Ulcer prevention guidelines -
Search database Books All Databases Assembly Biocollections BioProject BioSample Books ClinVar Conserved Domains dbGaP dbVar Gene Genome GEO DataSets GEO Profiles GTR Identical Protein Groups MedGen MeSH NLM Catalog Nucleotide OMIM PMC PopSet Protein Protein Clusters Protein Family Models PubChem BioAssay PubChem Compound PubChem Substance PubMed SNP SRA Structure Taxonomy ToolKit ToolKitAll ToolKitBookgh Search term.
Show details NICE Clinical Guidelines, No. Search term. ALGORITHM D - Management of pressure ulcers in adults PDF, K. ALGORITHM E - Management of pressure ulcers in neonates, infants, children and young people PDF, K. Key priorities for implementation From the full set of recommendations, the GDG selected 10 key priorities for implementation.
Carry out and document an assessment of pressure ulcer risk for adults. receiving NHS care in other settings such as primary and community care settings, and emergency departments, if they have a risk factor, for example:.
Offer adults who have been assessed as being at high risk of developing a pressure ulcer a skin assessment by a trained healthcare professional see recommendation 1. The assessment should take into account any pain or discomfort reported by the patient and the skin should be checked for:.
variations in heat, firmness and moisture for example, because of incontinence, oedema, dry or inflamed skin. Develop and document an individualised care plan for neonates, infants, children, young people and adults who have been assessed as being at high risk of developing a pressure ulcer, taking into account:.
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. If they are unable to reposition themselves, offer help to do so, using appropriate equipment if needed.
Document the frequency of repositioning required. assessed as being at high risk of developing a pressure ulcer in primary and community care settings.
Carry out and document an assessment of pressure ulcer risk for neonates, infants, children and young people:. receiving NHS care in other settings such as primary and community care and emergency departments if they have a risk factor, for example:.
Provide further training to healthcare professionals who have contact with anyone who is assessed as being at high risk of developing a pressure ulcer.
Training should include:. Discuss with adults with heel pressure ulcers and if appropriate, their carers, a strategy to offload heel pressure as part of their individualised care plan.
Full list of recommendations Document the surface area of all pressure ulcers in adults. If possible, use a validated measurement technique for example, transparency tracing or a photograph.
Document an estimate of the depth of all pressure ulcers and the presence of undermining, but do not routinely measure the volume of a pressure ulcer.
Document the surface area of all pressure ulcers in neonates, infants, children and young people, preferably using a validated measurement technique for example, transparency tracing or a photograph. Document an estimate of the depth of a pressure ulcer and the presence of undermining, but do not routinely measure the volume of a pressure ulcer in neonates, infants, children and young people.
Categorise each pressure ulcer in adults using a validated classification tool such as the International NPUAP-EPUAP Pressure Ulcer Classification System. Use this to guide ongoing preventative strategies and management.
Repeat and document each time the ulcer is assessed. Categorise each pressure ulcer in neonates, infants, children and young people at onset using a validated classification tool such as the International NPUAP-EPUAP Pressure Ulcer Classification System to guide ongoing preventative and management options.
Offer adults with a pressure ulcer a nutritional assessment by a dietitian or other healthcare professional with the necessary skills and competencies. Offer nutritional supplements to adults with a pressure ulcer who have a nutritional deficiency.
Do not offer nutritional supplements to treat a pressure ulcer in adults whose nutritional intake is adequate. Provide information and advice to adults with a pressure ulcer and where appropriate, their family or carers, on how to follow a balanced diet to maintain an adequate nutritional status, taking into account energy, protein and micronutrient requirements.
Do not offer subcutaneous or intravenous fluids to treat pressure ulcers in adults whose hydration status is adequate. Offer an age-related nutritional assessment to neonates, infants, children and young people with a pressure ulcer.
This should be performed by a paediatric dietitian or other healthcare professional with the necessary skills and competencies. Discuss with a paediatric dietitian or other healthcare professional with the necessary skills and competencies whether to offer nutritional supplements specifically to treat pressure ulcers in neonates, infants, children and young people whose nutritinal intake is adequate.
Offer advice on a diet that provides adequate nutrition for growth and healing in neonates, infants, children and young people with pressure ulcers. Discuss with a paediatric dietitian whether to offer nutritional supplements to correct nutritional deficiency in neonates, infants, children and young people with pressure ulcers.
Assess fluid balance in neonates, infants, children and young people with pressure ulcers. Ensure there is adequate hydration for age, growth and healing in neonates, infants, children and young people.
If there is any doubt, seek further medical advice. Use high-specification foam mattresses for adults with a pressure ulcer. If this is not sufficient to redistribute pressure, consider the use of a dynamic support surface.
Do not use standard-specification foam mattresses for adults with a pressure ulcer. Consider the seating needs of people who have a pressure ulcer who are sitting for prolonged periods. Consider a high-specification foam or equivalent pressure redistributing cushion for adults who use a wheelchair or who sit for prolonged periods and who have a pressure ulcer.
Use a high-specification cot or bed mattress or overlay for all neonates, infants, children and young people with a pressure ulcer.
If pressure on the affected area cannot be adequately relieved by other means such as repositioning , consider a dynamic support surface, appropriate to the size and weight of the child or young person with a pressure ulcer, if this can be tolerated.
Consider using specialist support surfaces including dynamic support surfaces where appropriate for neonates, infants, children and young people with pressure ulcers, taking into account their current pressure ulcer risk and mobility.
Tailor the support surface to the location and cause of the pressure ulcer for neonates, infants, children and young people. Do not routinely offer adults negative pressure wound therapy to treat a pressure ulcer, unless it is necessary to reduce the number of dressing changes for example, in a wound with a large amount of exudate.
