1. Pressure Ulcer Prevention
Care Home Education Facilitator Donna Craig & Lynn McCourtney
Welcome and introduction, our role in suporting the delivery of the session.

2. Aim & outcomes for the session
To increase your knowledge of pressure ulcer prevention to support improving care delivered to residents
Outcomes
Have an understanding of the background and rational of the prevalence of pressure ulcers both Nationally and Locally
Develop knowledge of the causes of PU and your role in prevention
Understand the importance of assessment using a systematic assessment process, utilising valid evidence based tools
Understand accountability within your role in reducing harm
Know how to access further resources which will reinforce a developing knowledge base
Avoidable versus unavoidable.
UnAvoidable means that everyhting has been put in place and attempts made to prevent breakdown in skin.

3. Most Pressure Ulcers are Preventable
Most pressure ulcers are preventable NHS Scotland, Scottish Government, NHS D&G
Zero Tolerance for avoidable Pressure Ulcers
There is a lot of evidence that suggests that appropriate clinical care can help to prevent the occurrence of pressure ulcers
In line with the national and local strategy which urges a zero tolerance policy for pressure ulcer development
gaining an understanding of how pressure ulcers develop and then
obtaining a Risk Assessment and implementing a plan of care based on the Assessment results
arms us with the knowledge on how to stop Pressure Ulcers forming in the first place 3

4. Prevalence and incidence
Nationally
Approximately 412,000 people annually
2014 a review of Care home reported incidents showed:
1020 residents were admitted with grade 2-4
1533 developed a grade 2-4 in a care home setting
Locally
were recorded in D&G in acute and community and cottage hospitals
Care Homes
63 were recorded within the are homes locally
Cost to heal of Grade 1 £1064 increasing to £10,551 for Grade 4
Cost of healing
Grade 1 £1064 increasing to £10,551 for Grade 4

5. Pressure Ulcer, what is it?
Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.
They are sometimes known as "bedsores" or "pressure sores".  
Pressure ulcers can range in severity from patches of discoloured skin to open wounds that expose the underlying bone or muscle
Definition
‘A pressure ulcer is a localised injury to the skin/or underlying tissue usually over a bony prominence, as a result of pressure or pressure in combination with shear’
Just a quickie recap on the definition of what a pressure ulcer is 5

6. Causes of Pressure Ulcers
Extrinsic
Pressure
Shear
Friction
Intrinsic
Health status
Mobility
Posture
Sensory impairment
Infection Nutrition
Status body weight
Previous pressure damage
Break into groups list factors and ask for rational. feedback as groups
Factors that contribute to pressure ulcers can be extrinsic i.e outside, environmental contributing factors
Match the definition
1. Pressure - Squeezes blood vessels
2. Sheer - Body slips down the bed but skin stays in same place
3. Friction - on the sheets, dragging up the bed. Covers too tight. Pulling over toes, pressing on heels. Poor fitting footwear.
Intrinsic – within the patient/client’s own body and. There are about 16 intrinsic factors – subheadings which need to be considered
Health status-Acute or chronic illness, Patientsts w/vascular/arterial disease, congenital cardiac anomalies, spina bifida, cerebral palsyMobility-Greatest risk to skin integrity2hrs max in one position Posture-Anatomical changese.g Pelvis tilt – not usual pt position -Nutritional Status/Body weight Emaciation/obesityNutrition – clear link MUST scoring Protein/Carbs/Calories/vits/mins Previous Pressure Damage scar tissue – reduced blood supply
Pain Status Pts move less if in pain Provide adequate analgesia Psychological Factors-Depression, apathy Reduced movement,Staring into space,Less walking/more sitting nutrition/self care-Medications Antihistamines – drowsiness Inotropes/steroids/chemo - reduce tissue perfusion Rheumatoid pts skin Cognitive Status-Alzheimers pts unaware mobility needs Blood Flow Compromised Damages skin integrity Delays healing Extremes of Age
Elderly - thinner drier Moisture – also extrinsic Multifactorial also extrinsic
And Some pts have multiple contributing risk factors
This makes them extremely susceptible to developing pressure ulcers

7. what you do makes a difference
Skin health
keep skin clean dry and well hydrated
ensure all areas are checked
looking for early signs of damadge
Incontince/moisture
incontinence is not an inevitable consequence of old age and should be treated whenever possible
patients should be encouraged to drink regularly to maintain hydration, reduce the risk of constipation and reduce the concentration of urine.
Nutrition
help residents to eat a healthy diet and have regular drinks
use simple measure to support residents to eat well
use a screening tool to assess nutritional needs and those at risk
Mobility
residents should be repositionred regulary
movements only need be small
plan movement into daily routine
discuss and ask for examples within practice from participants

8. Risk Assessment –informal & formal
Observation & using your initative
Formal- Assessment tools
Waterlow
SSKIN Bundle (ARC)
MUST – nutritional assessment
PPURA (preliminary pressure ulcer assessment) HIS
Skin test
Excoriation tool (NATVNS)
Grading tool (NATVNS)
How do we assess- when do we asses? informal continual inspection of skin what are we looking for? what can we assupport workers do? (Group sessions)
Discuss each of the tools in detail -local adaptions- ensure understanding.

9. Accounatbility
Risk assessment & reduction strategies for pressure ulcer prevention must be embedded in everyday practice by all those involved in direct resident care.
Last Slide
Accountabliity not enough to pass concerns to a senior individual accounatablility- PU standards 2016 (handout) give sections ask in groups to relate to home. compare.
Risk Assessment and reduction strategies must be embedded in everyday clinical practice in order to reduce the risk of pressure ulcer formation
SSSC registration and fitness to practice

10. additional resources
Healthcare Improvement Scotland. Tissue Viability webpage px
Reducing pressure ulcers in Care Homes-resurces link has access to a number of different web resources used in the Pressure Ulcers Collaborative
Preventiona and management of pressure ulcers 2016
bility_resources/pressure_ulcer_standards.aspx