Pressure Ulcer Prevention

Heidi Cross's picture
Turning and Positioning

by Heidi H. Cross, MSN, RN, FNP-BC, CWON

Failure to T&P (turn and position) is always part and parcel of a pressure ulcer lawsuit and a key element of a complaint related to pressure ulcers, as illustrated in the opening quotation. T&P documentation is a dominant focus in chart analysis and is usually one of the first things that an attorney and the expert witness look for. If T&P documentation is satisfactory, the defendant is likely to prevail; if not, then the plaintiff may have a pretty rock-solid case. But as I have opined in previous blogs, is there such a thing as perfect documentation? Alas...NO! (Or at least, rarely.)

Blog Category: 
Susan Cleveland's picture
Support Surfaces for Special Populations

By Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

Part 2 in a two-part series looking at the basics of correctly using support surfaces to help redistribute pressure. Read Part 1 here.

Blog Category: 
Susan Cleveland's picture
Support Surfaces

By Susan Cleveland, BSN, RN, WCC, CDP, NADONA Board Secretary

Part 1 in a two-part series looking at the basics of correctly using support surfaces to help redistribute pressure. Read Part 2 here.

Blog Category: 
Aletha Tippett MD's picture
Pressure Ulcer Prevention

by Aletha Tippett MD

How do you prevent pressure ulcers? This is an interesting question and one that eludes many. Currently, I am involved in reviewing research proposals to prevent pressure ulcers (injuries). The funny thing is that there is nothing new. Everyone is using the same known techniques, just trying different forms. However, there is a proven way to prevent pressure ulcers and it was done years ago in a Cincinnati nursing home I was working in without any fanfare. The results from this nursing home wound care program were even published.1

Blog Category: 
Holly Hovan's picture
patient mobility and activity

By Holly Hovan MSN, APRN, CWOCN-AP

The Braden Scale for Predicting Pressure Sore Risk® category of activity focuses on how much (or how little) the resident can move independently. A resident can score from 1 to 4 in this category, 1 being bedfast and 4 being no real limitations. It is important to keep in mind that residents who are chairfast or bedfast are almost always at risk for skin breakdown

Blog Category: 
Holly Hovan's picture
enteral nutrition feeding

By Holly Hovan MSN, APRN, CWOCN-AP

A common misconception by nurses is sometimes predicting nutritional status based on a resident's weight. Weight is not always a good predictor of nutritional status. Nutritional status is determined by many factors and by looking at the big picture.

Blog Category: 
Holly Hovan's picture
Moisture on Skin

By Holly Hovan MSN, APRN, CWOCN-AP

When nurses hear the term moisture, they usually almost always think of urinary or fecal incontinence, or both. There are actually several other reasons why a patient could be moist. Continued moisture breaks down the skin, especially when the pH of the aggravating agent is lower (urine, stomach contents—think fistula, stool). When there is too much moisture in contact with our skin for too long, we become vulnerable to this moisture, and our skin breaks down. Increased moisture places a patient at risk for a pressure injury as the skin is already in a fragile state.

Holly Hovan's picture
neuropathy testing for sensory perception (Braden Scale)

By Holly Hovan MSN, APRN, CWOCN-AP

As wound care professionals, the Braden Scale for Predicting Pressure Sore Risk® is near and dear to our hearts. With that in mind, our evidence-based tool needs to be used correctly in order to yield accurate results. Working with long-term care and geriatric populations opens up a world of multiple pre-existing comorbidities and risk factors that aren’t always explicitly written into the Braden Scale categories. Additionally, the frequency of the Braden Scale may also contribute to a multitude of different scores; the resident behaves differently on different shifts, for example, asleep on night shift but up and about on days. What is the correct way to score them? I believe that a less frequent Braden Scale assessment yields more accurate results. However, we should still complete a Braden Scale on admission, transfer, receiving, and most importantly, with any change in condition.