1. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia When Pressure Persists: Prevention of Pressure Ulcers for Those at Risk written by Barbara Levine, PhD, CRNP Gerontological Nursing Consultant revised by Ingrid Sidorov, MSN, RN Gerontological Nursing Consultant

2. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia 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 in long term care settings

3. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Pressure Ulcer: Definition A pressure ulcer is localized injury to the skin and or underlying tissue, usually over a boney prominence, that happens as a result of pressure and/or friction/shear issues. (NPAUP, 2007)

4. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Pressure Ulcers  Occur more 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 an enormous amount of money

5. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia What Causes Pressure Ulcers?  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  Moisture, especially from urine or stool increases the risk of wounds multifold

6. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Who’s at Risk? Individuals who:  Are bed or chair-bound  Have contractures  Are unable to sense discomfort  Are incontinent  Are poorly nourished  Are dehydrated  Suffer from an altered LOC or CI  Are febrile or hypotensive  Are chronically ill

7. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Pressure Points  Back of the head  Back of shoulders  Elbows  Hip  Buttocks  Heels

8. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia 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 Geriatric Education Center of Greater Philadelphia Clean and Dry  Clean gently with warm water  Prevent incontinence by maintaining toileting schedule  Help person off the bed pan or toilet promptly  Clean skin at time of soiling  Absorbent underpads or briefs only as needed – try to keep off to promote healing  Use of moisture barriers

10. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Beyond Clean and Dry  Look for and report any changes  Clean skin and keep it well lubricated  Minimize dryness and avoid excessive moisture  Do not rub over reddened areas; this only increases damage to tissues.

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

13. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia 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 Geriatric Education Center of Greater Philadelphia 30 o 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 Geriatric Education Center of Greater Philadelphia Reducing Pressure in Chairs  Reposition at least every hour  Instruct to shift weight every 15 minutes  May need cushion  Do not use doughnuts or rings

16. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Nutrition  Encourage residents to drink enough fluids  Assist to eat enough protein and calories

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

18. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia 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 program for long term care?

19. TLCTLC TLCTLC LTCLTC LTCLTC Geriatric Education Center of Greater Philadelphia Thank you for your attention! The End