1. PRESSURE ULCER PREVENTION: refresher training
Tissue Viability Service

2. Causes of Pressure ulceration
Immobility **
Existing /Previous PU
Vulnerable skin
Perfusion
Sensory perception
Hydration/ nutrition
Moisture
Pain
As defined by systematic review and expert consensus group.
Immobility is the main factor.

3. Assessing risk:
When & how
PURPOSE T

7. Normal skin/Blanching erythema

8. Category 1 Report to Staff Nurse immediately
If you identify a Category 1
Report to Staff Nurse immediately
Review 2 hourly and increase repositioning to 2 hourly
Discuss with Link Nurses
If no improvement in a couple of days then refer to Tissue Viability

9. Category 2

10. Category 3

11. Category 4

12. Category U (unstageable)

13. Incontinence Associated Dermatitis (IAD)
IAD is superficial and are associated with redness, rash or vesiculation – can get deeper if infection present
Examples of IAD:
Other moisture lesions:
Combined pressure and moisture lesion
Sweat/moisture rash, possibly fungal
Moisture “kissing lesion”

15. Planning Care
Care plan should:
address the patient’s risk profile (factors)
consider patient preferences & ability to self-care
Patients should be involved in decisions about their care
Essential Elements of Care include:
promotion of movement
re-positioning
support surface provision
Active monitoring of skin response

16. Keep Moving/2 hourly
If a patient is moving they wont develop pressure ulcers

17. Beds & Surfaces

18. Alternating cell

19. Seating Chairs with integral pressure relief?
Pressure relieving cushions
Wheelchair cushions

20. Heels (& other body areas)
Aderma

21. Planning Care
Other aspects of care may include management of:
Moisture
Diabetes
Poor perfusion
Nutrition
Pain
Skin
Poor sensory perception & response

22. New Proposed Pressure Ulcer Prevention Pathways: PUPPs
PURPOSE T Assessment
Existing PU/scar
Secondary Prevention & Treatment Pathway
No PU but at risk
Primary Prevention Pathway
Not currently at risk
Re-assess If condition changes
Continuous Active Monitoring of Skin Response
Deterioration Prompts Action

23. The patients perspective Involve the patient
PRESSURE ULCERS
The patients perspective
Involve the patient
Patient information leaflets

25. Summary
The development of a pressure ulcer indicated a patient has suffered HARM whilst in our care.
The key to preventing HARM is recognising VULNERABLE SKIN and ACTING on it.
Any vulnerable skin or pressure damage should be seen per shift by the RN responsible for that patients care and not just by a non-registered nurse.