Chronic wounds raise concern all around. Patients with chronic wounds worry about pain, loss of appetite and sleep, and the impact of their wounds on quality of life and ability to socialize. For providers and institutions, facility-acquired pressure injuries are a common and ongoing quality and risk management concern, as well as a financial and legal worry.
Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” This is especially true with prevention of pressure injuries (PIs). To prevent PIs — and ease concern on multiple fronts — consider these tips.
1 Skin Assessment
Starting at admission, perform careful and routine skin inspections. Conduct visual assessments of bony prominences, such as the sacrum, coccyx, buttocks, heels, ischium (especially for chair-bound individuals) and trochanters, elbows and beneath medical devices. Then, continue to monitor bony prominences closely, especially when non-blanchable redness is noted.
To determine skin changes in all patients — regardless of their age and ethnicity — use adequate lighting and compare the temperature of skin on bony prominences to surrounding tissue. Be sure to include in the assessment risk factors such as fragile skin and existing pressure injury.
2 Skin Care
To help reduce the risk of skin cracks, skin tears and pressure injuries, keep skin healthy by using skin moisturizers daily. Also use skin cleansers that are pH balanced for the skin.
To protect high-risk skin, promptly moisturize and use a barrier product with incontinence or when moisture is present from sources such as wound exudate and respiratory secretions. Protect skin around tracheostomy tubes from moisture by using a non-petrolatum-based protectant, such as thin foam dressings or a liquid skin protectant like cyanoacrylate.
Always keep the patient off of areas of redness or other existing skin breakdown. It’s important to use a support surface befitting a patient’s condition and need for microclimate control and comfort.
3 Turning and Repositioning
Set up a schedule for turning and repositioning all individuals at risk for pressure injury. To determine frequency of turning, consider a patient’s medical condition, needs and preferences, as well as existing areas of breakdown and their support surface. Individuals who cannot turn themselves should be repositioned at appropriate intervals, regardless of the surface. Also consider factors not related to skin, such as respiratory, gastrointestinal and genitourinary functions.
- A 30-degree lateral turning position to keep patients off of the sacrum and trochanter
- A pillow or wedge between the knees in a side-lying position to further protect the area
- Heel offloading devices or polyurethane foam dressings on patients at high risk for heel ulcers
Other tips include:
- Assisting in repositioning individuals in bedside chairs or wheelchairs hourly
- Using additional padding and protection for patients undergoing an operative procedure, particularly one lasting more than four hours
- Applying polyurethane foam dressings to protect bony prominences
Hospitalized individuals are at risk for undernutrition and malnutrition. As such, nutrition is a key area of assessment for elderly patients and those whose illnesses cause reduced food intake over time.
A nutritionist consult may be warranted for those at high risk for pressure injury from malnutrition, and nutritional supplements between meals and oral medications may be recommended. Encourage those at risk for pressure to consume adequate fluids and a balanced diet, and assess changes in weight over time.
Educate individuals, as well as families and caregivers, about the risk of pressure injury. Discuss with them the goals of interventions and how they can assist in attaining those goals. Document everything. This includes documenting interventions such as turning and repositioning, as well as support surfaces, skin care and preventive measures. Last, continue to assess and modify the care plan to meet your patients’ changing conditions and needs.