COMMUNITIES DIRECTORATE
ADULT SOCIAL CARE
TITLE
Pressure Ulcer Prevention For
Older People’s Residential And Day
Service
SERVICE AREA;
OLDER PEOPLE
STATUS:
PROCEDURE
REF. NO.
PRO – 5006 / 2008
DATE ISSUED:
AUGUST 2007
REVIEW DATE:
AUGUST 2009
WRITTEN BY:
JILLIAN GUILD - HOMES
MANAGER
APPROVED BY:
HEAD OF SERVICE
BRIEF DESCRIPTION:
Care workers many support service users who are at risk from developing
pressure ulcers and therefore need to know how and why they occur and how
they can easily be avoided.
RELATED FORMS:
Form No:
Description:
Date Issued:
Communities Directorate
Adult Social Care
Direct Provision
Pressure Ulcer Prevention
For
Older People’s Residential
And
Day Services
Author:
Jillian Guild
Date:
August 2007
Review Date:
August 2009
Contents
1.
Introduction
2.
Understanding a Pressure Ulcer
3.
Skin
4.
Common Sites for Pressure Ulcer Development
5.
Risk Factors
6.
Prevention of a Pressure Ulcer Development
7.
Review of Service Users’ Needs
8.
Professionals who can help
9.
Glossary
Appendix 1:
Body Map
Appendix 2 :
Risk Assessment
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1.
INTRODUCTION
Care workers may support service users who are at risk from
developing pressure ulcers and therefore need to know how
and why they occur, and how they can easily be avoided.
Over the years, pressure ulcers have been called many
things, including bed sores – however, today they are known
as pressure ulcers.
2.
UNDERSTANDING A PRESSURE ULCER
There are two main layers which make up the anatomy of the
skin; the epidermis and the dermis. When pressure is
applied to the skin, the blood supply is cut off and the tissue
becomes damaged.
There are three main types of force that cause damage to
the skin through pressure. These are:
• Direct pressure – caused by direct pressure pressing
on the skin, which cuts off the blood supply.
• Shear or shearing force – caused by a one directional
force across the surface of the skin which makes the
blood vessels kink and cuts off the blood supply.
• Friction or friction force – caused by multi-directional
forces back and forth over the skin, which makes the
epidermis break away from the dermis and damages
the skin and blood vessels.
3.
SKIN
The length of time for a pressure ulcer to start forming is
different for each person: some people are more susceptible
than others. Previously people thought that pressure ulcers
started forming after two hours, but this is now known to be
inaccurate.
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4.
AREAS ON THE BODY THAT ARE COMMON SITES FOR
PRESSURE ULCER DEVELOPMENT
•
•
•
•
•
•
•
Scalp
Shoulder blades
Elbows
Sacrum
Heels
Ears
Hips
These areas can be identified by using a body chart
(Appendix 1). Pressure ulcers develop over bony
prominences.
Checking Skin for Pressure Damage:
5.
4.1
Initially, examine all the areas which are common sites
for pressure ulcer development for redness. If redness
on the skin is observed, feel the area to check for heat
and press the area with your fingers to check for
damage of the blood vessels.
4.2
When the reddened areas are pressed, healthy skin
will go white under pressure and then return to its
normal colour, but damaged skin will stay red, which
shows that the blood vessels are damaged.
4.3
In some cases, people have had to have amputations
and even died as a consequence of their pressure
ulcer.
RISK FACTORS
There are certain factors which make service users more
susceptible to pressure ulcers:
• Age
• Being under or overweight
• Moisture on the skin
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•
•
•
•
Reduced mobility
Circulatory problems
Lack of sensation
Previous history of pressure damage
A risk assessment (Appendix 2) will help measure the
likelihood of a pressure ulcer forming and how to minimise
further pressure developing.
A risk assessment will also show the important steps to take
to maximise the best outcomes for the individual. It must
also show all the people, whether professional carers or nonpaid carers, who are involved with supporting the individual.
The risk assessment will also identify the use of pressure
care equipment such as hoists, turning tables, profiling
cushions and mattresses, etc.
6.
PREVENTION OF PRESSURE ULCER DEVELOPMENT
There are many measures which can be taken to ensure that
the service user is as comfortable as possible and at the
least risk of developing pressure ulcers:
6.1
Allow the service user to sit in a chair that is the correct
height to prevent shearing forces.
