Pressure Ulcer/Injury Risk Assessment Using a Whole Patient Approach

Introduction

Prevention of Pressure Ulcer/Injury is aimed at the “whole” patient, with a focus on positive outcomes as well as maintaining skin integrity. Your patient is captured as a person and their Pressure Injury risk is identified. Preventing pressure ulcers and pressure injuries should be a priority for all caregivers. We can use every risk assessment and tool available, but if we don’t educate our patients, healthcare professionals, and caregivers, a preventative program won’t work. Pressure Injury/Ulcer prevalence can occur with patients of any age, weight, and in any type of setting. When people hear the terms “Pressure Ulcer,” “Pressure Injury,” “Sore,” “Decubiti,” and “Bedsore,” they automatically assume that nursing homes are to blame. In our work as healthcare providers, we’re often preoccupied with the particular populations of patients we serve. Most pressure ulcers and injuries can be avoided.  

Plan Out Your Risk Management Strategy

Structured preventative measures can be achieved by developing policies and processes on pressure injury prevention, as well as treatment. Pressure Ulcer/Injury risk may only be accurately predicted by using a reliable risk assessment tool, such as the Braden Scale or the Pressure Ulcer Scale for Healing (PUSH). There is a wide variation in the risk assessment tools and the frequency with which they are employed in different healthcare settings. With each MDS 3.0 evaluation, long-term care institutions may screen for pressure ulcers/injuries. As a case in point: 

Verify Your Process of Risk Assessment

Pressure Ulcers/Injuries can be prevented and treated with an algorithm in your facility. To help you evaluate your risk assessment process, here are some questions you should ask yourself:

  • For patients at low, moderate, and high risk of pressure injury/ulcer, do you have immediate interventions in place that can be implemented immediately
  • Does your facility have the proper equipment to implement, like re-distribution mattresses, heel-offloading devices, and other equipment for bariatric patients?
  • Patients who are wearing medical gadgets should follow a specific routine, right? High-risk individuals should be viewed as the norm.
  • Does your facility perform skin inspections on a daily, weekly, or monthly basis?

The Focus on the Risk Assessment Tool

  • Consider everyone high risk. Prevention goes a long way. 
  • When a person is unable to move freely (e.g. while lying in bed or sitting in a chair), assistance with turning and positioning, as well as ambulation and weight transfer is necessary (preventive, redistributing) to ensure proper seating height and posture (risk of friction or shear) by inspecting the seat cushions
  • Examine the bed and chair for signs of “bottoming out.”
  • Toileting program -spot checks every two hours -incontinence care procedure. Incontinence and moisture (barrier, sealant creams) uncover the root cause of incontinence.
  • Nutritional deficiencies (malnutrition, eating difficulties) -encourage fluids -Dietician advice as needed. Nutritional supplements (multivitamins, protein) and support with feeding.
  • Alteration in tissue tolerance, inadequate perfusion, and impaired sensory perception.
  • Offload bony prominences after checking medical devices every two hours.
  • A well-balanced diet and regular skin moisturizing are important for those who are older.
  • Use multimodal communication wherever possible to improve your ability to communicate (speech, gestures, technology devices, take the extra time to listen)
  • Conditions that are related to one another (diabetes mellitus, peripheral vascular disease, malnutrition, dementia, obesity, etc.)
  • Passive range of motion and splinting are both examples of contractures (check medical device every 2 hours)
  • A few examples of these are binders, identification bands, oxygen masks, and cannulas, anti-embolic stockings and hoses, fecal management tubes, negative pressure wound therapy tubing, restraints, and bedpans, as well as medical devices such as these: casts, splints, braces, binders, bindings, identification bands.

Conclusion

The development of a pressure ulcer or injury can be slowed or perhaps prevented if we are proactive in our assessments. Patients’ outcomes, complications can all be improved by healthcare practitioners. Engage in collaborative planning of treatment by listening carefully to your patients. The ultimate goal is to eliminate all instances of pressure injury or ulcer.

Disclaimer

The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.

 

Future Reading and References

A Clinical Guide to Pressure Injury Risk Assessment & Prevention https://pages.woundsource.com/a-clinical-guide-to-pressure-injury-risk-assessment-prevention/

CMS MDS 3.0 RAI Manual. Centers for Medicare & Medicaid Services. https://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityinits/MDS30RAIManual.html.  Accessed September 21, 2018.

Pressure Injury Prevention Points. The National Pressure Ulcer Advisory Panel. http://www.npuap.org/wp-content/uploads/2016/04/Pressure-Injury-Prevention-Points-2016-pdf. Published April 2016. Accessed September 21, 2018.

Preventing Pressure Ulcers in Hospitals.  A Toolkit for Improving Quality of Care https://www.ahrq.gov/sites/default/files/publications/files/putoolkit.pdf

EPUAP, NPUAP, Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline. 2014.

 

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