On Nov. 15, 2012 Mölnlycke Health Care U.S. will address the issue of hospital-acquired pressure ulcers (HAPU) and offer guidelines in a webcast, “Recognize Pressure Ulcer Prevention Day: The Latest Clinical Data, Guidelines and Ideas You Need to Make the Right Choices,” available at: http://eo2.commpartners.com/users/molnlycke/index.php. The webcast starts at 1 p.m. EST.
The program will feature a panel of three healthcare experts: C. Tod Brindle, RN, of Virginia Commonwealth University Medical Center; Dr. Peggy Kalowes, RN, director of nursing research, evidence based practice, and advanced practice nursing at Long Beach Memorial Medical Center in Long Beach, California; and Joyce Black, PhD RN CWCN FAAN, associate professor of nursing at the University of Nebraska. In August, Black co-chaired a consensus group that developed global evidence-based practice recommendations for the use of wound dressings to augment pressure ulcer prevention protocols.
Mölnlycke Health Care US is sponsoring the webcast in observance of global Pressure Ulcer Prevention Day on Nov. 16, 2012 and has dedicated a website (http://stoppressureulcersnow.com/) to preventing HAPU.
The presenters will share data from peer reviewed articles as well as randomized, controlled study results. They’ll place a special focus on the importance of pressure ulcer prevention in the OR, discussing risk factors as well as suggestions on preventing OR related pressure ulcers. A question-and-answer session will follow the presentations.
Participants will learn:
- Risk factors associated with HAPU and how a dressing can help reduce these as part of a prevention protocol
- Incidence rates and preventable action that can be taken to reduce OR related pressure ulcers
- Data supporting the use of a dressing as part of prevention protocol as well as how it works and what an ideal dressing should look like
Webcast participants will discuss the results of a randomized clinical trial of a soft silicone, self-adherent, bordered foam dressing to reduce pressure ulcer formation in high-risk patients in the ICU.(1) Overseen by Kalowes, the study found that Mepilex® Border Sacrum (MxBS) was effective in preventing pressure ulcers (statistically significant) and that adoption of this new wound technology will improve outcomes of high risk patients. The 10-month study included 367 patients; 183 in a control group received usual care (skin bundle) and 184 in the intervention group, where the dressing was added to the prevention protocol. Seven pressure ulcers developed in the control group without MxBS and one DTI pressure ulcer in the intervention group with MxBS.
HAPUs occur most commonly in the ICU (12 percent to 42ercent),(2) with the rate of interoperatively acquired HAPU ranging from 12 percent to 66 percent in surgical patients.(3) These pressure ulcers are caused by intense, prolonged and unrelieved pressure, resulting in damage to skin and underlying tissue. The sacrum is generally reported as the most common location for pressure ulcers, with an incidence rate in acute care settings of 31 percent.(4) The heel is typically reported as the second most common location. Medical device related pressure ulcers are a growing concern.(5)
“Hospital-acquired pressure ulcers are a common and costly reality,” says Magnus P. Persson, senior brand manager, prevention, for Mölnlycke Health Care US. “Hospitals no longer receive Medicare or Medicaid reimbursement for HAPU and therefore are more committed than ever to the reduction of pressure ulcers.”
Pressure ulcers—the most frequent type of avoidable side-effect of care—have been estimated to cost a facility $10,288 per occurrence.(6) The total cost of managing a Medicare patient with a pressure ulcer in acute care averages $43,180 per hospital stay.(7)
“Adding a dressing to a prevention program may help to reduce HAPU costs by stopping them before they start,” Persson says, citing a study by Brindle that showed that using Mepilex Border Sacrum dressings as a preventative measure reduced sacral pressure ulcers in the ICU. (None of the 41 patients who wore the dressings developed pressure ulcers.) The study has since been replicated by Nancy Chaiken at the Swedish Covenant Hospital in Chicago(9) and by Cecile Cherry of the University of Alabama(10) with similar results.
Six Tips to Prevent Pressure Ulcers
A pressure ulcer prevention strategy should always include risk and skin assessments, provision of correct nutritional support and pressure redistribution strategies. An emerging intervention is that of using a protective dressing such as Mepilex® Border Sacrum when used as part of a pressure ulcer prevention protocol.
Key elements in prevention, adapted from National Pressure Ulcer Advisory Panel (NPUAP) and European Pressure Ulcer Advisory Panel, include:
1. Risk Assessment. Not only should a risk assessment policy be implemented in a structured manner but the healthcare team should be educated on both the use of the tool and the basics in pressure ulcer related issues. All risk assessment must be carefully documented and reassessments undertaken on a scheduled basis.
2. Skin assessment. Moisture can increase the risk of damage; therefore a moisture and incontinence assessment as part of an overall risk assessment should be implemented and practical precautions initiated where needed.
3. Nutrition. Assess the nutritional status of a patient and refer to a dietician when required for nutritional support and assessment of hydration status.
4. Repositioning. This is a key step in reducing the impact of pressure. Frequency will depend upon an individual's general health status, skin condition and support surface. Repositioning should be undertaken in a manner that ensures pressure is relieved or
redistributed while avoiding shear/friction forces. Consider use of 30 degree tilted side-lying position. Ensure documentation is meticulous and the healthcare team correctly educated.
5. Support surfaces. Select the appropriate device based on the individual's requirements. Reassess frequently. Pay particular attention to heels. Relieve pressure completely if possible by using correctly positioned pillows. Note: The NPUAP has defined the characteristics of various support surfaces.
6. Consider the implications for special groups. The elderly and patients in surgery, critical care and pediatrics – all of these may need additional care.
1. Kalowes et al. Use of a Soft Silicone, Self-Adherent, Bordered Foam Dressing to Reduce Pressure Ulcer Formation in High Risk Patients: A Randomized Clinical Trial. Poster presented at Fall SAWC 2012.
2. Cox, J. Predictors of Pressure Ulcers in Adult Critical Care Patients. American Journal of Critical Care 2001; Vol 20, No 1.
3. Primiano, M. Pressure Ulcer Prevalence and Risk Factors During Prolonged Surgical Procedures. AORN Journal 2011; 94(6).
4. Wittington, K. and Briones, R. National Prevalence and Incidence Study: 6-Year Sequential Acute Care Data. Advances in Skin & Wound Care 2004; 17(9).
5. Black et al. Medical device related pressure ulcers in hospitalized patients. International Wound Journal Vol 7 No 5 2010.
6. Cheryl Clark. Top 10 Most Costly, Frequent Medical Errors. HealthLeaders Media , August 11, 2010
7. Courtney H. Lyder. The Benefits of a Multi-Disciplinary Approach to the Prevention and Treatment of Pressure Ulcers http://www.infectioncontroltoday.com/ Posted on: 08/10/2011
8. Brindle, C. T. Outliers to the Braden Scale: Identifying High-Risk ICU Patients and the Results of a Prophylactic Dressing Use. WCET Journal 2010; 30(1).
9. Chaiken, N. et al. Reduction of Hospital Acquired Sacral Pressure Ulcers in the Intensive Care Unit Utilizing a Soft Silicone Dressing. Poster presentation at the WOCN Congress, 2011.
10. Cherry, C. et al. The Pressure Ulcer Prevention Care Bundle. Magnet Research Day, Alabama 2010