Positioning and Mobilization. Immobility can be a big factor in causing pressure injuries. Immobility can be due to several factors, such as age, general poor health condition, sedation, paralysis, and coma. Monitoring, Training and Leadership Support. In any type of process improvement or initiative, implementation will be difficult without the right training, monitoring and leadership support.

Reddy M, et al. Treatment of pressure ulcers: A systematic review. The Journal of the American Medical Association. Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. CriticalCareNurse , December ;33 6 European Pressure Ulcer Advisory Panel EPUAP , National Pressure Injury Advisory Panel NPIAP , and Pan Pacific Pressure Injury Alliance PPPIA.

The International Guideline. National Pressure Injury Advisory Panel NPIAP. NPIAP Pressure Injury Stages. Lyder CH and Ayello EA. Chapter 12; Pressure Ulcers: A Patient Safety Issue.

National Center for Biotechnology Information, U. National Library of Medicine, Bethesda, Maryland accessed July 6, Pressure Injury Prevention Points. Bedsores pressure sores.

Mayo Clinic. The Joint Commission. Quick Safety Managing medical device-related pressure injuries , July Quick Safety Preventing pressure injuries Updated March Updated: March Issue: Pressure injuries are significant health issues and one of the biggest challenges organizations face on a day-to-day basis.

Provides recommendations on approaches to measuring and reporting pressure injury rates. Applies to all clinical settings, including acute care, rehabilitation care, long term care, and assistive living at home, and can be used by health professionals, patient consumers and informal caregivers.

Includes guidance for population groups with additional needs, including those in palliative care, critical care, community, or operating room settings, individuals with obesity, individuals with spinal cord injury, and neonates and children.

Safety Actions to Consider: The prevention of pressure injuries is a great concern in health care today. Use a structured risk assessment tool to identify patients at risk as early as possible. Refine the assessment by identifying other risk factors, including existing pressure injuries and other diseases, such as diabetes and vascular problems.

Repeat the assessment on a regular basis and address changes as needed. SKU: D Format: DVD. Duration: 22 minute video in 6 sections to be used in a suggested 3 hour training session. Consultant: Trudie Young, RMN, RGN, Dip N, BN, MSc, Lecturer in Tissue Viability, University of Wales.

Supporting Materials: Contains a Lesson plan, Handouts, Question and Answer sheets and a CPD Accredited Certificate. Peer Review: Wirral Hospital Trust. Current Stock:. Quantity: Decrease Quantity: Increase Quantity:.

Product Overview Pressure ulcers are potentially avoidable if carers have the correct understanding about their causes and how they can be prevented.

Subjects covered include: How do Pressure Ulcers Occur? Related Products. Together they form a unique fingerprint. View full fingerprint. Cite this APA Standard Harvard Vancouver Author BIBTEX RIS Black, J. Ceska a Slovenska Neurologie a Neurochirurgie , 78 , SS In: Ceska a Slovenska Neurologie a Neurochirurgie , Vol.

Black, J , ' Implementation of Pressure Ulcer Prevention Guidelines - Where to Start? Black J. Ceska a Slovenska Neurologie a Neurochirurgie. doi: Black, J.

The questionnaire and the consent form were prepared in English. Participants were asked 22 knowledge based and 22 practice based questions to assess their level of knowledge and practice towards prevention of pressure ulcer.

Four midwife nurses and Public Health Officers collected the data with close supervision. Data quality was controlled by giving trainings and appropriate supervisions for data collectors.

The overall supervision was carried out by the principal investigator. Appropriate modifications were made after analyzing the pretest result before the actual data collection. The appropriateness of the instrument was measured through a pre-testing exercise, and the constraining factors were rectified.

Prior to applying the survey instrument, the researchers engaged different expert reviewers as subject matter specialists at Gondar University Hospital to evaluate and finalize the instrument.

a lesion of skin or underlying tissues by direct unrelieved pressure for more than 3 hours on the skin. Nurses, who scored above the mean score of the knowledge questions, were considered as having good knowledge on pressure ulcer prevention.

