1. PRESSURE ULCER AWARENESS Prevention Pressure Ulcers in the Community1

2. Introduction
Supported by the Public Health Agency this session is designed to increase awareness to help prevent avoidable pressure ulcers
By the end of this session we hope you will:
Understand what is meant by a pressure ulcer
Be able to identify who is at risk
State the most common causes of pressure ulcers
Identify the most common places on the body where pressure ulcers occur

3. The Frightening Statistics
In ,617 people were reported as having pressure ulcers. Around 80-90% of these were avoidable if preventative best practice had been followed.
Out of this figures approximately 1200 people died as a direct result of their pressure ulcer.

4. Overall Aims
To eliminate all avoidable stage 2, 3 and 4 pressure damage
Avoidable pressure ulcers are a key indicator of the quality of nursing care
Preventing them will improve all care for vulnerable people.

5. Why Carers Are Important
Care professionals have a key role to play in the prevention of pressure ulcers
Care professionals look after those most at risk in our community
Carers are in an ideal position to impart information and basic prevention steps to
Those they care for
Family members of those they care for
Other professional involved in the care of that person 5

6. What Are Pressure Ulcers
Pressure ulcers are a type of injury that affects areas of the skin and the underlying tissue
They are caused when an area of skin is placed under pressure
They can vary in severity from patches of discoloured skin to open wounds exposing bone or muscle 6

7. Who Is At Risk?
The greatest risk is to those who are immobile or have limited mobility and are unable to change position
People unable to feel pain due to spinal cord injuries or neurological disorders
Diabetics and people with vascular disease
Elderly people in general are at greater risk because the skin is thinner, drier and less elastic and is therefore more fragile
Anyone who is incontinent
Anyone suffering from muscle spasms
Peoples whose skin suffers with excessive moisture or dryness
People with decreased mental awareness

8. How Pressure Ulcers Can Affect People’s Lives
They are painful
Can cause depression, anxiety and paranoia
Stop people taking part in activities
Possible hospital admission due to infection or for plastic surgery on wound
Can and do cause death

9. Providing You With Simple Tools
The Blanch Test
What is it?
How do you do it?
Try is for yourself and see the results of healthy skin

10. Providing You With Simple Tools
What else to look for:
Blisters
Discolouration of the skin (if the skin is hard or leathery it indicates tissue death and a severe pressure ulcer)

11. The Four Steps of Prevention
Step 1- Awareness
Simple advice and knowledge that can improve the outcomes for the people you are caring for
Demonstrates a commitment and willingness to prevent pressure ulcers with simple techniques

12. The Four Steps of Prevention
Step 2 – Policy
A management led task
Agree a ‘Policy on Pressure Ulcer prevention’?
Publish the policy for all to see
Put it on your website
Tell relevant authorities about your proactivity in this area
Have escalation plans in place to refer to relevant professional e.g. nursing, G.P.

13. The Four Steps of Prevention
Step 3 – Using The New Tools
There are some new tools available to help
A pressure ulcer information leaflet
A pressure ulcer public poster
A staff poster
A pressure ulcer checklist
A pressure ulcer booklet
An At Risk card

14. The Four Steps of Prevention

15. The Four Steps of Prevention

16. The Four Steps of Prevention
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 along with the Your Turn logo to show your commitment
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

17. SSKIN – The Five Basics Sick or unwell Skin red or sore Keep moving
Incontinent
Nutrition – food and drink

19. Human Biology

20. 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

21. 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

22. The Skin

23. What Causes Pressure Ulcers
Pressure ulcers are caused by pressure against the skin that prevents blood getting to the skin and underlying tissues. Other factors can make the skin vulnerable and contribute to the development of pressure ulcers:
Sustained pressure
Friction
Shear

24. Sustained Pressure
When your skin and underlying tissues are trapped between the bone and a surface such as a chair or bed
This kind of pressure tends to happen in areas that aren’t well padded with muscle or fat
The affected area starts to hurt and then feels numb

25. Friction Friction is the resistance to motion
This can occur when a person is dragged (instead of being lifted) over a surface
Can occur between skin and mattress or skin and clothing
The resistance may be greater if the skin is moist
This results in damage to the top layer of skin

26. Shearing
Shearing occurs when two surfaces move in the opposite direction
E.g. when a bed is elevated at the head a person can slide down it. As the tailbone moves down, the skin over the bone may stay in place – pulling in the opposite direction
Shearing causes the blood vessels in the skin and muscle to tear
The skin is now more vulnerable to damage from sustained pressure

27. Exercise Try this in the comfort of your own home
Lie on a hard surface on your back, side and front – each for 1 minute
Do you feel where you main pressure areas are?
Were they where you thought they would be?
Were there any that you wouldn’t have thought of?

28. Where Do Pressure Ulcers Develop?

29. 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

30. Mental Illness and Pressure Ulcers
People with sever mental health conditions such as schizophrenia or severe depression have an increased risk of pressure ulcers for a number of reasons:
Their diet tends to be poor
They often have other physical conditions such as diabetes or incontinence
They may neglect their personal hygiene making skin more vulnerable to injury
Some mental illnesses affect the nerves in the body such as MS, Parkinson’s and Alzheimer’s disease

31. 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
Educate those you are caring for and others around them

34. 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

35. Revision By the end of this session we hope you will:
Understand what is meant by a pressure ulcer
Be able to identify who is at risk
State the most common causes of pressure ulcers
Identify the most common places on the body where pressure ulcers occur