Those working with at-risk populations must be aware of how to address the skin care needs of our patients and prevent pressure ulcers and injuries. At-risk populations, such as older adults, persons who are incontinent, pediatric patients, immobile patients, post-operative patients, and those with chronic disease processes and spinal injuries, for example, are most at risk for developing pressure ulcers. Those patients who have comorbidities such as obesity, diabetes, and cardiovascular disease are at additional risk.
Pressure ulcers are a key concern in health care and have a variety of contributing factors. It is essential that caregivers are aware of how pressure ulcers occur, as well as how to manage the skin of persons at risk of developing these ulcers. This blog covers skin management of patients at risk, assessment guidelines, and therapeutic interventions.
It is important to know that in persons at very high risk, such as a recent motor vehicle accident victim who is on vasopressors in the intensive care unit, skin complications may be inevitable. In these situations, caregivers must choose what the priority is, and occasionally skin integrity is of less importance than the patient’s spinal alignment or cardiac output. These patients may be moved less often, and sometimes only out of necessity, until they are cleared by a computed tomography scan and can handle changes in movement without aggravating or causing strain on the heart.
There are those who are at the end of life, and these patients should be evaluated using the SCALE system.
Although there are a few guidelines available, such as the Norton Scale and the Braden Scale for Predicting Pressure Sore Risk (Braden Scale), in most facilities you will find the Braden Scale commonly used. Using the assessment tool is important for consistency among staff. Yet, it has been proven that the use of the scale is beneficial only if it is paired with the prevention techniques outlined by the National Pressure Ulcer Advisory Panel (NPUAP) and Wound, Ostomy and Continence Nurses Society (WOCN).
Assessment should be completed on all admitted patients, during every shift (every eight hours is recommended), and with any changes in mobility or medical conditions. The Braden Scale includes evaluation of sensory perception, moisture, activity, mobility, nutrition, and friction, with a higher score indicating a lower risk.
Particular areas of attention are evaluation of skin temperature, color, moisture level, turgor, and integrity of the area, which includes open areas and intact skin. The assessment should be all inclusive, from head to toe. Anatomic structures and medical devices to consider in the assessment are bony prominences, including the often missed occiput and elbows, the sacral and perineal area, oxygen tubing, and the back of the head for infants. Essentially, any area that touches the bed, tubes, or equipment should be evaluated for pressure.
There are many techniques that have proven to be best practices over time. Organizations such as the NPUAP and WOCN have published guidelines on how to prevent skin breakdown in patients who are compromised. Prevention of pressure ulcers includes many interventions, including but not limited, to:
Dilligence in preventing skin care–related conditions, such as incontinence-associated dermatitis and pressure ulcers, is an important component of the patient’s care plan. All members of the health care team should be educated and kept accountable for their actions in preventing these occurrences. Documenting changes and the time of assessment and possibly taking secure photographs for the electronic medical record are important in the chronological order of documentation. Being aware of best practices for managing those patients at risk for skin breakdown is the responsibly of all caregivers.
Haesler E, ed. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Perth, Australia: Cambridge Media; 2014.
Wound, Ostomy and Continence Nurses Society. Guideline for Prevention and Management of Pressure Ulcers (Injuries). WOCN Clinical Practice Guideline Series 2. Mt. Laurel, NJ: Wound, Ostomy and Continence Nurses Society; 2016.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.