But in the contrarily, those scored below the mean value considered as having poor knowledge towards prevention of pressure ulcer. Nurses who scored above the mean score of the practice questions related to prevention of pressure ulcer were considered to have good practice.

But in the contrarily, those who scored below the mean score were considered as having poor practice towards prevention of pressure ulcer.

The questionnaires filled by the nurses were checked for completeness and entered into EPI INFO version 3. Both bivariate and multivariate logistic regression models were used to identify associated factors.

Ethical clearance was obtained from University of Gondar, Ethical Review Committee of Department of Nursing. A formal letter of cooperation was written to Gondar University Hospital. After the purpose and objective of the study had informed, verbal consent was obtained from each study participant.

Data were kept anonymously in the distributed questionnaire in order to keep confidentiality. Out of the expected respondents, agreed to participate in the study, yielding a response rate of The mean age of the respondents was Around half Nearly half of them Most Majority More than half of the nurses More than three quarter While Less than half Participants were asked 22 questions to assess their knowledge on pressure ulcer prevention, and they were categorized in to two groups based on their score in relation to the mean.

The mean score was More than half From the six dimensions of knowledge regarding prevention of pressure ulcer, the nurses had a poor knowledge on three including risk assessment, skin care and management for mechanical loads. By using 22 practice based questions, the mean practice score of the respondents was found to be Those nurses who had bachelor degree were 2.

Nurses who had work experience of years were 4. Those nurses who had formal training about pressure ulcer were 4. Prevention of pressure ulcers is an indicator of quality of care. Nursing care has a major effect on pressure ulcer development and prevention.

Hence, Pressure ulcers are a major nurse-sensitive outcome [ 16 ]. In this study, While substantial proportions Because, as they are nurses working in recognized teaching referral hospital, and are expected to be well experienced, this level of knowledge is below the anticipated.

The finding of this study is comparable with other studies conducted in different parts of the world.

In a study conducted in Turkey the mean score of correct answer was Pressure ulcer prevention related content included in their curriculums might not be sufficient. In addition, lack of learning resources for nurses to update their knowledge would be another reason for the poor level of knowledge.

Specifically in Ethiopia, there is a limited learning resource for nurses to update their knowledge. Moreover nursing journals are not available even at the nursing institutes or hospitals.

Specific to this study This could be attributed to the possibility that more educated respondents have a higher opportunity of exposure to different courses directly or indirectly related to prevention of pressure ulcer.

Similar finding was reported in study conducted in Nigeria; where years of experience were significantly associated with clinical practice and knowledge [ 21 ].

Also since they have more prolonged exposure to patient care, they have greater chance to learn how to prevent pressure ulcer even from their own mistakes as compared to those who have less years of working experience.

Nurses who took formal training on pressure ulcer prevention were found to have good knowledge than those who had not. Similarly in a study conducted in Swedish healthcare to assess knowledge, attitude and practice of nursing staff on pressure ulcer prevention; nurses who had training were more knowledgeable than those who did not [ 23 ].

This might be due to the fact that training increases the chance of the trainees to get up to date information about pressure ulcer related preventions. Similarly study conducted in England showed that, majority of the nurses reported lack of staff and time as barrier to implement effective care practices related to prevention of pressure ulcer [ 24 ].

Especially in countries like Ethiopia where number of health professionals is near to the ground, inadequate nurse to patient ratio may limit the implementation of quality care related to pressure ulcer prevention.

In this study more than three fourth of nurses did not use a risk assessment scale. This can be explained by lack of evidence based nursing practice and in-service training on prevention of pressure ulcer. Respondents who were satisfied with the nursing leadership had good practice as compared to those who were not.

Possible reason for this result might be nurses who are satisfied with the nursing leadership are happier on their working environment, so that they are motivated to invest all their knowledge and experiences on practices related to prevention of pressure ulcer.

Inadequate facilities and equipments in the workplace were associated with poor practice on prevention of pressure ulcer. Having higher educational status, attending formal training, being more experienced showed a positive and significant association with knowledge; whereas inadequate facilities and equipments, dissatisfaction with the nursing leadership and staff shortage and were found to be associated with poor practice of pressure ulcer prevention.

