The Risks and Prevention 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.

Treatment of a pressure ulcer costs the NHS more than £3.8 million, despite the progress and management of pressure ulcers 700,000 people are still affected this remains to be a significant problem for health care professionals (NHS Improvement, 2016). Therefore, this case study will enumerate the cause, treatment, prevention and risk factors of a pressure ulcer in relation to a patient who is suffering from a grade three-pressure ulcer to his sacrum and therefore requires long-term care from the district nurses. Pressure ulcers can occur more commonly on the sacrum or heels in any health care settings (Clarkson, 2007). Although more prevalent in the elderly, people of all ages are at risk of developing a pressure ulcer

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.

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

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

Pressure ulcers that occur in the long term care setting are increasing in the number of incidences each year in the United States. Consequences and complications of pressure ulcer development include pain, sepsis, cellulitis, bone, and joint infections. Pressure ulcers are also associated with an increased morbidity and mortality rate, negative emotional and physical effects on patients and caregivers, and are the second leading cause of litigation in long term care facilities. The cost of treatment for pressure ulcers in the United States is estimated at 11 billion dollars annually. This has led to many programs that focus on education and intervention to prevent the development of pressure ulcers, even being addressed in public initiatives such as Healthy People 2010. Appropriate information and education for healthcare providers, patients, and families has proven to be a key factor in the prevention of pressure ulcer development. Wound management is an area of healthcare that must include a comprehensive plan for the best outcome. A care plan that includes a well-educated care team composed of various disciplines working together for holistic care of each patient has seen the best results for patients who suffer from pressure ulcers.

Pressure ulcer or bedsores as it is called is commonly referred to as very prevalent among high-risk patients, especially those confirm to hospital or long-term care setting. These individuals may be adults, elderly, frail, poorly nourished, and with comorbid illness. The objective of this assignment Is to Provide Awareness to my PICOT question which will be a quantitative research and will be supported by evidence-based research and obtained by systematic review from many database searches.

In 2008, the Centers for Medicare and Medicaid Services (CMS) announced that they would not be paying for any additional cost incurred for hospital-acquired pressure ulcers (Cooper, 2013). Pressure ulcers continue to be problem for health care organizations, despite their aggressive move to eliminate them in the health care setting. Furthermore, the acute care units pressure ulcers occurrences continues to be one of the most underrated problem that has a major impact on patient outcomes as well as reimbursement of care. Acute care patients are at a higher risk for developing pressure ulcers than other patients within the hospital. Primarily due to the fact that patients are hemodynamically unstable, from the use of vasopressors, the use of life saving devices, population age and other health issues. Health care must continue to place emphasis on the prevention of pressure ulcers in order to reduce co-morbidities and ensuing costs. The aim of this paper is to discuss the cost of pressure ulcers, multiple risk factors associated with the development of pressure ulcers, to show one acute care unit’s current practices to decrease pressure ulcers, look at evidence-based interventions, then to propose a change in current practice to reduce the number of pressure ulcers.

Furthermore, another factor creating a risk for pressure ulcer development is malnutrition. Wysocki (2002) observed that 10 to 50% of hospitalized patients are malnourished. Nurses should be alert to inadequate nutrition and its effects. Also, Cobb and Warner (2004) noted that when thirty percent of weight is lost, spontaneous pressure ulcers begin to develop, and prevention strategies might not work. In addition, urinary and fecal incontinence are also significant risk factors. Incontinence results in excess moisture, and irritation of the skin. The nurses and assistive personnel in XY hospital often do not assist their incontinent patients for long periods of time, and they do not utilize the available skin protectants. Studies confirmed the effectiveness of no-rinse cleansers and moisture barrier creams, and found that they were less likely to harm skin integrity than soap and water (Thompson, et al., 2005). The findings also advise that checking the patients for soiling every two hours adds to the effectiveness. Although not all pressure ulcers are preventable and curable, the literature provides supportive evidence that appropriate prevention protocols decrease the incidence of stage one and two

According The Joint Commission pressure ulcers continue to be a problem across all health care settings. Approximately three million adults in the United States are affected by pressure ulcers, and up to eleven billion dollars are spent annually on their treatment (Qaseem, 2015). One of the national patient safety goals which The Joint Commission established was to assess every patient for the risk of developing pressure ulcers and to take appropriate action to treat any identified risk. This patient assessment can be achieved by utilizing the assessment tool such as the Braden Scale (National Patient Safety Goals, 2015). The Braden Scale assesses six areas: sensory perception, moisture, activity, mobility, nutrition, and friction or shear.

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

Jaul, E. (2010). Assessment and management of pressure ulcers in the elderly: current strategies. Drugs & Aging, (4), 311.

This qualitative study by Gorecki, Nixon, Madill, Firth, and Brown (2012) was conducted to ascertain the health-related quality of life (HRQL) as an important and relevant outcome in patients suffering pressure ulceration and the various factors that affect it. Pressure ulcers (PUs) are areas of necrosis and ulceration where tissues are compressed between bony prominences and hard surfaces.

Pressure Ulcers affects patients the older patients due to the problem of immobility. A pressure