1. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk by Barbara Levine, PhD, CRNP Gerontological Nursing Consultant

2. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center When Pressure Persists: Learning Objectives Direct Care Staff will be able to:  Identify the risk factors for pressure ulcers  Discuss common reasons for pressure ulcers  Discuss strategies to prevent these wounds  Describe a team approach to pressure ulcer prevention and care  Describe a pressure ulcer prevention program for a nursing home

3. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Pressure Ulcer: Definition A pressure ulcer is any change in color or break in the skin caused by too much pressure on the skin for too long a period of time.

4. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Pressure Ulcers  Occur commonly in older people  Can be prevented in many residents  Can be painful, lead to infection, and are a marker for increased risk of death  Cost more than $6,000 each to treat

5. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center What Causes Skin Injury?  Pressure – reduces blood flow to skin  Friction – repeated rubbing causes a break in the skin  Shear – sideways pulling on the skin layers until it breaks

6. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Who’s at Risk? Individuals who are:  bed or chair-bound  unable to sense discomfort  incontinent  poorly nourished or dehydrated  feverish, have diabetes, or low blood pressure

7. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Pressure Points  Back of the head  Back of shoulders  Elbows  Hip  Buttocks  Contractures  Heels

8. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center A Team Approach to Prevention  Identify at-risk individuals  Maintain and improve skin condition  Protect against pressure and injury  Assure adequate nutrition and hydration  Encourage activity and mobility  Educate older adults, families, and care providers  Early identification of skin injury

9. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Clean and Dry  Clean gently with warm water  Prevent incontinence by maintaining toileting schedule  Help resident off the bed pan or toilet promptly  Clean skin at time of soiling  Absorbent underpads or briefs  Moisture barriers

10. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Beyond Clean and Dry  Look for and report any changes  Clean skin and keep it well lubricated  Minimize dryness and avoid excessive moisture

11. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Skin Checks  Check all surfaces at least twice a day  Remove clothing and position for visibility  Check pressure points with every position change  If you note a reddened area, reassess in 15 minutes

12. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Abnormal Skin Changes Note location, size and degree of:  Areas of redness or warmth in fair skin  Areas of duskiness or darkness and warmth in dark skin  Areas of pain or discomfort  Blisters – fluid-filled or broken  Weeping or drainage

13. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Reducing Pressure in Bed  Turn at least every two hours  Prevent skin- to- skin contact  Complete pressure relief for heels  Elevate head of bed as little as possible  Use lift sheets or trapeze  Do not position directly on hip bone  Do not rub or massage reddened areas

14. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center 30° Laterally Inclined Position  Weight not on sacrum or trochanter  Support with pillows or foam wedge  Use pillows to protect vulnerable areas  Head of bed as low as possible

15. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Reducing Pressure in Chairs  Reposition at least every hour  Instruct to shift weight every 15 minutes  Do not use doughnuts or rings

16. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Nutrition  Encourage residents to drink enough water  Assist residents to eat enough protein and calories

17. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center You can make a make a difference!  Keep your older adults moving  Position immobile or dependent individuals frequently and carefully  Assist with meals and snacks  Provide plenty of clear, cool water  Keep those with incontinence clean and dry  Be alert to changes and report them

18. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Objectives Review Can you now:  Identify the risk factors for pressure ulcers?  Discuss common reasons for pressure ulcers?  Discuss strategies to prevent these wounds?  Describe a team approach to pressure ulcer prevention and care?  Describe a pressure ulcer prevention

19. TLCTLC TLCTLC LTCLTC LTCLTC Delaware Valley Geriatric Education Center Thank you for your attention! The End