Nurses and other health care professionals providing care to patients regularly face challenges that can make it more difficult to perform routine tasks and ensure patient comfort and well-being, especially with regard to pressure ulcer/injury prevention and treatment. From a lack of mobility to chronic diseases, these challenges often coincide and interplay, creating unique risks and complications in managing the care of patients. To address these issues effectively, it is important to be aware of key best practice techniques for preventing pressure injuries and to stay proactive. This blog provides a brief overview of three of the most common patient challenges related to pressure injury prevention and offers strategies for effectively addressing each.

1. Immobility

Patients who are homebound, in hospitals, or in long-term care facilities often lack mobility because of age or other conditions. Many health care professionals also encourage less activity to reduce the risk of falling. This issue has become so prevalent that one study found that hospital patients spend over 95% of their time in bed.¹ However, limited mobility while in bed or in a chair can pose several other risks for patients.

A lack of movement may contribute to general functional decline, deteriorating mental health, and pressure injuries.^1,2 To address limitations in mobility, health care professionals should take steps to encourage controlled activity when possible. This means encouraging patients to take supervised walks to reduce the risk of falling. For those patients who are unable to walk or move themselves, it is important to reposition them regularly to prevent pressure injuries.^1,2 For risk secondary to sensory perception, consider limiting time in a chair or wheelchair to intervals of no more than one to two hours, encouraging position changes every 15 minutes while in chair, and teaching the patient and family the importance of turning and positioning.

2. Chronic Wounds

Chronic wounds (wounds where healing progress has stalled for 30 days) affect approximately two percent of the population, with significantly higher rates among the elderly and patients in hospitals.³ Pressure injuries account for a significant number of chronic wounds, making these injuries a major challenge for health care professionals. Managing pressure injuries and other chronic wounds can be incredibly time consuming and costly to treat.³ To address this issue effectively, it is important to follow wound care best practices and take steps to promote patient comfort and reduce the risk of complications that may be costly and dangerous to patients, such as infection.

Pressure injuries require a focused wound treatment regimen that includes a critical look into preventive measures. Once a pressure injury has been identified, risk factors should be reassessed, such as drugs that impede healing, uncontrolled diabetes, anemia, hypothyroidism and malnutrition. The care plan should then be intensified to ensure the most effective healing environment and to prevent additional wound development. Best practices recommend using advanced wound care products that enhance healing, mitigate the risk of infection, and control wound pain.⁴

3. Incontinence

Incontinence increases a patient’s risk of developing a pressure injury and poses a significant challenge for health care professionals. Incontinent patients are at risk for moisture-associated skin damage, such as incontinence-associated dermatitis and wound infection. To reduce the risk of complications associated with incontinence, it is important to follow a comprehensive skin care regimen that involves regularly repositioning patients to avoid irritation or erythema, cleansing the skin using pH-balanced products, moisturizing the skin, and protecting exposed skin using barrier products.^5,6

Consider using absorbent pads or briefs that wick away moisture. It is also important to ensure that any wound dressings used are impermeable to moisture to prevent the ingress of fluid that may irritate the wound or cause infection.⁷ Staying current with evidence-based practices for these issues is critical to ensuring good patient health and optimizing the prevention and treatment of pressure injuries. This guide represents only a brief overview of effective approaches to managing several common challenges associated with pressure injuries. It is important for health care professionals to research proactively the techniques that meet the unique needs of their patients and comply with facility protocol. This approach can make a significant impact on the effort to minimize the risk of complications associated pressure injuries and to streamline care in the facility.

References:

1. Growdon ME, Shorr RI, Inouye SK. The tension between promoting mobility and preventing falls in the hospital. JAMA Inter Med. 2017 Jun 1;177(6):759-60. doi:10.1001/jamainternmed.2017.0840.

2. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler, ed. Cambridge Media: Osborne Park, Western Australia; 2014.

3. Järbrink K, Ni G, Sönnergren H, et al. Prevalence and Incidence of Chronic Wounds and Related Complications: A Protocol for a Systematic Review. Syst Rev. 2016 Sep 8;5(1):152. doi:10.1186/s13643-016-0329-y.

4. HSE Office of the Nursing Services Director. National Best Practice and Evidence Based Guidelines for Wound Management. www.lenus.ie/hse/bitstream/10147/92646/1/HSE+Wound+Management.pdf. Published October 2009. Accessed October 24, 2017.

5. Beeckman D. Incontinence-Associated Dermatitis: Moving Prevention Forward. Wounds international. www.woundsinternational.com/consensus-documents/view/incontinence-assoc…. Published February 13, 2015. Accessed October 24, 2017.

6. Gray M, Black JM, Baharestani MM, et al. Moisture-associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nurs. 2011 May-Jun; 38(3):233-41. doi: 10.1097/WON.0b013e318215f798.

7. Chatham N, Carls C. How to Manage Incontinence-Associated Dermatitis. Wound Care Advisor. www.woundcareadvisor.com/how-to-manage-incontinence-associated-dermatit…. Published May 8, 2012. Accessed October 24, 2017.