Pressure Ulcer Clinical Analysis

A study conducted over seven years by Amir et al (2011) showed a significant decline of pressure ulcer development after three years of the study. This was partly due to strategies being implemented in regards to repositioning along with adequate nutrition, pressure ulcer prevention information leaflets were given to patients and skin assessments (Amir et al., 2011). It must also be considered that different patients will have different comorbidities and the use of a risk assessment tool is vital to assess and implementing a plan for pressure ulcer prevention according to the patient’s score (Tannen et al., 2010).

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

"A pressure ulcer is a 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, 2007). It is essential to give education to the patients, family, care givers and health care providers to decrease the pressure ulcer rate. Multiple study about pressure ulcer revealed that pressure ulcer causes significant harm to the patients by increasing the length of stay in the hospital due to frequent pain, discomfort, infection and poor healing. The infection and sepsis occur from pressure ulcer can even lead to death. However, pressure ulcers

To start the search for evidence within University Hospital, questions were asked in regards to pressure ulcers. Monthly updates are often sent out via email from the wound care team to keep everyone up to date on knowledge. While there was informative numbers within those updates, this information falls short according to Moore, Webster, & Samuriwo (2015). The main limitation of the study is the lack of a control group in pressure ulcer prevention and treatment. There is no clarity in the specific criterion that contributed to improved clinical outcomes. Teams used more than one method in the research project. Also, there is no study that meant the inclusion criteria in the random clinical trials. The lack of standardized

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

Pressure ulcers are areas of localised damage to the skin and underlying tissue caused by pressure. (Stechmiller et al., 2008) Pressure ulcers still one of the most significant health problem in our hospitals today, It affects on patients quality of life patient self-image and how long they will stay in hospital then the cost of patient treatment . Moore (2005) estimate that it costs a quarter of a million euro’s per annum to manage pressure ulcers in hospital and community settings across Ireland .which allows one to take immediate actions and prevent the ulcer if possible. To support pressure ulcer risk assessment several standardized pressure ulcer risk assessment scales have been introduced

Implementing prevention plan for pressure ulcers would become a marker for a quality of care, which ultimately leads to improvement of quality by making healthcare more reliable, accessible, patient-centered and safe. As a part of the pressure ulcer prevention plan effort, one should regularly assess the pressure ulcer rates and practices. Steps to regularly monitor are: An outcome which can be pressure ulcer prevalence or incidence rates. Minimum one to two care processes (ex: skin assessment). Key aspects of the organizational structure to support best care practices. Below are the steps that will help to develop processes and measures for assessing pressure ulcer and practices.

A pressure ulcer is a localized injury to the skin usually over bony prominence, as a result of pressure, or pressure in combination with shear. It is estimated that 5 to 10 percent of patient admitted to the hospital acquire a pressure ulcer and it result in increased suffering, morbidity and mortality. The policy titled Pressure Ulcer Prevention and Managing Skin integrity provides direction for the nurses to prevent the development of pressure ulcer. It

Each articles made the purpose of the article clear and emphases on the pressure ulcer risk factors and importance of prevention and management. Pressure ulcers once were considered an accepted evil that accompanied any prolonged hospital stay. Despite pressure ulcers being recognized as a largely preventable adverse event, they remain a major problem for patients in all health care settings and can lead to increased morbidity particularly for the chronically ill and the elderly. In some instances, pressure ulcers are complicated by infection, patient deterioration and even death if strategies are not implemented early in patients identified at risk. Performance improvement data can serve as a rich medium for the creation, development, and

Furthermore, elderly people have very fragile skin—thinner and lack elasticity; making it very easy for them to get pressure ulcers. In skilled care and nursing home-type facilities, prevalence of pressure ulcers has been shown to range from 2.4 to 23 percent. These data are particularly difficult to generalize to other similar facilities; however, because of the highly variable ulcers increases with length of stay (Bergstrom, Allman, Carlson, Eaglestein, Frantz & Garber,

Preventing pressure ulcers in an acute care or a critical care situation can be challenging for nursing staff. Pressure ulcers cause an increase in morbidity and mortality, along with very high cost for the hospitals. Treatment cost average $11 billion per year in the United States. (Skolnik M.D. & Carcia, D.O., 2015) They cause patient pain and are preventable by all nursing staff. “The skin is the body’s largest organ and the first line of defense against the internal and external environment, and it plays an important part in maintaining health.” (Brunner et al., 2012) For adult patients does the use of a skin care products reduce the risk of pressure ulcers compared to those patients using no skin care

A weakness within the study was the authors inability to use 40.8% of hospital patients participation in the pain prevalence study, this was due to illness, difficulty of assessment or patients were unavailable either off the floor 24%, or in isolation (Briggs, et al., 2013). Another strength within the study was the authors decision to use the 1998 European Pressure Ulcer Advisory Panel classification (EPUAP), the reason for this was that the updated version for 2009 was not being used at the participating hospitals, and this classification was familiar with the staff doing the skin assessments, allowing for all participating hospitals to have the same standards of skin classification in place (Briggs, et al.,

The largest organ of our body is our skin, and it can be very fragile as we age. However, medications, tanning, and illness can all play a part in the skin thinning as well. I believe education is the key to understanding the prevention of pressure ulcers. Hospital patients are at a higher risk for developing a pressure ulcer. All hospital patients should be screened on admission to see if they are at risk for developing a pressure ulcer. Patients that have pressure ulcers can have pain and discomfort at the sight. Many factors contribute to the development of a pressure ulcer. One would think it was just from not being turned every two hours. However, every patient is at risk for a pressure ulcer when they cannot move or change their position

Some of the problems we learned that could be encountered in reducing hospital acquired pressure ulcers is when dealing with patients who have diseases like diabetes mellitus, obesity, corticosteroids, coronary artery disease, renal disease. We learn that elderly people are the most prone to pressure ulcers because of their skin changes associated with aging, some of them have two or three chronic medical conditions at the same time; their decreased nutritional status, their mobility conditions, their ability to be aroused and respond to stimuli from their environment, tissue perfusion, frictional force and shear, and exposure to moisture (Plácido de Brito, Ferreira de Oliveira, Costa, Barros, & Dias, 2016). Also patients who are overweight and are immobile as a result can also be problematic in reducing HAPUs. Another problem we learned that can be encountered in trying to reduce hospital acquired pressure ulcers is inadequate staffing, lack of motivation, and not adequately educating the staff.

The assessment of the skin is no different and just as important. The Braden scale evaluates the patient’s sensory perception, moisture, activity, mobility, nutrition, friction and shear. After the evaluation of these aspects, a score is given in relation to the risk that the patient is at for developing a pressure ulcer. The Braden scale is the highest predictive tool used to assess the patient’s skin integrity (Yatabe, Saito, & Ishida, 2011). According to Mallah, Nassar, Badr (2015), the sensitivity of the Braden scale in predicting a hospital-acquired pressure ulcers was 92.30%. Following the assessment, appropriate interventions can be initiated. The patients who are most at risk for developing pressure ulcers are unable to effectively reposition themselves or are not able to provide the sensory feedback needed (which is assessed on the Braden scale). With the loss of mobility and sensation, the patients need assistance in distributing their weight (Sprigle & Sonenblum, 2011). Sprigle and Sonenblum (2011) also show a study that indicates the importance of turning patients every two hours. A study concluded that redness and oxygen reduction while lying in bed can occur in less than two hours. The use of specialty beds, sheets, and redistribution devices are shown to significantly reduce the incidences or pressure ulcers. Tools such as Mepilex