Understanding pressure ulcers: prevention and management

Understanding pressure ulcers

• Immobile or have limited mobility
• Incontinent
• Malnourished
• Suffering from chronic conditions such as diabetes or heart disease

Key pressure care techniques

1. Regular assessment: Conduct routine assessments of residents’ skin to identify those at risk and detect early signs of pressure ulcers.
2. Skin inspection: Regularly inspect the skin, especially over bony areas like the heels, hips, elbows, and sacrum, where pressure ulcers are more likely to form.
3. Pressure redistribution: Use pressure-relieving devices such as specialist mattresses, cushions, and pillows to distribute weight evenly and reduce pressure on vulnerable areas.
4. Skin hygiene: Maintain excellent skin hygiene to prevent infections and irritation, ensuring skin is clean and dry, especially in individuals with incontinence.
5. Nutrition and hydration: Proper nutrition and hydration are essential for skin health and tissue repair. Ensure residents have balanced diets and sufficient fluid intake to promote skin integrity.
6. Mobility and activity: Encourage regular movement and activity to stimulate circulation, which helps prevent the formation of pressure ulcers.
7. Staff training: Provide staff with comprehensive training on the prevention and management of pressure ulcers. This includes recognizing early warning signs, correctly positioning residents, and using equipment effectively.

Pressure care equipment

1. Pressure-relieving mattresses: These mattresses are specifically designed to reduce the pressure exerted on the skin by redistributing weight evenly. There are different types, including static foam mattresses and dynamic air mattresses, which alternate pressure levels to prevent prolonged compression in any one area.
2. Cushions and overlays: Pressure-relieving cushions and mattress overlays can be placed in wheelchairs or beds to help reduce pressure on key areas like the buttocks and lower back. These are particularly useful for residents who spend long periods seated or in bed.
3. Heel protectors: The heels are particularly vulnerable to pressure ulcers. Heel protectors, often made of foam or gel, help to offload pressure from this delicate area, reducing the risk of sores developing.
4. Turning and positioning devices: Regular repositioning is vital for residents who are immobile or have limited mobility. Devices such as positioning wedges and turning slings help staff reposition residents safely and comfortably, reducing the strain on care staff and ensuring correct positioning.
5. Incontinence pads and Skin barriers: Residents who are incontinent are at higher risk of developing pressure ulcers due to the presence of moisture and bacteria. High-quality incontinence pads, alongside skin barrier creams, help to keep the skin dry and protected from irritation.
6. Specialty beds: Some residents may benefit from specialty beds that allow for easier repositioning and automated pressure relief. These beds can help reduce the risk of pressure ulcers for residents who require long-term bed rest.

Choosing a pressure care approach

• Resident needs: Each resident’s mobility, risk factors, and medical conditions must be considered when choosing equipment and strategies.
• Available resources: Evaluate your care home’s resources, including budget, staffing levels, and access to pressure care equipment.
• Evidence-based practices: Utilise techniques and equipment that are backed by clinical research and best practices to ensure optimal outcomes.
• Collaboration: Work closely with healthcare professionals, including nurses, dietitians, and wound care specialists, to develop a comprehensive care plan for each resident.

Challenges and considerations

1. Resource constraints: Limited financial and staffing resources may make it challenging to implement every aspect of an effective pressure care program. However, focusing on key interventions such as staff training and the acquisition of critical equipment can still have a significant impact.
2. Staff training: Ongoing training is essential to ensure staff are up-to-date on the latest practices in pressure care, including how to use new equipment effectively.
3. Compliance: Care homes must ensure that they comply with regulatory standards and best practice guidelines related to pressure ulcer prevention.
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