Bours G, Halfens R, Abu-Saad H, Grol R. Prevalence, prevention, and treatment of pressure ulcers: descriptive study in 89 institutions in the Netherlands.

Res Nurs Health. Article PubMed Google Scholar. Robinson, Maureen: Australian Council On Healthcare Standards:Primary Intention The Australian Journal Of Wound Management , 13 3. Fogerty M, Abumrad N, Nanney L, Arbogast P, Poulose B, Barbul A.

Risk factors for pressure ulcers in acute care hospitals. Wound Repair Regen. Thomas DR. Prevention and Treatment of Pressure Ulcers.

J Am Med Dir Assoc. Shiny V: Prevention of pressure ulcer for immobilized patients among care givers in Bapuji Hospital. Medical Surgical Nursing Bansal C, Scott R, Stewart D, Cockerell C.

Decubitus ulcers: a review of the literature. Int J Dermatol. Oot-Giromini B, Bidwell F, Heller N, Parks M, Prebish E, Wicks P, et al. Pressure ulcer prevention versus treatment, comparative product cost study. CAS PubMed Google Scholar. Eckman K. The prevalence of dermal ulcers among persons in the U.

who have died. Gorecki C, Brown J, Nelson E, Briggs M, Schoonhoven L, Dealey C, et al. Impact of pressure ulcers on quality of life in older patients: a systematic review. J Am Geriatr Soc.

Black J, Girolami S, Woodbury MG, Hill M, Contreras-Ruiz J, Whitney JD, et al. Understanding Pressure Ulcer Research and Education Needs: A Comparison of the Association for the Advancement of Wound Care Pressure Ulcer Guideline Evidence Levels and Content Validity Scores.

Ostomy Wound Management. Google Scholar. Gunningberg L, Lindholm C, Carlsson M, Sjödén P. Risk, prevention and treatment of pressure ulcers—nursing staff knowledge and documentation.

Scand J Caring Sci. Article CAS PubMed Google Scholar. Clark MB, Defloor T: Summary report on the prevalence of pressure ulcers. EPUAP Review. Beeckman D, Defloor T, Schoonhoven L, Vanderwee K.

Knowledge and attitudes of nurses on pressure ulcer prevention: a cross-sectional multicenter study in Belgian hospitals. Worldviews Evid Based Nurs.

Kimberly C, Cheryl H, Polly J, Michelle M, Molly M, Misty O. PUPPI: The Pressure Ulcer Prevention Protocol Interventions. Am J Nurs. Article Google Scholar. Gedamu H, Hailu M, Amano A: Prevelence and associated factors of pressure ulcer among hospitalized patients at Felegehiwot Referal Hospital, Bahir Dar, Ethiopia.

Advances in Nursing Lyder CH, Ayello EA: Pressure Ulcers: A Patient Safety Issue. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Edited by RG H; Rengin A, Merdiye S. Pressure ulcer prevention and management strategies in Turkey. J Wound Ostomy Continence Nurs. Islam S: Knowledge, Attitude and Practice regarding Pressure Ulcer Prevention for Hospitalized Patients at Rajshahi Medical Collge Hospital in Bangladesh In.

Enein NYAE, Zaghloul AA. Int J Nurs Pract. Mockridge J, Anthony D. Nurs Stand. Pain and temperature changes often preceded skin color changes.

Discoloration may appear differently in darkly pigmented skin. The wound may evolve rapidly to reveal the actual extent of tissue injury or may resolve without tissue loss. If necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle, or other underlying structures are visible, this indicates a full-thickness pressure injury unstageable, Stage 3 or Stage 4.

Do not use DTPI to describe vascular, traumatic, neuropathic, or dermatologic conditions. Medical Device-Related Pressure Injury — This describes the etiology. Medical device-related pressure injuries result from the use of devices designed and applied for diagnostic or therapeutic purposes.

The resultant pressure injury generally conforms to the pattern or shape of the device. The injury should be staged using the staging system.

Mucosal Membrane Pressure Injury — Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury.

