Pressure Ulcers

Major benefits of relieving and preventing pressure ulcers

Social isolation, feelings of guilt and increased healthcare costs are just three examples of the negative impacts that pressure ulcers can have. But through well-planned prevention work, a lot of pressure ulcers can be avoided.

Pressure ulcers cause a great deal of suffering, are extremely painful and can severely limit the daily life of those affected. They can, for example, contribute to a person becoming dependent on others for ulcer treatment, even when living at home. They can also have a negative affect on your social life, particularly if they leak or smell bad.

Another impact of pressure ulcers is that they often lead to feelings of guilt for the patient or the people caring for them. This is often due to preconceptions and lack of information; many people believe that ulcers usually occur due to poor care and hygiene, which is not the case.

The treatment of pressure ulcers also entails major costs for the medical and healthcare industries.

In other words, there is much to gain from preventing pressure ulcers, both in the form of reduced suffering and reduced costs.

 

How to prevent pressure ulcers

Pressure ulcers can be prevented, mainly by identifying risk patients early and taking suitable action. Action such as movement, pressure equalization, pressure redistribution and positioning.

There are also a number of pressure equalizing and pressure redistribution aids that supplement other preventative measures. Some aids can also reduce friction and moisture, as well as divert heat and enable the patient to move about more easily. They can also reduce shear, which is caused by the person sliding against the bed/chair.

In order for the preventative measures to work, healthcare staff of all levels should have routines in place for the quick identification of risk patients when it comes to the development of pressure ulcers. Ideally, the preventative measures should continue throughout the entire care chain, wherever there is a risk of pressure ulcers.

There are a number of different ways to carry out a risk assessment. In Sweden, the most common assessment instrument is the modified Norton scale. According to this scale, points are awarded to different areas, such as general health, physical activity, mental status, mobility, food intake, fluid intake and incontinence. The maximum number of points is 28, and anyone with 20 points or less is deemed to be in the risk zone for pressure ulcers.

Ideally, the risk assessment should be carried out as soon as the patient arrives at the hospital, nursing home or similar, and should be repeated regularly throughout their stay. That way, you are on top of the risk at all times and can quickly take preventative action as and when necessary.

• A pressure ulcer is tissue damage to the skin that arises due to insufficient blood supply. They can develop throughout the body, but are most common in areas where bone is close to the skin, as the pressure there is concentrated to a small area of skin. Typical areas for pressure ulcers are therefore the sacrum, heels, iliac crests, seat bone and ankles.

• Pressure ulcers often develop from pressure damage, which occurs when a person has been lying or sitting in the same position for a long period of time. This type of pressure damage can arise in the home, during transportation or while staying at or visiting an institution or hospital.

• Eating and drinking poorly is another risk factor in the development of pressure ulcers, as sufficient nutritional intake is necessary for both wound healing and protection from infection.

 

Facts about pressure ulcers

Pressure ulcers are classified according to EPUAP (European Pressure Ulcer Advisory Panel) on a four-grade scale:

Grade I: residual redness, which does not fade under pressure
Grade II: partial skin damage, a shallow open wound
Grade III: full skin damage no ulcer hole
Grade IV: deep full skin damage with ulcer hole and exposed bone, tendon
or muscle tissue

 

SKL’s (Sveriges Kommuner och Landsting) “Pressure ulcers – preventative measures” names the following actions:

  • Assess pressure ulcer risk
  • Assess skin
  • Reduce the pressure
  • Keep skin dry, soft and supple
  • Provide and follow up nutrition and fluid requirements
  • Inform the person and their relatives
  • Inform the next care giver during shift change

 

More information

» A brief version of EPUAP’s international guidelines for pressure ulcer prevention is provided here (PDF)
» Pressure ulcers in Sweden – Research overview and calculation of inpatient care costs (produced by Nordic Health Economics on behalf of Care of Sweden) (PDF)

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