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Pressure Ulcer Prevention

Pressure Ulcer Prevention. Lessons Learned from Skin Fair Jeri Lundgren, RN, CWS, CWCN Pathway Healthcare Services Jody Rothe, RN, WCC MetaStar, Inc. December 2, 2009. Skin Care . Objectives for our learning session: The importance of hydrating skin How to handle fragile skin

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Pressure Ulcer Prevention

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  1. Pressure Ulcer Prevention Lessons Learned from Skin Fair Jeri Lundgren, RN, CWS, CWCN Pathway Healthcare Services Jody Rothe, RN, WCC MetaStar, Inc. December 2, 2009

  2. Skin Care • Objectives for our learning session: • The importance of hydrating skin • How to handle fragile skin • Moisture – friend or foe • How to turn the frail elderly patient • What causes pressure and the stage definitions • Importance of nutrition • Overall care of the skin

  3. Causes of Pressure

  4. Interventions

  5. The Daily Post – The Barren Dessert • Protect Dry Skin which can lead to friction injuries and skin tears • Use moisturizers frequently and as often as necessary • Always be on the look-out for skin changes

  6. The Daily Post – Fragile Handle With Care • Be cautious when changing incontinent products, bandages, or even their clothes • Your elder’s skin is very fragile and can tear easily

  7. The Daily Post – The Barrier Reef • Use a moisture barrier to help protect the skin from stool and urine • Barrier creams and ointments only work if they are applied, and applied correctly • These creams can be the first line of defense for your elder to stop a pressure ulcer before it develops

  8. The Daily Post – You’re Tearing Me Apart • Simple movements, such as turning or lifting, can create friction and shearing, which can injure the skin • To move and reposition residents, use lifting devices and draw sheets • Avoid dragging.

  9. The Daily Post – Under Pressure • Reposition bedbound residents every two (2) hours • Reposition chairbound residents every one (1) hour • Use devices, such as pillows and cushions, to keep bony prominences from direct contact

  10. The Daily Post – Taster’s Choice and Treasure Hunt • Poor nutrition is a risk factor in developing a pressure ulcer • Assist residents to eat as necessary • Notify the nurse if there is a decline or change in a resident’s eating habits • Choose supplements that are tasty • Consider choice in dining as a strategy to increase weight

  11. The Daily Post – The Princess and the Pea • Use support surfaces on beds and chairs to reduce pressure • Avoid donuts • Use pillows or devices to raise heels off the bed

  12. The Daily Post – Dorothy’s Shoe • Always be on the lookout for anything that could create pressure on the skin, including the feet

  13. The Daily Post – Squeezing Me Too Tight • Stage IV pressure sores can take the longest to heal • In some residents Stage IV ulcers can develop in a matter of hours (i.e., if left on the wrong surface too long)

  14. Kick Up Your Heels • Heels are especially vulnerable to pressure even on a good support surface • Heel elevation will help prevent pressure ulcers to the heels • Tip: On daily rounds monitor to ensure heels are off on the beds and equipment is being used appropriately

  15. Stages of Pressure Ulcers – Terrors of the Deep • DEEP TISSUE INJURY: • Purple or maroon localized area of discolored intact skin or blood-filled blister • Due to damage of underlying soft tissue from pressure and/or shear • The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

  16. Stage 1 • Intact skin with non-blanchable redness of a localized area usually over a bony prominence • Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area

  17. Stage 2 • Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough • May also present as an intact or open/ruptured serum-filled blister

  18. Stage 3 • Full thickness tissue loss • Subcutaneous fat may be visible but bone, tendon or muscle are not exposed • Slough may be present but does not obscure the depth of tissue loss • May include undermining and tunneling

  19. Stage 4 • Full thickness tissue loss with exposed bone, tendon or muscle • Slough or eschar may be present on some parts of the wound bed • Often include undermining and tunneling

  20. Unstageable • Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed

  21. Braden Scale Puzzle – Sensory Perception • Sensory Perception: • The person’s ability to perceive and respond MEANINGFULLY to pressure related pain & discomfort • Interventions • Remember the shoe exercise? Check for anything that could be creating pressure on the skin • For the resident with limited ability to perceive pressure, put on a turning schedule to ensure pressure relieved at regular intervals

  22. Braden Puzzle – Moisture • Moisture: • The amount of moisture the skin is exposed to • Interventions: • Use moisture barrier in particularly wet areas (peri-area, buttocks, etc.) • Change clothing, incontinence products, and linen as often as you need to

  23. Braden Scale Puzzle – Activity • Activity: • Getting up and around • Interventions: • Change position at least every 2 hours • ROM • Ambulate • Teach resident to change his/her own position

  24. Braden Scale Puzzle – Mobility • Mobility: • Changing position and controlling body position • Interventions: • Float the heels • Reposition at least every 2 hours for bed-bound residents; hourly for chair bound • Use pillows for support

  25. Braden Scale Puzzle – Nutrition • Nutrition: • USUAL food intake • Interventions: • Help to eat • Get foods they like (within their diet) • Offer fluids frequently (as diet allows) • Provide supplements as ordered

  26. Braden Scale Puzzle – Friction and Shear • Friction & Shear: • Ability to move without rubbing or dragging • Interventions: • Use lift sheet • Soft socks on feet • Long sleeves or elbow protectors • Keep the head of the bed at the lowest degree of elevation consistent with medical condition and other restrictions • Limit the amount of time the head of the bed is elevated

  27. Pressure Ulcer Prevention • You can make a difference • Implement preventative interventions • Report changes in skin • Thank you

  28. Contact Information: Jody Rothe, RN, WCC Quality Consultant MetaStar, Inc. 2909 Landmark Place Madison, WI 53713 (608) 274-1940 or (800) 362-2320, ext. 8271 www.metastar.com jrothe@metastar.com This material was prepared by MetaStar, the Medicare Quality Improvement Organization for Wisconsin, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.  9SOW-WI-PS-09-223.

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