Due to the anatomy of the tissue, injuries cannot be staged. The prevention of pressure injuries is a great concern in health care today. Many clinicians believe that pressure injury development is not solely the responsibility of nursing, but the entire health care system.

Pressure injury prevention and treatment requires multi-disciplinary collaborations, good organizational culture and operational practices that promote safety. Per the International Guideline, risk assessment is a central component of clinical practice and a necessary first step aimed at identifying individuals who are susceptible to pressure injuries.

Risk Assessment should be considered as the starting point. The earlier a risk is identified, the more quickly it can be addressed. Skin Care. Hospitalized individuals are at great risk for undernutrition. Positioning and Mobilization. Immobility can be a big factor in causing pressure injuries.

Immobility can be due to several factors, such as age, general poor health condition, sedation, paralysis, and coma. Monitoring, Training and Leadership Support. In any type of process improvement or initiative, implementation will be difficult without the right training, monitoring and leadership support.

Reddy M, et al. Treatment of pressure ulcers: A systematic review. The Journal of the American Medical Association.

Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. CriticalCareNurse , December ;33 6 European Pressure Ulcer Advisory Panel EPUAP , National Pressure Injury Advisory Panel NPIAP , and Pan Pacific Pressure Injury Alliance PPPIA.

The International Guideline. National Pressure Injury Advisory Panel NPIAP. NPIAP Pressure Injury Stages. Lyder CH and Ayello EA. Chapter 12; Pressure Ulcers: A Patient Safety Issue. National Center for Biotechnology Information, U. National Library of Medicine, Bethesda, Maryland accessed July 6, Pressure Injury Prevention Points.

Bedsores pressure sores. Mayo Clinic. The Joint Commission. Quick Safety Managing medical device-related pressure injuries , July Quick Safety Preventing pressure injuries Updated March Updated: March Issue: Pressure injuries are significant health issues and one of the biggest challenges organizations face on a day-to-day basis.

Provides recommendations on approaches to measuring and reporting pressure injury rates. Applies to all clinical settings, including acute care, rehabilitation care, long term care, and assistive living at home, and can be used by health professionals, patient consumers and informal caregivers.

Includes guidance for population groups with additional needs, including those in palliative care, critical care, community, or operating room settings, individuals with obesity, individuals with spinal cord injury, and neonates and children. Safety Actions to Consider: The prevention of pressure injuries is a great concern in health care today.

Use a structured risk assessment tool to identify patients at risk as early as possible.

These include: Identify any pressure ulcers that may be present. Assist in risk stratification; any patient with an existing pressure ulcer is at risk for additional ulcers. Determine whether there are other lesions and skin-related factors predisposing to pressure ulcer development, such as excessively dry skin or moisture-associated skin damage MASD.

Identify other important skin conditions. Provide the data necessary for calculating pressure ulcer incidence and prevalence. Additional Information It is important to differentiate MASD from pressure ulcers. The following articles provide useful insights on how to do this: DeFloor T, Schoonhoven L, Fletcher J, et al.

Statement of the European Pressure Ulcer Advisory Panel: pressure ulcer classification. J Wound Ostomy Continence Nurs ; Gray M, Bliss DZ, Doughty DB. Incontinence associated dermatitis a consensus. J Wound Ostomy Continence Nurs ;34 1 Usual practice includes assessing the following five parameters: Temperature.

Moisture level. Skin integrity skin intact or presence of open areas, rashes, etc. Tools Detailed instructions for assessing each of these areas are found in Tools and Resources Tool 3B, Elements of a Comprehensive Skin Assessment.

Practice Insights Take advantage of every patient encounter to evaluate part of the skin. Always remind staff performing comprehensive skin assessments of the following helpful hints: Don't forget to wash your hands before doing the skin assessment and after and to use gloves.

Make sure the patient is comfortable. Minimize exposure of body parts while you are doing the skin assessment. Ask for assistance if needed to turn the patient in order to examine the patient's backside, with a particular focus on the sacrum. Look at the skin underneath any devices such as oxygen tubing, indwelling urinary catheter, etc.

Make sure to remove compression stockings to check the skin underneath them. Action Steps Assess whether your staff know the frequency with which comprehensive skin assessment should be performed.

