Pressure ulcer prevention Melissa Beer- Tissue viability nurse

Why prevention is so important Patients safety Quality of life Cost implications Category 2 – £6,000/ulcer Category 4 £14,000/ulcer (Source: Department of Health 2010) Can indicate poor practice

Who is at risk? Reduced mobility Vascular damage Sensory impairment, reduced consciousness Over 65 years old Malnourished/dehydrated

What should we be doing? ‘Press your mind to be pressure kind’ Think about the patients in your care consider are they at risk- Initial assessment to be completed within 6 hours (NICE 2014) Assessment to include: Braden Must Reassess weekly or if condition changes This will give a numerical figure to indicate the level of risk in developing a pressure sore 15-16 = low risk, 13-14 = moderate risk, 12 or less = high risk.

SSKIN assessment Support surface – mattress and cushion Consider patients mobility ICES mattress and cushion training Consider shear Skin inspection: Check for areas of discoloration- press to see if blanching if not blanching remember this is classed grade 1 Keep moving – repositioning and mobilisation : Regular turns titrate to needs of patient for example if skin marking turns may need to be increased- NICE guidelines recommend high risk patients should be encouraged to change positon at least 4 hourly.

SSKIN continued Incontinence/moisture Management: Ensure continence needs are met- consider continence assessment. Barrier cream to protect against moisture lesions. Nutrition and hydration: Food and fluid charts- Supplements MUST assessment weekly

P = Press reddened skin to check for blanching Skin assessment P = Press reddened skin to check for blanching U = Uncover the skin and remove stockings and socks L = Lift and check heels with a mirror S = Search for redness on the sacrum E = Evaluate elbows for redness. (Nursing standard 2013)

Things to consider Sitting in a chair is a high risk activity for those at risk of pressure ulcer development When considering a cushion remember to ensure a comfortable seated position with both feet on floor. Air mattresses are good tools but do not take away the need for regular repositioning Needs change every day always remember to reassess. Think about circulation DOCUMENT!

Thank you, Any questions?

References NICE. (2014). Pressure ulcer: prevention and management. Available: https://www.nice.org.uk/guidance/cg179?unlid=909313302201691914490. Last accessed 12/10/2016. RCN. (2013). Pressure ulcers, a guide to eliminating all avoidable grade 2, 3 and 4 pressure ulcers. Available: http://nhs.stopthepressure.co.uk/docs/Pressure_ulcer_care_best_practice.pdf. Last accessed 12/10/2016