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Pressure ulcers and their care

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Pressure ulcers have been reported across all healthcare settings, affect all age groups and are costly in terms of quality of life and health care resources. Pressure ulcers develop when persistent  pressure on a bony site obstructs healthy capillary flow leading to tissue necrosis. This typically  occurs over a bony prominence but can occur in any situation where blood flow to the skin is impeded. The aetiology of pressure ulcers is multi-factorial and although mechanical forces are the  prime aetiological factors, more than 100 risk factors have been identified in the literature that reduce tissue tolerance and increase patient susceptibility (1).

Pressure ulcers and their care
Pressure ulcers cause suffering, increase morbidity and affect quality of life. British and US
figures suggest that around 10% of acute care hospital patients are affected. Other vulnerable people are those living in long-term residential care or in the community, such as wheelchair
users. 

A recent study investigating the costs of pressure ulcers in the UK identified that between £1.4 and £2.1 billion was being spent annually on treatment; this equates to 4% of total National Health Service expenditure (2). 

Pressure ulcers are multi-factorial in origin but commonly affect those persons who have
reduced mobility. Effective prevention and management strategies require person centred
care, an interdisciplinary approach and organisational support (3). 


Factors affecting pressure ulcers development
Patients should be assessed using a psychosocial model of care rather than using purely a physiological approach; this is particularly important for those patients who are being cared for in a community setting. When a patient is noted to be ‘at risk’ of pressure  damage, outcomes may be improved if the patient and those caring for them know why  they are ‘at risk’ and the measures required to prevent pressure ulcers from developing.  Patients and their carers may have outdated views on how pressure ulcers can be prevented  for example; use of surgical spirit, talcum powder and donut type cushions.

Use of pressure re-distributing devices such as specialist mattresses and cushions are a major
factor but are not the only intervention that should be implemented as part of a pressure
ulcer prevention programme. The ideal pressureredistributing  support system should be
comfortable, relieve pressure and prevent tissue damage. Although efficacy is important, in order to ensure patient concordance with the choice of mattress, patient comfort and quality of sleep should be among the most important factors involved in the decision-making process. Factors  which must be taken into account include:

• The desired outcome (a joint decision between patient and practitioner)
• Other risk factors such as nutritional and continence status
• Funds available
• How frequently the patient can be repositioned and reassessed
• The environment where the patient is being nursed
• Availability of carers 

Product selection must be based upon a full assessment and not solely on pressure ulcer risk
assessment scales.
 
References
1)  Lyder C (2003). Pressure ulcer prevention and management. JAMA; 289(2): 223-226.
2)  Bennett G, Dealey C, Posnett J (2004). The cost of pressure ulcers in the UK. Age and Aging; 33: 230-235.
3)  RCN (2005).The management of pressure ulcers in primary and secondary care.A clinical practice guideline. Royal College of Nursing. 

 

 
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