Action Steps Assess the following: Are results of the comprehensive skin assessment easily located for all patients? Are staff comfortable reporting any observed skin abnormalities to physicians and nurse managers?

Tools A sample sheet can be found in Tools and Resources Tool 5A, Unit Log. Practice Insights Have a standardized place to record in the medical record the results of the skin assessment.

A checklist or standardized computer screens with drop-down prompts with key descriptors of the five components of a minimal skin assessment can help capture the essential information obtained through the patient examination.

Communication among licensed and unlicensed members of the health care team is important in identifying and caring for any skin abnormalities. Some places have found it effective to use a diagram of a body outline that an unlicensed heath care worker can mark with any skin changes they might see while bathing or performing care activities.

Be especially concerned about the following issues: Finding the time for an adequate skin assessment: As much as possible, integrate the comprehensive skin examination into the normal workflow.

But remember that this is a separate process that requires a specific focus by staff if it is to be done correctly. Determining the correct etiology of wounds: Many different types of lesions may occur on the skin and over bony prominences.

In particular, do not confuse moisture-associated skin changes with pressure ulceration. If unsure about the etiology of a lesion, ask someone else who may be more knowledgeable. Using documentation forms that are not consistent with components of skin assessments: Develop forms that will facilitate the recording of skin assessments.

Having staff who do not feel empowered to report abnormal skin findings: Communication among nursing assistants, nurses, and managers is critical to success. If communication problems exist, staff development activities targeting cross-level communication skills may be in order.

Nurses and managers may need to solicit and positively reinforce such reporting if nursing assistants do not have confidence in this area.

Develop methods to facilitate communication. One example would be a sticky note pad that includes a body outline, patient name, and date. Aides would mark down any suspicious lesions and give the note to nurses. Tools An example of a notepad to be used for communication among nursing assistants, nurses, and managers can be found in Tools and Resources Tool 3C, Pressure Ulcer Identification Notepad.

Encourage staff to: Ask a colleague to confirm their skin assessments. Having a colleague evaluate the skin assessment will provide feedback as to how they are doing and will help correct documentation errors. Perform skin assessments with an expert.

Consider having an expert or nurse from another unit round with unit staff quarterly to confirm findings from the comprehensive skin assessment.

Ask for clarification when they are unsure of a lesion. Take advantage of the local wound care team or other staff who may be more knowledgeable. Use available resources to practice their ability to differentiate the etiology of skin and wound problems.

Resources This slide show illustrates how to perform a skin assessment: www. Practice Insights A full-body skin inspection does not have to mean visualizing all aspects of the patient in the same time period. When applying oxygen, check the ears for pressure areas from the tubing.

If the patient is on bed rest, look at the back of the head during repositioning. When checking bowel sounds, look into skin folds. When positioning pillows under calves, check the heels and feet using a hand-held mirror makes this easier.

When checking IV sites, check the arms and elbows. Examine the skin under equipment with routine removal e. Each time you lift a patient or provide care, look at the exposed skin, especially on bony prominences.

Action Steps Ask yourself and your team: Do you have a policy about who is responsible for the risk assessment on admission and thereafter? Does everyone know the process for performing risk assessment? Pressure ulcer risk assessment is essential for a number of reasons: It aids in clinical decisionmaking.

Many clinicians are not skilled in identifying patients at risk for developing pressure ulcers. Use of a standardized risk assessment helps to direct the process by which clinicians identify those at risk and quantify the level of this risk. It allows the selective targeting of preventive interventions.

Pressure ulcer prevention is resource intensive. Resources should be targeted toward those at greatest risk who would most-benefit. It facilitates care planning. Care plans focus on the specific dimensions that place the patient at greatest risk. It facilitates communication between health care workers and care settings.

Workers have a common language by which they describe risk. Action Steps Ask yourself and your team: Do the unit staff understand why they are doing the risk assessment?

Are unit staff communicating the risk assessment results to all clinicians who need to know? Presence of a pressure ulcer: All patients with an existing pressure ulcer should be considered at-risk for an additional ulcer.

