Proper Pressure Ulcer Prevention

Posted: August 1st, 2011 in Advance for Long-Term Care Management

Proper Pressure Ucler Prevention

by James G. Spahn

To assist the general public as they research potential long-term care facilities for themselves or their loved ones, new quality measures have been issued by the federal government to aid in their decision process. In order for consumers to accurately and effectively compare potential facilities, these new measures consider patients' outcomes and personal experiences while at the given facility and track the percentage of patients who have been subject to each measure.

Whether positive or negative, this readily available information gives the necessary parties insight into the level of patient care they can expect at each facility. As caregivers strive to lower pressure ulcer incidence, it's no surprise that pressure ulcer risk is included in the issued measures.

To better quality care in relation to the prevention and treatment of pressure ulcers, long-term care providers must pay close attention to the products they are using. The proper selection of products cannot be based solely on hypothetical concepts, promotional materials, or "the more the better" philosophy. Proper product utilization combines clinical effectiveness and reasonable cost so the product usage outcomes match the clinical and financial expectations. In short, product selection should be based on scientific and clinically substantiated outcomes utilizing the most cost-effective product, which will deliver equivalent results.

With the above as the mindset for product selection, one can address the support surface usage in a more rational fashion. This understanding, based on scientifically proven facts of physics, chemistry, anatomy and mechanics, will help caregivers select products which meet their needs and thus match their expectations.

Defining the difference between comfort needs and pressure ulcer prevention/intervention needs is very important. Comfort products deliver different outcomes than pressure ulcer-related products. The products used for comfort only are usually less expensive (egg crates, foam overlays without friction reducing covers, and contouring mattresses without pliable friction reducing covers). In the same light, unquestioned usage of expensive surface products (mechanized surfaces utilizing low air loss, alternating and fluidized technologies) don't always make economic sense when mid-cost products (static fluid--air or liquid) can give equivalent clinical results. This demonstrates how underutilization can be clinically dangerous and overutilization can be financially foolish.

The key to success in the prevention and treatment of pressure ulcers is to use protocols that identify product categories based on clinical outcome goals. The clinical outcome goals and corresponding product categories are as follow:

• Foam overlays without friction reducing covers should be used when the goal is to provide only comfort and pain management.
• Static fluid devices, either air or liquid, should be provided to patients for prevention of all risk levels, as well as for treatment of all stages of pressure ulcers, including deep tissue injuries (DTI).
• Low-air loss and air-fluidized products should be used for the treatment of post-flap and non-responding stage III, IV and unstageable pressure ulcers.

This approach of ramping up to and down from the more expensive products is simple for caregivers to follow and will give better clinical outcomes with marked cost savings.

A new approach that allows caregivers to detect and prevent pressure ulcers is the use of infrared thermal imaging and predictive modeling software. Thermal imaging provides a non-invasive, non-radiating means to assess physiologic activity below the skin's surface to locate at-risk areas that are not yet visible to the naked eye. In addition, predictive modeling is able to use patient data and apply advanced algorithms to provide unbiased risk assessments. Long-term care providers can define the differing effects support surfaces have on the soft tissue of each patient and extrapolate individualized care plans that lead to the proper matching of support surfaces to individual patients' needs.

In order to effectively prevent and treat pressure ulcers, there are many important factors, in addition to support surfaces, that must be addressed. First, complete assessments should be done upon admission and weekly thereafter or as per facility policy. If a pressure ulcer is present and progress in healing has not been made within two weeks of product selection, caregivers should reevaluate the care plan and consider a support surface change.

Also, if at any time it is noted that goals have been met, they should move back to the prior level of care. For additional assistance in identifying at-risk patients, the use of accepted risk scales that include a comprehensive physiologic status assessment are suggested as basis for prevention, early intervention and treatment goals relating to staff requirements and product selection. A comprehensive risk assessment should be used for prevention and treatment of pressure ulcers on the ankle, foot and heel, due to the fact that support surfaces alone cannot adequately address this problem, along with foot drop and lateral rotation.

To ensure equalized load redistribution is provided at all times, long-term care providers must implement the proper products on all surfaces including wheelchairs, geri-chairs, transportation beds, etc. Addressing outside factors can also prove beneficial in prevention and treatment. These factors include but are not limited to nutrition, incontinence, moisture and the general physiologic state of the patient. Knowing a patient's history is critical when deciding on a proper support surface. When patients have had previous pressure ulcers, caregivers must always consider them moderately or highly at risk for future pressure ulcers.

In summary, product education and knowledge can greatly aid in the reduction of pressure ulcer incidence throughout the long-term care setting. With the availability of equalized load redistribution products, it's important to use scientifically proven solutions that provide the most clinical and cost-effective patient care.

Dr. James G. Spahn is the founder of two wound care companies: EHOB Inc. and WoundVision.