed, specifically a 1-2 hour repositioning schedule for patients at high risk will be needed. Two, dynamic support surfaces can be used to redistribute pressure. Dynamic devices use pump or electricity as well as air-fluidized beds, which are particularly useful for moderate to high risk patients (Lyder, 2003). Other strategies including regular skin exams, moisturizing sacral skin, optimizing nutrition, and improving staff education (Sullivan & Schoelles, 2013). Prevention methods will be implemented from initial point of entry into the health care system, beginning with risk assessment at admission.
Some pressure ulcers will still occur regardless of attempts at prevention and these have to be managed. First, a comprehensive evaluation of the pressure ulcer must take place, which begins with cleaning with antiseptic. The National Pressure Ulcer Advisory Panel staging system will be used to classify the ulcer and determine what needs to be done. This will be combined with the use of one of the following instruments to assess the healing of pressure ulcers, such as the simple Pressure Ulcer Healing Scale or the more complex Pressure Sore Status Tool.
Second, dressings are an important part of managing pressure ulcers (Lyder, 2003). There are many dressings from which to choose, and one will be chosen to manage pressure ulcers that can lead to the maintenance of a moist wound environment, which is the main goal of dressing the wound (Lyder, 2003). Non-gauze dressings will be used as they can be more cost-effective over time because they need to be changed less frequently, plus they promote faster healing and support infection less (Lyder, 2003). Overall though, different of dressings will be needed depending on the stage of the ulcer, including foams and hydrogels.
Third, in addition to being important for preventing pressure ulcers, good nutrition is also indicated for optimal wound healing, since “nutrition is important to maintain the body in positive nitrogen balance, thus increasing would healing” (Lyder, 2003, p. 225). The type of nutritional support given will depend on the state of the client’s health. Fourth, where pressure ulcers have not improved substantially after three months, adjunctive therapies will be integrated into the treatment plan, where covered by insurance. Potential adjunctive therapies to be used include radiant heat, negative pressure therapy, and electrical stimulation. Finally, where there are full-thickness (stage IV) pressure ulcers, surgery may be undertaken to close the ulcer. However, the benefits have to carefully considered since ulcers closed using surgery often recur (Lyder, 2003).
References
Lyder, C. H. (2003). Pressure ulcer prevention and management. JAMA, 289(2), 223-226.
Sullivan, N., & Schoelles, K. (2013). Preventing in-facility pressure ulcers as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5_Part_2), 410-416.
