Pressure Ulcer Prevention

Abstract

The purpose of this article is to provide education to the RN regarding pressure ulcer prevention and best practice interventions. This investigation focuses on the definition of a pressure ulcer, risk factors for pressure ulcers, and the benefits and importance of using unlicensed assistive personnel to help prevent pressure ulcers. A comprehensive literature review was completed using the Texas Woman's University Library, the Texas Christian University Library, and the World Wide Web. The search engine used was Google. The databases included were CINAHL, Academic Search Complete, Cochrane Library, MEDLINE, and ProQuest Nursing & Allied Health Source. The literature was current, defined as from the last 10 years, and the primary language searched was English. Full-text articles from these databases were included as well as print publications from the university collections. The key search terms from the literature review included (a) pressure ulcer, (b) prevention, (c) unlicensed assistive personnel, (d) nursing assistant, (e) theory of nursing knowledge, (f) incidence, (g) prevalence, (h) Braden scale, (i) moisture, and (j) repositioning. Best practice guidelines were reviewed via the Joanna Briggs database, National Guideline Clearinghouse, Cochrane Library, the Centers for Medicare & Medicaid Services, and the National Institutes of Health. Literature was synthesized to define evidence-based practices that would justify the use of unlicensed assistive personnel for the prevention and care of pressure ulcers.

Factors in facilitating an organisational culture to prevent pressure ulcers among older adults in health-care facilities

“…7,9,15,29 Support from senior leadership is critical for an ongoing commitment to professional development, protected education time and resource development for patients and families. 2,9,15,16,18,23 Staff education is crucial for increasing knowledge and building capacity to decrease HAPU, although increased knowledge does not always translate into sustained practice. 2, 21,27 Knowledge retention is dependent upon at least an annual review of PU prevention delivered in a short, interactive session focused on a single topic with opportunities for hands-on practice.…”

“…However, few health-care facilities mandate an annual review of PU prevention for existing staff. 2,5,8,[15][16][17]20,25 HCA are often excluded from ongoing education, but their participation is fundamental to practice change because they are the largest group of health-care workers and provide the most direct patient care of any discipline. 11,22,24 Well-educated and engaged HCAs can identify skin changes early and are empowered to notify nursing staff to further assess and intervene.…”

“…11,22,24 Well-educated and engaged HCAs can identify skin changes early and are empowered to notify nursing staff to further assess and intervene. 15,22 With only one in three patients and families reporting that they have received PU prevention information from staff, effective patient and family education establishes practice change. Ongoing quality improvement initiatives and PU prevalence and incidence studies result in ongoing monitoring.…”

“…3,4,7,12 Insufficient staff knowledge, negative attitudes, inconsistent care, and a perceived lack of time, resources and staff are barriers encountered by frontline staff. 2,3,5,8,12,15,[18][19][20][21][22][23][24][25] Organisational barriers can be overcome if factors are promoted that facilitate an ongoing focus on PU prevention. However, while rates of HAPU universally decrease after implementation of PUPP positive outcomes are not routinely sustained beyond four years of implementation.…”

“…3,[10][11][12] They cost the health-care system billions of dollars each year, take up time and resources, increase complications and length of stay in hospital, and result in a threefold increase in admissions to long-term care facilities. 10,11,[13][14][15] PUs are associated with debilitating negative health outcomes for older adults, such as pressure ulcer prevention • pressure ulcer • older adult • organisational culture decreased quality of life (QoL), pain, depression, social isolation, loss of mobility, loss of autonomy, impaired social roles, and altered self-image. 2,10,14 Due to acute medical events, comorbid conditions, side effects of medications, or changes at end-of-life, some types of skin injuries are medically unavoidable despite prevention interventions that meet or exceed the standard of care.…”