Prior Stage III or IV pressure ulcers: When Stage III or IV ulcers close through a process of scar tissue formation and eventual epithelialization, the resulting skin is not normal as it lacks its former tensile strength and is very prone to break down again.

Hypoperfusion states: Patients who are not perfusing vital organs as a result of conditions such as sepsis, dehydration, or heart failure are also not adequately perfusing the skin. Minimal amounts of pressure may then cause ulceration.

Peripheral vascular disease: Because of the limited blood supply to the legs, these patients are predisposed to pressure ulcers of the feet, particularly the heels. Diabetes: Patients with diabetes have consistently been shown to be at increased risk of pressure ulcers.

Smoking: Smoking interferes with oxygen delivery. Smoking is associated with recurrence of pressure ulcers postsurgery and likely increases risk of new pressure ulcers.

Restraint use: Patients with physical restraints have limited mobility in addition to having pressure applied at the site of the restraints. Chemical restraints with resulting sedation may lead to rapid decline in mobility.

Spinal cord injury: Immobility, incontinence, and impaired sensation may combine to place these patients at exceptionally high risk. The level and completeness of the spinal cord injury is critical in this determination. Operating room OR and emergency room ER stays: Prolonged time on a hard surface or in one position increases the risk of skin breakdown.

This often happens in an OR or ER, with lengthy procedures, or while transporting a patient,. Always consider the length of time that the patient may need to stay in one position. Patients who undergo a procedure longer than 4 hours are at particularly high risk.

Practice Insights Comprehensive risk assessment includes both the use of a standardized scale and an assessment of other factors that may increase risk of pressure ulcer development.

Action Steps Ask yourself and your team: Are we using a risk assessment tool in conjunction with the assessment of additional specific patient risk factors?

When and what kind of training did the staff receive on how to use and interpret the scales? Are risk assessment results being used as a basis for planning care? Tools Copies of the Braden and Norton scales are included in Tools and Resources Tool 3D, Braden Scale , and Tool 3E, Norton Scale.

Resources Consider the following resources for risk assessment in special populations: Palliative Care: Hunters Hill Marie Curie Centre Risk Assessment Tool.

Chaplin J, McGill M. Pressure sore prevention. Palliative Care Today ;8 3 Home Care: Braden Scale for Predicting Pressure Sore Risk in Home Care.

Available at: www. Pediatrics: Braden Q 21 days to 8 years. Quigley SM, Curly MAQ. Skin integrity in the pediatric population: preventing and managing pressure ulcers. J Spec Pediatr Nurs ;1 1 Glamorgan Scale birth to 18 years. Willock J, Harris C, Harrison J, et al.

Identifying the characteristics of children with pressure ulcers. Nursing Times ; 11 Pediatric Waterlow neonate to 16 years. Waterlow J. Pressure sore risk assessment in children.

Pediatr Nurs ;9 6 Neonatal Skin Risk Assessment Scale NSARS 26 to 46 weeks. Huffines B, Logsdon MC. The neonatal skin risk assessment scale for predicting skin breakdown in neonates. Issues Compr Pediatr Nurs ; Chapter: National Patient Safety Goals NPSG. First published date: April 11, This Standards FAQ was first published on this date.

This page was last updated on November 18, with update notes of: Editorial changes only Types of changes and an explanation of change type: Editorial changes only: Format changes only.

No changes to content. Review only, FAQ is current: Periodic review completed, no changes to content. Reflects new or updated requirements: Changes represent new or revised requirements.

Was this response helpful? Yes No. Pressure ulcers: Advice for patients and carers We are committed to preventing pressure ulcers and helping local patients, families or carers to manage pressure ulcers more effectively.

What is a pressure ulcer? Pressure ulcer information:. Play video. Pressure ulcer information: The facts about pressure ulcers: Pressure ulcers can occur within a matter of hours for those at risk Regular top to toe skin inspections are needed to help prevent pressure ulcers occurring.

Look out for reddening that does not subside over bony areas. Good SSKIN can help prevent pressure ulcers click here. Michael McGrath's story How to prevent pressure ulcers film Play video.