1. PRESSURE ULCER AWARENESS TRAINING Eliminating Avoidable Pressure Ulcers

2. The Frightening Statistics Every year around 700,000 people are reported as having pressure ulcers, each one costing around £4000 in additional care costs. Around 80% of these are avoidable if preventative best practice had been followed.

3. Pressure Ulcers in Coventry and Warwickshire Between April 2013 and February 2014 187 pressure ulcers were recorded in Coventry and Warwickshire. This equates to almost £750,000 in additional care costs Each one of these 187 people may have suffered unnecessarily Each one of these pressure ulcers could potentially have been prevented with a great amount of knowledge and understanding of preventative best practice

4. What Are We Trying To Do? Supported by the CCG, C&WPT, Coventry City Council and UHCW, React to Red Skin is designed to increase education to help prevent avoidable pressure ulcers This is part of a co-ordinated effort across the area to increase the amount of knowledge around pressure ulcer prevention

5. The Aim of Training This training is a basic level of training aimed at staff who care for people who are at risk of pressure ulcers but who are not required to classify or treat pressure damage It will provide you with basic information about prevention It will provide you will tools to assessment a person’s level of risk

6. Introduction Care professionals have a key role to play in: –The prevention of pressure ulcers –The education of those being cared for –The education of others involved in the care Clients with impaired mobility are at a higher risk of developing pressure ulcers so carers need to be particularly vigilant Clients with mental health issues will also present additional challenges where carers may need to take a more proactive role

7. What Are Pressure Ulcers A pressure ulcer is a localised injury to the skin and/or tissue usually over a bony prominence as a result of pressure or pressure in combination with shear. An area of damage to the skin and underlying tissues that is caused by unrelieved pressure, friction or shear forces

8. Who Is At Risk? The greatest risk is to those who are immobile Any person who is unable to change position without help People unable to feel pain due to nerve damage Diabetics and people with arterial disease Elderly people in general are at greater risk because the skin is thinner and more fragile

9. How Pressure Ulcers Can Affect People’s Lives They can be painful Can cause depression and anxiety Stop people taking part in activities Possible hospital admission due to infection May cause death

10. Understanding Oxygen and Blood Flow The human body needs oxygen to survive Oxygen is carried in the blood supply The blood supply also carries carbohydrates and amino acids It removes carbon dioxide All of this is needed for healthy metabolism

11. Oxygen Deprivation and the Skin Skin deprived of oxygen will begin to die if the blood supply is cut off for more than a few hours

12. The Skin

13. Physical Causes of Pressure Ulcers

14. Other Causes Level of mobility – level of consciousness, terminal illness Extremes of age Nutrition and hydration status Moisture to the skin Sensory – neuropathy, MS,CVA History of pressure ulcers

15. Where Do Pressure Ulcers Develop?

16. Medication and Pressure Ulcers Some medication can inadvertently increase the risk of a pressure ulcer if it reduces sensitivity to pain or pressure Care plans should be clearly noted with details of sedatives or other medication being given in order that correct pressure area care is undertaken

17. What is NOT a Pressure Ulcer? Burn Skin tear Cut Graze Bruise Corn Leg ulcers Diabetic foot ulcers Surgical wounds Bruise Incontinence

18. S – SURFACE S – SKIN INSPECTION K – KEEP MOVING I – INCONTIENCE N – NUTRITION AND HYDRATION Five Simple Steps

19. Surface Pressure mattresses and cushions are used by people at risk of or who have pressure ulcers – cut foam, memory foam, air alternating (not cushions) Check covers for damage Remove slide sheets and hoist slings Reposition on mattresses If there is a problem consult the instruction booklet and/or call the engineer

20. Skin Inspection Vulnerable areas – bony prominence Discolouration, blisters, changes in skin temperature, swelling (boggy feel), discomfort (pain, itching, loss of sensation) Document what is found even if skin is normal Report any concerns through the PUT form

21. Blanching Skin

22. Non-Blanching Skin

23. Keep Moving Assist those who cannot reposition/move themselves Reposition people on mattresses Limit chair sitting – 2 hours maximum Encourage regular, gentle movements

24. 30 Degree Tilt

25. Incontinence and Moisture Ensure people are clean and dry Limit the use of vigorous movements when washing and drying If soiled wash using a soap substitute Apply barrier cream/spray if prescribed Report any concerns

26. Nutrition and Hydration Ensure people are eating and drinking Monitor intake of food and fluid where possible Check mouths for any problems such as thrush, ill fitting dentures Ensure supplements are offered where prescribed

27. Four Steps of Prevention

28. Care Homes Step 1- Training –Simple advice and knowledge that can improve the outcomes for the people you are caring for –Will be recorded on your employment history (certificates are available) –Demonstrates a commitment and willingness to prevent pressure ulcers with simple techniques

29. Care Homes Step 2 – Policy –Agree what is your ‘Policy on Pressure Ulcer prevention’? –Publish your policy for relatives to see –Put it on your website –Gain React to Red Skin Accreditation –Tell the commissioners about your proactivity in this area

30. Care Homes Step 3 – Using The New Tools We have produced some tools to make your jobs easier when it comes to pressure ulcer prevention –Patient information leaflets –Posters –Workbooks –Pressure Ulcer Trigger checklists –Safety Cross

31. Care Homes Step 4 – Keep It Going –Pressure Ulcer Prevention needs to become part of your day to day lives –Get used to using the tools to help record the work that you are doing –Publish your pressure ulcer prevention policy on your website –Get your organisation accredited by React To Red Skin –Keep a log of how many days ‘Pressure Ulcer Free’ you are in your area and communicate it regularly to staff using the Safety Cross

32. Roles and Responsibilities Communication is the key Report concerns –Deterioration –Declining to use prescribed equipment –Breakdown of equipment –Increase in risks to unacceptable levels –48 of red, non-blanching sking

33. 5 Simple Steps Incontinence – keep people dry and clean Sore Skin – early skin inspection means early detection Unwell – feeling ill can lead to other complications Reduced Mobility – those who can move less are more at risk Food and Drink – make sure people have a good diet with plenty of fluids

34. Mental Illness and Pressure Ulcers Clients suffering from mental illness are at risk of developing pressure ulcers if their illness affects their motivation Care professionals should remain vigilant of both client groups with mental illnesses/impairments as well as physical ones

35. Summary The care professional has an important part to play in reducing the risks of people developing pressure ulcers A good understanding of how pressure ulcers develop and client groups at risk means that care professionals are better equipped to: Reduce the risks Provide a better standard of care

36. Conclusion Only by really working together can we stop pressure ulcers, and stop suffering We are all responsible for our client's wellbeing Please help us to prevent pressure ulcer occurring in the first place

37. PRESSURE ULCER AWARENESS TRAINING Eliminating Avoidable Pressure Ulcers