6.2
Encourage the service user to alter their position every
two hours whilst seated.
6.3
Reposition the service user during the night, ensuring
they get a balance altering their position and gaining a
restful night.
6.4
Make the service user’s bed, ensuring there are no
ridges in the bedding that will act as a pressure point.
6.5
Do not tuck bedding in too tight and put pressure on
the service user’s toes.
6.6
Ensure service users do not sit on items of clothing,
such as zips or buttons.
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6.7
Keep the service user’s skin free from perspiration and
urine and use barrier creams if appropriate.
6.8
Pass on knowledge to the service user about pressure
ulcer risk factors and skin inspection.
6.9
Teach the service user to alter their position to
minimise friction and shearing forces.
6.10 If the service user has a lack of feeling in their feet,
ensure their shoes and socks are the correct size and
not too tight.
Service users can be taught how to inspect their own skin by
showing them how they can distinguish between simple
redness and actual pressure damage, and how to use a
mirror to look at parts of the body they cannot see.
7.
REVIEW OF SERVICE USERS’ NEEDS
The service user must have an individual care plan which
details the essential steps to prevent a pressure ulcer
developing. The individual’s care plan should also detail the
support and action needed to be taken if a pressure ulcer is
present.
Reviewing the service user’s day can highlight situations
when pressure damage may become a problem.
8.
PROFESSIONALS WHO CAN HELP WITH PRESSURE
ULCER PREVENTION
•
•
•
•
•
GP
Community District Nurses
Occupational Therapist
Physiotherapist
Skin Care Specialist Nurses
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Glossary
Blanching erythema – area of redness of the skin that turns white
when light finger pressure is applied and then returns to previous
colour once pressure is removed.
Bony prominence – an area of the body where the underlying
bone projects outwards and is a potential site for pressure
damage.
Cerebral Vascular Accident (stroke) – a disease of the
circulatory system that can result in paralysis and loss of sensation
and inability to feel the pain and discomfort of external pressure.
Urinary incontinence – the service user has lost full or partial
control of their bladder and is unable to control their flow of urine,
often they may be sat in wet clothes and the urine can damage the
integrity of the skin.
Dependant odema – a collection of fluid in the tissues of the lower
limbs, often due to prolonged sitting in the chair.
Dermis – the living lower layer of the skin.
Diabetes Mellitus – a multisystem disease in which the service
user has little or no insulin. As a result service users may develop
a loss of feeling in their feet and are subsequently unaware of the
pain and discomfort of external pressure.
Epidermis – the outer layer of the skin.
Muscle
Hair
Sebaceous
gland
Epidermis
Dermis
Nerve
Fat
Capillary
Erythema – non specific redness of the skin caused by, amongst
other things, pressure.
Extrinsic factors – factors external to the patient that put them at
risk of developing pressure damage eg catheters.
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Friction – the skin and an external force are rubbed together, this
can cause the damage and the separation of the epidermis from
the dermis.
Grading system – a framework that describes what a pressure
ulcer looks like and how deep it extends into the skin and
underlying tissue.
Non-blanching erythema – an area of redness of the skin that
remains red and does not turn white when light finger pressure is
applied, this is a grade one pressure ulcer.
Pressure – the skis in compressed between underlying bone and
the support surface, if the pressure is high enough and sustained
for long enough pressure ulceration will occur.
Pressure areas – areas of the body that contain bony
prominences and are prone to pressure damage.
Pressure relieving equipment – equipment that removes
pressure from different areas of the body.
Pressure relieving equipment – low tech – a conforming support
surface that distributes the weight of the service user over a larger
surface area thus reducing the pressure on the skin.
Pressure relieving equipment – high tech – an electronically
powered mattress or overlay that is made of air filled cells that
either alternately inflate and deflate or provide a constant low
pressure under the patient.
Pressure ulcer – an area of localised damage to the skin and
underlying tissue caused by pressure, shear, friction and or a
combination of these (European Pressure Ulcer Advisory Panel
1998).
Sacrum – the lowest end of the spinal column.
Shear – pressure applied to the skin at a 45 degree angle, often
occurring when a service user slides down from a sitting position to
a slumped position or lying position. The dragging of the skin
results in kinking of blood vessels and reduced blood supply to the
skin. In addition the epidermis can separate and slide off from the
underlying dermis.
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Common sites for pressure ulcers
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