Are you or a loved one at risk of developing a pressure ulcer?
Do you or a loved one have reduced mobility? Reduced appetite/fluid intake? Incontinence? Long term health condition?
Today is a national campaign to raise awareness of pressure ulcers (bed sores) and help prevent people from developing one or more!
Pressure ulcers can be very serious and cause a lot of harm to the person. They are painful and can come with complications such as cellulitis (infection of the skin and connective tissues), bone and joint infections and sepsis (serious systemic infection). It is so important to identify those at risk and ensure adequate prevention is put in place to avoid people from developing pressure damage.
What is a pressure ulcer?
Pressure ulcers are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. Have a think… Without realising it we are prompted by our own body to move our position by either a pain or uncomfortable feeling in the area with prolonged pressure. When sat for a long period the boney area on our bottom begins to hurt and so we shift position. This is because the prolonged pressure to that boney prominence had resulted in the small blood vessels in the skin being closed off. Without the blood (carrying oxygen) to the skin, the skin cells begin to die. As more skin cells die to that area, tissue death leads to pressure damage. This damage is created from the bone right through to the surface that we see which means that when we notice changes to the outer skin, this also means the damage extends down to the bone. Hopefully these skin changes are noticed quickly, and prevention is put in place to stop deterioration but unfortunately in those people where risk factors are not addressed then pressure ulcers develop. Pressure ulcers are graded 1-4 with a grade 4 pressure ulcer extending down to visible bone or internal structures. Just imagine those of us who either have reduced sensation or are unable to move themselves!
Who is at risk?
All patients are potentially at risk of developing a pressure ulcer. However, they are more likely to occur in people who are seriously ill, have a neurological condition, impaired mobility, impaired nutrition, or poor posture or a deformity. Also, the use of equipment such as seating or beds which are not specifically designed to provide pressure relief, can cause pressure ulcers.
If the following applies to you or your loved one, then you will find that you/they are at risk:
- Being admitted to secondary care or care homes in which NHS care is provided or
- Receiving NHS care in other settings (such as primary and community care and emergency departments) if they have a risk factor, for example:
- significantly limited mobility (for example, people with a spinal cord injury)
- significant loss of sensation
- a previous or current pressure ulcer
- nutritional deficiency
- the inability to reposition themselves
- significant cognitive impairment.
What do you need to do if you/they are at risk?
- Check the skin regularly– look for changes in colour or discolouration, variations in heat, firmness and moisture (for example, because of incontinence, oedema, dry or inflamed skin).
- Check Surfaces– make sure that there are no devices causing pressure damage to the skin. Look at providing a specialised pressure redistributing mattress or cushion.
Pressure redistributing mattresses and cushions come in different forms depending if the person is low/medium/high/very high risk– make sure you have the best surface for the person.
If legs are elevated onto a stool- encourage the person to place their legs on a cushion on the stool and have their heels over the edge so that prolonged pressure to the heels is reduced. Check that footwear fits well and not causing excessive friction.
If the person is bedbound it is good practice to elevate the heels off the mattress, so they are suspended.
Look at Transfer aids such as slide sheets to reduce friction and sheer forces that add to the risk of pressure ulcers.
Check the persons posture when seated so that excessive pressure is not put on the bone around the bottom. The chair needs to be the correct size for the person so their feet can reach the floor comfortably so that they are in a good position and to avoid slippage creating sheering forces.
- Movement– as mentioned before- it is the blood supply being cut off that causes a pressure ulcer to form. If you remove the pressure to the boney prominence and get the blood flowing to that area it will prevent cell death. Encourage adults who have been assessed as being at risk of developing a pressure ulcer to change their position frequently and at least every 6 hours. Encourage adults who have been assessed as being at high risk of developing a pressure ulcer to change their position frequently and at least every 4 hours. If they are unable to reposition themselves, help needs to be arranged using appropriate equipment if needed. Do NOT massage the skin to prevent pressure ulcers.
- Moisture control– for people who are incontinent you must ensure that this is managed well and the person has regular personal care. The skin needs to be washed using PH balances cleaning products and kept as dry as possible. Barrier creams/sprays can be used to help protect the skin from incontinence in between personal care. Encourage the person to visit the toilet regularly or if this is difficult look at getting a bathroom aid such as a commode.
In some causes people can get excoriated skin as a result of poor incontinence management and skin care, this is called incontinence associated dermatitis and leaves the skin vulnerable to pressure damage
- Nutrition and hydration– our skin is fed by what we eat and drink and this has a significant impact on its health. Aim to eat a well balance diet that includes vitamins and minerals (fruit and vegetables), protein (dairy, meat and fish), and carbohydrates. Drink 8 glasses of water a day to keep skin hydrated. If you or your oved one has lost weight and has a poor appetite- consider speaking to your GP where you may be prescribed supplements and have a referral to a dietician.
- Ask for help– if you feel that you are at risk or have noticed change to your skin make sure that you seek help in good time to avoid the suffering pressure ulcers cause. Contact your GP or local nursing team for advice and support if you think you skin has deteriorated.
- One of our clinicians at Total Body Orthotics is more than happy to advice in this area and we have more pressure ulcer prevention products coming soon.
Here is a video explaining how pressure ulcer effect people