By Courtney H. Lyder, ND, GNP, FAAN
Pressure ulcers have become more prevalent in hospitals and nursing homes in the last decade, even though preventive protocols backed by clinical research have been shown to be effective. Pressure ulcers, also known as decubitus ulcers, are skin lesions associated with pressure, moisture, and other factors. They can affect any area of skin and are especially common on the sacral area, greater trochanter, heels and other areas with bony prominences. Without adequate blood flow, the affected tissue dies. If not properly treated these ulcers can evolve into deep wounds that go down to the bone and lead to serious and potentially life-threatening infections. Pressure ulcers are categorized by severity, from Suspected Deep Tissue Injury and Stage I (earliest signs) to Stage IV and Unstageable (worst).
In addition, as patients age the risk of pressure ulcers increases. The growing numbers of obese patients, elders with chronic illnesses, and people with diabetes could mean that the incidence of pressure ulcers will continue to rise in the years ahead. An estimated 2.5 million people now develop pressure ulcers each year, and 60,000 U.S. hospital patients die from complications related to hospital-acquired pressure ulcers. From 1993 to 2006 the number of hospitalizations caused by pressure ulcers increased by 80 percent.
Anatomically, the ischial tuberosity or sacrum region is by far the most common area for pressure ulcers to develop. These account for more than 70 percent of all occurrences, with sacral (46 percent) and ischial (26 percent) locations being most common. A study in the International Journal of Nursing Studies found that the prevalence of pressure ulcers ranges from 14.3 percent to 15.6 percent among patients in acute care settings and that pressure ulcers affect an estimated 27.7 percent of patients in long-term care facilities. The cost of managing a Medicare patient with a pressure ulcer in the acute care averages $43,180.00 per hospital stay, adding more than $11 billion to healthcare costs each year. Pressure ulcers are listed as the direct cause of death in 7 percent to 8 percent of all patients with paraplegia. The Centers for Medicare and Medicaid Services (CMS) has designated the incidence of pressure ulcers as one of the three primary markers of quality care in long-term-care settings.
One option is the application of protective dressing applied to high risk areas before pressure ulcers develop. Experts call for more training on risk reduction for all members of the patient-care team. Identification and proper care of at-risk skin is a very important part of pressure ulcer prevention as hospitals and long-term care facilities look to adopt strategies to reduce risk, improve patient comfort and safety while reducing costs.
Other options include cleaning and protecting the area, taking steps to control incontinence, and removing damaged tissue (debridement). The first step in managing an ulcer at any stage is to relieve the pressure on the area of skin at risk by changing positions or by using support beds.
Efforts to cleanse, moisturize and protect skin could have a substantial and positive impact on reducing the risk of pressure ulcers for millions of patients each year. Training should include proven and effective strategies that may help prevent skin from breakdown and exposure to viral or bacterial infection, including the use of a protective dressing that can be applied to high-risk areas on the skin.
This algorithm was designed to help facilities and caregivers improve outcomes, clinical efficiency and standardized care for patients. ConvaTec developed a Solutions® Algorithm for Prevention that provides information on prevention and recommendations of appropriate skin care and prophylactic dressings to effectively help to prevent pressure ulcers. To help reduce risk and improve patient comfort some medical device companies are working with nurses and other clinicians who use skin care products to develop new protocols to protect patient skin.
Because this effort involves action by many members of a patients care team, a comprehensive multi-disciplinary team approach is highly recommended to prevent and treat pressure ulcers. Education and training for hospital staff at all levels regarding prevention, assessment, early recognition and treatment is imperative for the prevention and management of pressure ulcers.
Courtney H. Lyder, ND, GNP, FAAN, is executive director of the Patient Safety Institute and professor of public health and medicine at UCLA.
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