1. Safe Patient Handling to Prevent Pressure Ulcer Development Linda Norton MSCH, OT Reg. (ONT) lnorton@shoppershomehealthcare.ca Marian Keith mkeith@shoppershomehealthcare.ca

2. What is a Pressure Ulcer? A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. National Pressure Ulcer Advisory Panel (www.npuap.org)

3. Skin Tear “traumatic wounds due to separation of epidermis from the dermis (partial- thickness wound) or of the epidermis and dermis from underlying structures” (full- thickness wound ). (Payne et al 1993) 1.5 million skin tears occur in the United States each year, (Bryant 2001) Where the cause is known 25% were caused by transfers (LeBlanc, 2008)

4. The Burden of Pressure Ulcers In 2003, the CAWC funded a study to determine the extent of chronic wounds in Canada. Results of the study indicated the prevalence of pressure ulcers was: 25% in acute care, 30% in non-acute care, 22% in mixed health-care settings, and 15% in community care The mean prevalence overall was 26%. 1 in 4 - Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian health-care settings. Ostomy/Wound Management. 2004;50(10):22-38.

5. Prevention Front line caregivers are essential in the effort to prevent pressure ulcers.

6. Pathway to Assessment/Treatment of Pressure Ulcers Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. Best practice recommendations for the prevention and treatment of pressure ulcers: Update 2006. Wound Care Canada. 2006;4(1):31-43.

7. How do I inspect the skin? Head to toe Look for tears, scraps, areas of discoloration, redness, or patches where the skin looks or feels different www.epuap.org

8. Why are skin checks so important Redness/changes in the skin are usually stage 1 pressure ulcers Immediate implementation of preventative measures e.g. pressure management devices, turning schedules etc. have been shown to resolve the skin changes, and prevent the progression of the ulcer Reference: VanderweeK., Grypdonck M., Defloor T. Non-Blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial. J Clin Nurs 2005 Aug 30;(16):325-35)

9. What is pressure? What is friction? What is shear?

10. Pressure Use pressure management surfaces Encourage frequent repositioning

11. Blood Flow When external pressure exceeds the mean arterial pressure blood flow ceases If this is true, why is there an inverse relationship between pressure and time? Slow tissue deformation is due to interstitial fluid flow…tissues can creep for several hours causing increased deformation around bony prominences

12. What do we know for sure? Minimize the use of incontinence pads. Use of an incontinence pad was shown to increase peak pressure values by 20 – 25%. (Fader M, 2004) Leg elevation at 10 degrees in the 30-degree head-up position is effective for reducing body displacement at the acrominon; it was not effective for reducing sacral interface pressures. (Harada C, 2002) Any pressure management surface is better than a “standard hospital mattress” (Callum et al 2006)

13. What else do we know? Nothing replaces good client care Consider the impact of the support surface on bed mobility and transfers. The greater the immersion in the surface, the more difficult bed mobility and transfers will be for the client People are individuals, there is no one surface which works for everyone Friction and shear magnify the impact of pressure

14. Friction and Shear Use devices which reduce friction and shear Lift, don’t drag the patient

15. Undermining Asymmetrical Undermining Shear Symmetrical Undermining Fluid Courtesy of D. Keast

16. Health Care Worker Injuries The health care sector in British Columbia accounts for more worker injuries than any other sector, including forestry, construction and transportation 14.” In British Columbia, “patient handling activities account for almost 50% of MSK injuries in acute care and long term care settings 14 ”. “Handle with Care: Patient Handling and the Application of Ergonomics (MSI) Requirements" from Worksafe BC.

17. Safe Patient Handling Program Safe Patient handling Programs are typically composed of 5 key components. Policy & Procedure, Assessment, Equipment, Training & Education, and Program Monitoring.

18. How can safe patient handling programs prevent skin injuries? Reduces friction and shear forces Makes repositioning easier, so patients are more likely to get repositioned more frequently

19. Transfer Boards

20. Consider a more dependent transfer to reduce friction and shear

21. Apply the sling without rolling the patient

22. One-way glides for repositioning

23. Repositioning Sling in bed

24. Multiglide

25. 4-Way Bed Management System

26. Ergo Slide LT

27. Final Thoughts Manage pressure, friction and shear forces everywhere all the time Encourage frequent changes in posture, to promote weight shifting Nothing replaces good client care

28. Questions and Thank You