1. Equipment. Assess the Needs of the Individual
ALL TOGETHER NOW PUSH
Pressure Ulcers Should be HISTORY
Equipment.
Assess the Needs of the
Individual

2. Scenario 1
On a routine visit to 78 year old Mrs Smith to administer Vitamin B12,you notice the patient does not seem herself. You are aware that she has been diagnosed with COPD and hypertension for which she has been prescribed Seretide 500 mcgs bd,Salbutamol 400 mcgs prn, Felodipine 10mgs and Perindopril 15mgs od. Mrs Smith confides in you that she is not able to walk for more than 15yds without becoming dyspnoeic.
Mrs Smith spends most of the day sitting in the chair and has coughing paroxysms ,resulting in a degree of stress incontinence
Her BMI is 34.
What cushion would you prescribe for her chair?
What other measures and equipment would you consider using to protect Mrs Smith?.
What potential problems could there be with either the equipment or the advice in relation to her condition? and how would you address these?
All together now PUSH. Pressure ulcers should be HISTORY

3. Community Equipment Selection Flow-chart for pressure relieving cushions.
Remember to compare patients weight against the manufactures recommendations for minimum /maximum
Consider the use of a n overlay cushion such as Proflex.
Waterlow Score
10-14
Low risk
Consider the use of a contour replacement cushion such as Flotech.
Waterlow Score
15-19
High risk
Waterlow Score
20 plus
Consider the use of a Day care replacement cushion.
Not suitable for use with recliners
High risk
Consider using a cushion such as the Trinova replacement cushion.
Not suitable for use with recliners
Waterlow Score
20 plus
Very high risk
All together now PUSH. Pressure ulcers should be HISTORY

4. Mrs Smith
Mrs Smith has become acutely unwell with an acute exacerbation of her COPD. She does not wish to be admitted to hospital and the GP has asked for your team to assess and support her. She has been prescribed Amoxicillin 500 mgs TDS,Soluble Prednisolone 35mgs OD for 10days. Her PO2 reading is 94%. Mrs Smith has taken to bed, and prefers to be supported by pillows to help her sit upright.
Would you prescribe a dynamic or static mattress ? and why/rationale
What other equipment would you advise?
What other assessments would you carry out ?
All together now PUSH. Pressure ulcers should be HISTORY

5. Community equipment selection for prevention and management 0f pressure ulceration
The chart does not replace clinical judgement, please assess patients holistically considering other contributing factors.
Overlay such as Proflex,.
NB: up to 17 stone only
Yes
Grade 1
Waterlow
10-14
Can the patient turn independently or has carers who reposition regularly
Use a system such as Premier Glide.
NB:up to 39 stone No
Yes
Waterlow
15-19
Use a system such as Viaclin.
NB: up to 20 stone
Can the patient turn independently or has carers who reposition regularly
GRADE 2 No
Use a system such as Trinova.
NB:up to 40 stone.
Yes
Waterlow220 plus
Can the patient turn independently or has carers who regularly reposition
Grade 3 No
Use a system such as Viaclin
NB:up to 20 stone
Yes
Grade 4
Waterlow
20 plus
Can the patient turn independently or has carers who regularly reposition
Use a system such as Trinova.
NB up to 40 stone. No
All together now PUSH. Pressure ulcers should be HISTORY

6. Mrs Smith
Mrs Smith ‘s response to treatment has been poor. She has a moist chesty cough and is expectorating copious amounts of thick yellow sputum. She is able to tolerate small amounts of soft foods and drinks about 75mls of fluid every 2 hours. She is complaining that her bottom and heels are sore.
On examination the skin on her sacrum has started to break down and her heels are red as is the skin around the vulva.
What equipment would you provide next?
What nursing interventions would you put in place
Think about Mrs Smith heels, how would you prevent any further damage?
All together now PUSH. Pressure ulcers should be HISTORY.

7. Time to reflect What were your main topics of discussion?
As a result of the module, have your team agreed to any changes in current practice? If so document what they are and share
Pressure ulcers should be HISTORY