Best Practices in Pressure Ulcer Prevention

Bette McNee, BSN, RN, NHA, senior clinical risk management consultant, Graham Company

Pressure ulcers, or bedsores, are a significant concern in senior care facilities, especially when residents have limited mobility. According to a case report, researchers have proven that pressure ulcers occur in 17% to 28% of patients over 70 years old in nursing homes.

Fortunately, pressure ulcers can be prevented. By creating a program consisting of best practices, senior care organizations can help residents to avoid these painful sores.

Understanding the Causes of Pressure Ulcers

Pressure ulcers are commonly attributed to the pressure created when a resident is bedridden or has limited mobility, but many more factors contribute to the condition. Bette McNee, BSN, RN, NHA, senior clinical risk management consultant at Graham Company, explains that people often assume pressure ulcers result primarily because of a lack of movement.

“In reality, there is a complex set of internal and external risk factors that play a role,” she says. “That’s why it’s vital to get a holistic assessment of an individual’s health, habits and physical environment to determine the best course of action.”

McNee explains that healthy skin and healing depend on proper nutrition, and that seniors may need nutritional supplements, since their bodies don’t absorb nutrients as effectively as they used to.

With decreased mobility, there is less blood profusion to tissues, which can increase the chance of pressure ulcers. Sweating on synthetic mattresses can further compromise skin integrity, and chronic diseases like diabetes and metabolic disorders can affect the rate of healing. All of these factors can contribute to pressure ulcer risk.

Best Practices in Preventing Pressure Ulcers

Senior care organizations can focus on skin care, optimal nutrition, and regular mobility to help prevent pressure ulcers. If residents depend on assistance for mobility, McNee notes that they should receive assisted restorative exercises and physical therapy.

“In many cases, traditional nursing best practices of keeping skin clean helps to avoid maceration and breakdown of skin tissue,” says McNee. “In cases of urinary and fecal incontinence, special attention should be paid to frequent cleaning with products designed to rinse easily and restore the pH level of the skin.”

Organizations can also support residents through the use of equipment including low loss air mattresses, shower chairs, and an adaptive bath set up to support pressure ulcer prevention. “While equipment can be a great resource, it should not be viewed as a cure-all,” advises McNee. “Specialized equipment should be complemented with a proactive care regimen and vigilance o the part of facility staff.”

A key element in preventing pressure ulcers depends on a team-based approach to care. “A key, but often overlooked, best practice is to assemble an interdisciplinary team that assesses the whole person, fully understanding all the factors that are resulting in ulcers and addressing the root causes,” says McNee. “For example, if you help someone better manage their diabetes, you’re also putting their body in a better place to fight ulcers.”

It’s essential that the team establish communication and documentation practices. McNee encourages organizations to keep family and loved ones fully informed about their loved one’s health, including factors that contribute to pressure ulcers. “Since there’s a limit to what one can do to manage these factors, it’s equally important to thoroughly document all treatments and health reports to minimize risk for the organization, its caregivers and staff.”

McNee notes that there are situations where unavoidable ulcers still can develop. “In those cases, it’s important to minimize their impact to the greatest extent possible and ensure that the individual’s overall health is maintained,” she says.

“From both a quality of care and risk management perspective, assembling an interdisciplinary team that assesses the full picture of an individual’s health ensures better outcomes and lowers exposure to risk for the facility,” says McNee. “At Graham, we make sure our clients’ facilities are assessing all factors that contribute to pressure ulcers and helping them put protocols and tools in place to mitigate them from happening.”

Paige Cerulli

Paige Cerulli is a contributing writer to i Advance Senior Care.