1. Pressure Ulceration Prevention

2. CAUSES PRESSURE SHEARING FRICTION

4. MORTALITY HAS BEEN REPORTED TO BE FIVE TIMES HIGHER THAN THOSE WITHOUT A SORE

5. COSTS 1982 - ESTIMATED AT 150 MILLION 1994- 750 MILLION 2007 – 1845 MILLION 2.6 %

6. Pressure ulcers Cause great deal of pain Cause great deal of discomfort Destructive to patients self esteem Long term problem Costly to treat Time consuming

7. Areas at risk

8. Who’s at risk Some groups of people are at greater risk from pressure ulcers than others. Immobility for any reason contributes to the risk of pressure sore. Examples of most at risk are elderly, wheelchair users and patients who are bed-ridden. Unrelieved pressure on a specific area of the body (e.g. the heels, the hips) will affect the blood supply to the skin and underlying tissues causing that area to become damaged.

9. Who’s at risk Incontinence People living with incontinence as prolonged exposure to moisture can cause breakdown of skin tissue. Medical conditions Conditions such as diabetes and arterial disease can also increase the risk of pressure ulcers as the supply of blood and oxygen to body tissue may be restricted. Pressure Ulcer Grading 4 recognised grades of pressure ulcers in the EPUAP Wound Classification system.

10. GRADE 1: Discolouration of intact skin not affected by light finger pressure (non blanching erythema) This may be difficult to identify in darkly pigmented skin. GRADE 2: Partial-thickness skin loss or damage involving epidermis and/or dermis. The pressure ulcer is superficial and presents clinically as an abrasion, blister or shallow crater.

11. GRADE 3: Full thickness skin loss involving damage of subcutaneous tissue but not extending to the underlying fascia. The pressure ulcer presents clinically as a deep crater with or without undermining of adjacent tissue. GRADE 4: Full thickness skin loss with extensive destruction and necrosis extending to underlying tissue

12. Risk Assessments How Accurate Are They ? Do They Need To Be Accurate? Why?

13. PREVENTING PRESSURE SORES RISK ASSESSMENTS ARE AN EXCELLENT WAY OF ASSESSING AND IDENTIFYING NURSING NEEDS FOR EVALUATING GENERAL CONDITION OF THE OF THE PATIENT SHOULD ALERT US TO THE REQUIREMENTS OF THE PATIENT

14. THE GOAL OF RISK ASSESSMENT IS NOT TO ASSESS RISK BUT TO MANAGE THE RISKS Kamrin M. (2000) Role of science in risk assessments Detroit News

15. Waterlow Intended for use by nurses, healthcare professionals and carers at the patient/client interface. It must be remembered that "Waterlow", like all risk assessment scoring systems is a simplistic tool. Professional judgement must be used in determining the risk status of the patient/client. All assessments and, just as importantly, reassessments must be documented and the plan of care adjusted as necessary.

16. When the Waterlow card is being used in the Community or in the Nursing and Residential homes it is vital to recognise that this environment is markedly different from the one in which the scoring system was developed. The risk factors are still the same, but can be alleviated by the client having for example: A) A good quality mattress, duvet for his/her bed. B) A good quality armchair to sit out in. C) A caring relative or friend who keeps a constant eye on them and provides good nutritious meals, for example. Remember that the score must be reassessed

17. One side illustrates the risk assessment scoring system

18. Reverse side provides guidance on nursing care, types of preventative aids associated with the three levels of risk status, wound assessment and dressings

19. Terminal cachexia Weight loss, wasting of muscle, loss of appetite, and general debility that can occur during a chronic disease The American Heritage® Medical Dictionary Copyright © 2007 A condition of general ill health, malnutrition, undesired weight loss, and physical weakness, often associated with cancer Gale Encyclopedia of Medicine. Copyright 2008

20. Preventative measures Important that those who are immobile have pressure relieved frequently either by manual turning or sophisticated bed systems. BUT remember even if a patient is lying on a bed system risk areas still require regular inspection. This may need to be more frequent if sitting. A healthy balanced diet and plenty of fluids Those at higher risk of pressure ulcers, such as the elderly and those with existing medical conditions should keep as active and mobile as possible, taking some form of exercise every day that uses a range of motions. Important to keep the skin clean and dry

21. Turning chart

22. PATIENT SUPPORT SURFACES CONSIDERABLE INCREASE IN BOTH VARIETY AND NUMBER COST VARIES FROM FEW HUNDRED TO THOUSANDS ADDS TO THE NEED OF A LOGICAL APPROACH TO THEIR SELECTION

23. Types of equipment Static mattresses Foam overlays Dynamic overlays and mattresses Alternating Low Air Loss Fluidised Cushions and boots

26. Assessment of pressure relieving equipment Very difficult Numerous parameters interface pressure transcutaneous blood

27. EVALUATION DECISIONS RATHER CONFUSING BUT STILL HAVE TO BE MADE SUPPLIERS PHRASES INCLUDE It allows fluid to drain Air to circulate Redistributed pressure to maintain the flow of o2 to body tissue

28. INAPPROPRIATE SELECTION WASTES CAPITAL RESOURCES AND CAN BE DETRIMENTAL TO PATIENTS

29. Wound Infection The deposition and multiplication of bacteria in tissue with an associated host reaction

30. Signs of Infection Localised erythema Localised pain Localised heat Cellulitus Oedema

31. Further criteria include Abscess Discharge which may be viscous in nature, discoloured and purulent Delayed healing not previously anticipated Discolouration of tissues both within and at the wound margins Abnormal smell

32. Wound contamination and infection development Direct Contact- transfer between patient to patient, nurse to patient, equipment to patient etc Airborne disposal Micro-organisms deposited from the air Self contamination Physical migration from patients gastrointestinal tract or skin

33. Treat the patient holistically Recognise the signs of inflammation/increased bacterial burden/ clinical infection Take reliable swabs Treat infection –cause Wound management products and regimes that are suitable. Minimise cross-infection

34. Finally Evidence-linked recommendations – identifying individuals at risk – use of risk assessment scales – recognising risk factors – skin inspection – pressure redistributing devices – use of aids – positioning – seating – education and training.