Pressure Ulcers among the Elderly Population PUs are considered a common and frustrating problem affecting geriatric patients. Frailty, comorbidities, impaired mobility and cognitive dysfunction are common problems found in the elderly population, predisposing them to the development of these ulcers. PUs usually occurs when a bony prominence is in contact with a surface for prolonged time periods (Buffel, 2015). The prevalence of PUs is high in older population, peaking in those between age 70 and 80 years. These ulcers usually occur in hospitals, nursing homes, and community settings, their prevalence ranging from 1.2% to 11.2%. The highest incidence of new ulcers occurs in hospitals, but the highest prevalence of ulcers occurs in long-term care facilities. The …show more content…
The cost of treating PUs in the United Kingdom (UK) fluctuates from £1.4- £2.1 billion annually and accounts for 4% of the total National Health Service (NHS) expenditure (Cooper, 2013). Since the first classification system for Pressure ulcer, developed by Shea (1975), other systems had been developed to describe the different degrees of tissue damage, with varying numbers for stages ranging from a 0- to 5-stage classification to a 1- to 7-grade classification (Witkowski & Parish 1981, Dealey & Lindholm 2006). In the United States of America, the National Pressure Ulcer Advisory Panel (NPUAP) developed in 1989 a pressure ulcer classification using 4 grades. This classification later was adopted by the European Pressure Ulcer Advisory Panel (EPUAP) in 1999 with some minor changes (Defloor & Schoon- hoven 2004). The purpose of this classification system is to standardize record-keeping and provide a common description of pressure ulcer severity for the purposes of clinical practice, audit and research (Nixon et al.
Evidence suggests that pressure ulcers greatly increase mortality rates in both hospitals and nursing homes (Thomas, 2001). Patients who develop a pressure ulcer within six weeks of admission to an acute-care facility are three times more likely to die than patients who do not develop pressure ulcers (Thomas, 2001). Moreover, patients who develop a pressure ulcer within three months of admission to a long-term care facility are associated with a 92% mortality rate compared with a 4% mortality rate for patients who do not develop them (Thomas, 2001). This evidence alone shows how significant this problem is to the overall health status of patients. In my personal nursing experience, I have heard many complaints voiced from patients and their family members concerning the development of new pressure ulcers. Patients and family members have expressed dissatisfaction because of the increased stress and prolonged hospital stay often associated with the treatment of pressure ulcers.
The research article "What influences the impact of pressure ulcers on health-related quality of life? A qualitative patient-focused exploration of contributory factors" was recently published (2012) in the Journal of Tissue Viability by Gorecki, Nixon, Madill, Firth, and Brown. This is a qualitative study.
Although the situation was quite challenging, it provided me with some useful experiences for the future practice. I understand that all institutions should have a policy for documenting the assessment of patients, including pressure ulcers (Morison 2001). I have come to be familiar with the homes assessment policy using the Sterling Pressure Sore Severity Scale and most importantly I have learned that by using a universal assessment tool it supports a systemic and consistent approach to pressure ulcer evaluation. This therefore supporting continuity of care.
Outcome 1: Understand the anatomy and physiology of the skin in relation to pressure area care
Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of
Nurses need to realise what they are looking for when performing skin assessments for patients. A study conducted by Thoroddsen et al (2013), found that out of 45 patients that had pressure ulcers only 27 were correctly recorded in the patient’s records.
Thus, the expected outcome is that there is prevention of skin breakdown relating to pressure ulcers during hospitalizations for patients.
While University Hospital is already on the brink of completely preventing pressure ulcers I would still recommend implementing all of the current practices but also add new additions to the team. Currently, we have a wound care team that diligently treats at risk and affected patients. Adding a nutritionist into the team to guarantee treatment from within along with prescribed medications. This will make the team and the strategies multidisciplinary. In addition to that, each treatment should be customized for each patient in regards to cost options and best treatment for their health. The project would also have to be performed repetitively without error to ensure that it is actually helpful. Patients’ skin should continue to be examined thoroughly in common places where ulcers could arise, the standardized pressure ulcer risk assessment should be used, and the proper care should be distributed once evaluated. The team should continue to record its progress and also provide company update emails to inform the facility, as well as send the appropriate data to the higher ups for public posting.
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).
A home health nurse knows that a 70-year-old male client who is convalescing at home following a hip replacement, is at risk for developing decubitus ulcers. Which physical characteristic of aging contributes to such a risk?
Despite advancement of technology, pressure ulcer continues to be a primordial in the health care system. Prevention of pressure ulcer remains an important issue in the health care facility. The critically ill ICU patient is the main target of this disease. Prevention remains the key for this problem. Some facility have standard policy for the eradication of pressure ulcer However the question is will the sacrum pressure ulcer formation be reduced in adult critically ill clients
According to Agency for Healthcare Research and Quality (AHRQ), 90% of all pressure ulcer related hospitalizations are due to secondary pressure ulcer diagnosis, 72% of patients are 65years or older and about 60,000 patients die each year as a result of a pressure ulcer. Some states legislation has declared secondary pressure ulcer as elderly abuse not covered by malpractice insurance. Fluid and
20). Further, the presence of pressure ulcers places a burden on patients and their family (Grinspun, 2005, p.21). As recommended by Grinspun (2005), pillows and foam wedges to separate prominences of the body and lifting devices have been beneficial to avoid friction (p. 32). Research suggests that the majority of pressure ulcers can be avoided. Although, the population at risk likely suffers from the possible contributors, as stated repositioning at least every 2 hours or sooner was effective (Grinspun, 2005, p. 32). When practicing I will reposition patients at appropriate times to reduce the risk of damage to the skin. Additionally, when moving a patient up in bed, I will request adequate assistance from other nursing staff to use a lifting device. This will help to avoid friction while the patient is being moved, ultimately reducing the development of pressure
Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure
The INTACT trial showed a significant reduction in pressure ulcers (PU) incidence in the intervention group at the hospital (cluster) level, but this difference was not significant at the