Here are highlights of pressure ulcer guideline
Best practices in skin care, treatment
The following are highlights from Pressure Ulcers in Adults: Prediction and Prevention, a clinical guideline published by the Agency for Health Care Policy and Research in Silver Spring, MD:
Skin care and early treatment
All individuals at risk should have a systematic skin inspection at least once a day, paying particular attention to bony prominences. Results of skin inspection should be documented.
Skin should be cleansed at the time of soiling and at routine intervals. The frequency of skin cleansing should be individualized according to need and/or patient preference. Avoid hot water and use a mild cleansing agent that minimizes irritation and dryness of the skin. During cleansing, care should be used to minimize the force and friction applied to the skin.
Minimize environmental factors leading to skin drying, such as low humidity (less than 40%) and exposure to cold. Dry skin should be treated with moisturizers.
Avoid massage over bony prominences.
Minimize skin exposure to moisture due to incontinence, perspiration, or wound drainage.
Skin injury due to friction and shear forces should be minimized through proper positioning, transferring, and turning techniques. Friction injuries may be reduced by the use of lubricants, protective films, protective dressings, and protective padding.
When apparently well-nourished individu-als develop an inadequate dietary intake of protein or calories, caregivers should first attempt to discover the factors compromi-sing intake and offer support with eating. Nutritional supplements or support may be needed. For nutritionally compromised individuals, a plan of nutritional support and/or supplementation should be implemented.
Mechanical loading and support surfaces
Any individual in bed who is assessed to be at risk for developing pressure ulcers should be repositioned at least every two hours if consistent with overall patient goals.
For individuals in bed, positioning devices such as pillows or foam wedges should be used to keep bony prominences from direct contact with one another.
Maintain the head of the bed at the lowest degree of elevation consistent with medical conditions and other restrictions. Limit the amount of time the head of the bed is elevated.
Use lifting devices such as a trapeze or bed linen to move (rather than drag) individuals in bed who cannot assist during transfers and position changes.
Any individual assessed to be at risk for developing pressure ulcers should be placed when lying in bed on a pressure-reducing device, such as foam, static air, alternating air, gel, or water mattresses.
For chairbound individuals, use a pressure-reducing device. Do not use donut-type devices.
Education
Educational programs for the prevention of pressure ulcers should be structured, organized, comprehensive, and directed at all levels of health care providers, patients, and family caregivers.
The educational program for prevention of pressure ulcers should include information on the following items:
the etiology and risk factors of pressure ulcers;
risk assessment tools and their application;
skin assessment;
selection and/or use of support surfaces;
development and implementation of an individualized program of skin care;
demonstration of positioning to decrease risk of tissue breakdown;
instruction on accurate documentation of pertinent information.
The educational program should identify those persons responsible for pressure ulcer prevention, describe each person’s role, and be appropriate to the audience in terms of level of information presented and expected participation.
[Editor’s note: For a copy of the Agency for Health Policy and Research guideline, contact the AHCPR at (800) 358-9295 or write to the AHCPR Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907. Complete Guideline: Publication No. 92-0050. Patient Guide: Publication No. 92-0048.]
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