1. By: Emily Ebright

2.  Cause:  Prolonged pressure on skin and tissue especially bony points, decreases blood flow to these areas.  Affected skin and tissue are deprived of nutrients and oxygen and start to die.  Contributing factors:  Immobility, mental and physical impairments, excess weight, increased age, dehydration, poor nutrition, bowel and bladder incontinence, smoking, and poor perfusion.

3.  Complications: Infection and sepsis, loss of quality of life, decreased life expectancy, cellulitis, bone and joint infection, and a form of cancer caused by wounds that heal slowly.  Scope of problem:  National Avg: 5 %  Local avg: 1.6%- 5% (Ayello, E. and Sibbald, G., 2012) (IMayo Clinic, 2015)

4.  For the Patient  Longer healing times  Weakened immune system  Loss of quality of life  Longer stays in a facility  For the Institution  Decrease in the amount of reimbursement  Wasted resources  Poor statistics and ratings (possible loss of business)  For healthcare resources  Wasted on preventable condition  Increased spending (Nationwide 11 billion a year to treat) (Reddy, M., Gill, S., Rochon, P., 2006)

5.  For patient care:  Ensure proper nutrition and hydration  Monitor and measure ulcers  Record progression of healing  For prevention/prophylaxis:  Ensure turning schedule is enforced  Skin checks  Keep patient dry- bowel and bladder program  Position with bony parts padded and reduce pressure on high risk parts  Initiate pressure sore prevention protocol for high risk patients.  Staff and patient education on ulcers.  Prevent and reduce sheering to the skin.

6.  Assess:  Skin Checks  Identify high risk patients  Address skin concerns early  Initiate interventions early  Plan  Change position q2  Keep clean and dry  Position off bony parts  Increase hydration and nutritional intake (protein)

7.  Intervene  Dressings to cover risk areas  Protect bony prominences  Increase Protein and caloric supplementation (snacks and shakes)  Specific plan of care for turning (turn sheet)  Create bowel and bladder program  Special weight distribution bed  Frequent skin assessment  Encourage as much independence and mobility as possible  Evaluate  Measure and evaluate healing and thoroughly document  Evaluate need for change in current plan.  Frequently assess skin for risk areas

8.  Initiatives  Skin check with 2 nurses on admission to the unit.  Braden daily skin assessment  Hyperbaric Chamber  Education  Informational Pamphlets  Online:  National Pressure Ulcer Advisory Panel  Mayo Clinic

9. Ayello, E. and Sibbald, G.( 2012). Hartford Institute for Geriatric Nursing, Nursing standard of practice protocol: Pressure ulcer prevention & skin tear prevention. Retrieved from: http://consultgerirn.org/topics/pressure_ulcers_and _skin_tears/want_to_know_more#item_4 Mayo Clinic. (2015). Diseases and Conditions: Bedsores, Retrieved from: http://www.mayoclinic.org/diseases- conditions/bedsores/basics/complications/con- 20030848 Reddy, M., Gill, S., Rochon, P. (2006) The Journal of American Medical Association. Preventing pressure ulcers: A systematic review. Retrieved from: http://jama.jamanetwork.com/article.aspx?articleid =203227