Pressure Ulcer Prevention

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

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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

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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.

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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.

Cheryl Carver's picture
fat grafting for pressure injuries

By Cheryl Carver LPN, WCC, CWCA, CWCP, FACCWS, DAPWCA, CLTC

This month's blog topic idea came about from a recent conversation with a middle-aged patient with paraplegia. She had a stage 4 pressure injury due to being in her wheelchair long hours, along with a low BMI. I made the comment, "I wish I could give you a fat transplant." She laughed. She then asked, "Well, why not?" Later that day the topic of fat grafting popped up on social media in a spinal cord injury group I follow. I ended up chatting with a few spinal cord injury folks that were serious about coming up with funds to get fat grafting done. They all had a fear of, or a previous history of pressure injuries. These folks with past pressure injuries had used advanced wound care dressings, support surfaces, high-end cushions, supplements, negative pressure wound therapy, a slew of antibiotics, and even flap closures.

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Holly Hovan's picture
wound care education

By Holly Hovan MSN, APRN, ACNS-BC, CWON-AP

As a wound, ostomy, and continence nurse in long-term care, education is a huge part of my role working in our Community Living Center (CLC), Hospice, and Transitional Care Unit (TCU). Unit specific, evidence-based training and continued follow-up are integral to the success of our pressure injury prevention program. The unit-based skin care nurses (UBSCNs) are at the frontline of prevention, along with all nursing staff, especially nursing assistants (NAs).

Janet Wolfson's picture
preventing-pressure-injuries

By Janet Wolfson PT, CLWT, CWS, CLT-LANA

As I read through wound care articles on pressure injuries and treatments, I keep going back to one thought: why are they still occurring? They are preventable! Staff are educated, have certifications and equipment, and have been oriented on policy to prevent pressure injuries. I think it comes down to opportunities and choices.

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Cheryl Carver's picture
Managing shear and pressure in preventing pressure injuries

By Cheryl Carver LPN, WCC, CWCA, CWCP, FACCWS, DAPWCA, CLTC

Let us start off this post with a typical scenario. You walk into any facility or institution and you see a patient slouched in their wheelchair, with no wheelchair cushion. You notice part of their brief hanging out of the top of their pants, so you assume the patient may be incontinent. So let’s think about this for a minute. We most likely have friction, shear, and moisture going on with this patient.

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