NURSING

Prevention and Care of Pressure Ulcers - Evidence based Practice

Prevention and Care of Pressure Ulcers - Evidence based Practice

Prevention and Care of Pressure Ulcers

Pressure ulcers are a commonly seen problem among elderly hospitalized patients. Despite new findings about the causes and approaches to treatment, the incidence of these wounds is still increasing. Scott, Gibran, Engrav, Mack and Rivara (2006) revealed that during the thirteen years of their study, the incidence of pressure ulcer development has more than doubled. As our elderly population becomes greater in number, and older in age, this problem is expected to escalate. It is of great importance for the patients as well as for the institutions to find the best practice guidelines to control the occurrence of preventable wounds. Many hospitals incorporate strict prevention measures with good effects, and others are more concentrated on treating the problem after it occurs, without paying much attention to prevention. In XY hospital, patients at risk do not receive the necessary preventive care, and many patients' existing wounds often become infected, and instead of healing, they deteriorate. This paper will review the research regarding the best prevention methods, as well as the best evidence based treatment of pressure ulcers, followed by suggestions how to implement those findings in XY hospital.

PICO question

In elderly and immobile patients, what are the most effective prevention and treatment methods to reduce the occurrence and complications of pressure ulcers, compared to no prevention and standard wet-to-dry dressings?

Effective management of pressure ulcers begins with a comprehensive assessment of the patient, with careful consideration of the risk factors. Hess (2004) reported that the Braden Scale is the most commonly used risk assessment tool. Also, it is important to regularly inspect the skin of the patients found to be at risk. Such inspection should focus particularly on the areas around bony prominences. Bethell (2005) argues that once stage one pressure ulcer develops, the irreversible damage to the tissue forms, and this will progress to open, deeper wound if pressure is not relieved. Stage one is defined as a change of intact skin in one or more of the following: skin temperature, colour, tissue consistency and/or sensation (Hess). Unfortunately, the staff at XY hospital is only concerned with skin breakdown, when assessing for pressure ulcers. No prevention strategies are implemented for patients at risk until they develop stage two ulcers, when skin breakdown is visible. One article notes that educational in-service for the staff is effective, and results in the professionals' better understanding and ability of staging pressure ulcers (Thompson, Langemo, Anderson, Hanson and Hunter, 2005). It is necessary that prevention techniques are implemented for all patients at risk from the moment that risk is identified, whether there is an existing tissue injury or not.

Another study indicates that the body can endure great amount of pressure for short time periods, but low pressure for a long amount of time causes significant tissue damage (Maklebust, 2005). Repositioning of patients should be performed at least every two hours or more often if ...