Do not routinely use negative pressure wound therapy to treat a pressure ulcer in neonates, infants, children and young people. Do not use the following to treat a pressure ulcer in neonates, infants, children and young people:.
Assess the need to debride a pressure ulcer in adults, taking into consideration:. consider using sharp debridement if autolytic debridement is likely to take longer and prolong healing time. The following article describes successful efforts to improve pressure ulcer prevention that relied on the use of the components in the IHI bundle: Walsh NS, Blanck AW, Barrett KL.
Pressure ulcer prevention in the acute care setting. J Wound Ostomy Continence Nurs ;36 4 Each component of the bundle is critical and to ensure improved care, each must be consistently well performed. To successfully implement the bundle, it is important to understand how the different components are related.
A useful way to do this is by creating or following a clinical pathway. A clinical pathway is a structured multidisciplinary plan of care designed to support the implementation of clinical guidelines.
It provides a guide for each step in the management of a patient and it reduces the possibility that busy clinicians will forget or overlook some important component of evidence-based preventive care. Given the complexity of pressure ulcer preventive care, develop a clinical pathway that describes your bundle of best practices and how they are to be performed.
Return to Contents. The first step in our clinical pathway is the performance of a comprehensive skin assessment.
Prevention should start with this seemingly easy task. However, as with most aspects of pressure ulcer prevention, the consistent correct performance of this task may prove quite difficult. Comprehensive skin assessment is a process by which the entire skin of every individual is examined for any abnormalities.
It requires looking and touching the skin from head to toe, with a particular emphasis over bony prominences. As the first step in pressure ulcer prevention, comprehensive skin assessment has a number of important goals and functions.
These include:. It is important to differentiate MASD from pressure ulcers. The following articles provide useful insights on how to do this:. A comprehensive skin assessment has a number of discrete elements.
Inspection and palpation , though, are key. To begin the process, the clinician needs to explain to the patient and family that they will be looking at their entire skin and to provide a private place to examine the patient's skin. Make sure that the clinicians' hands have been washed, both before and after the examination.
Use gloves to help prevent the spread of resistant organisms. Recognize that there is no consensus about the minimum for a comprehensive skin assessment. Usual practice includes assessing the following five parameters:.
Detailed instructions for assessing each of these areas are found in Tools and Resources Tool 3B, Elements of a Comprehensive Skin Assessment. Comprehensive skin assessment is not a one-time event limited to admission. It needs to be repeated on a regular basis to determine whether any changes in skin condition have occurred.
In most hospital settings, comprehensive skin assessment should be performed by a unit nurse on admission to the unit, daily, and on transfer or discharge. In some settings, though, it may be done as frequently as every shift. The admission assessment is particularly important on arrival to the emergency room, operating room, and recovery room.
It may be appropriate to have more frequent assessments on units where pressure ulcers may develop rapidly, such as in a critical care unit; or less frequently on units in which patients are more mobile, such as psychiatry. Staff on each unit should know the frequency with which comprehensive skin assessments should be performed.
Optimally, the daily comprehensive skin assessment will be performed in a standardized manner by a single individual at a dedicated time.
Alternatively, it may be possible to integrate comprehensive skin assessment into routine care. Nursing assistants can be taught to check the skin any time they are cleaning, bathing, or turning the patient.
Different people may be assigned different areas of the skin to inspect during routine care. Someone then needs to be responsible for collecting information from these different people about the skin assessment. The risk with this alternative approach is that a systematic exam may not be performed; everybody assumes someone else is doing the skin assessment.
Decide what approach works best on your units. Assess whether your staff know the frequency with which comprehensive skin assessment should be performed. In order to be most useful, the result of the comprehensive skin assessment must be documented in the patient's medical record and communicated among staff.
Everyone must know that if any changes from normal skin characteristics are found, they should be reported. Nursing assistants need to be empowered and feel comfortable reporting any suspicious areas on the skin.
Positive reinforcement will help when nursing assistants do find and report new abnormalities. In addition to the medical record, consider keeping a separate unit log that summarizes the results of all comprehensive skin assessments. This sheet would list all patients present on the unit, whether they have a pressure ulcer, the number of pressure ulcers present, and the highest stage of the deepest ulcer.
By regularly reviewing this sheet, you can easily determine whether each patient has had a comprehensive skin assessment. This log will also be critical in assessing your incidence and prevalence rates go to section 5. Nursing managers should regularly review the unit log.
A sample sheet can be found in Tools and Resources Tool 5A, Unit Log. There are many challenges to the performance of comprehensive skin assessments. Be especially concerned about the following issues:. An example of a notepad to be used for communication among nursing assistants, nurses, and managers can be found in Tools and Resources Tool 3C, Pressure Ulcer Identification Notepad.
Comprehensive skin assessment requires considerable skill and ongoing efforts are needed to enhance skin assessment skills. Take advantage of available resources to improve skills of all staff. Encourage staff to:. This slide show illustrates how to perform a skin assessment: www.
org for useful advice on evaluating erythema and the proper staging of pressure ulcers. A full-body skin inspection does not have to mean visualizing all aspects of the patient in the same time period. As discussed above, one purpose of comprehensive skin assessment is to identify visible changes in the skin that indicate increased risk for pressure ulcer development.
However, factors other than skin changes must be assessed to identify patients at risk for pressure ulcers. This can best be accomplished through a standardized pressure ulcer risk assessment. After a comprehensive skin examination, pressure ulcer risk assessment is the next step in pressure ulcer prevention.
Pressure ulcer risk assessment is a standardized and ongoing process with the goal of identifying patients at risk for the development of a pressure ulcer so that plans for targeted preventive care to address the identified risk can be implemented.
This process is multifaceted and includes many components, one of which is a validated risk assessment tool or scale. Other risk factors not quantified in the assessment tools must be considered.
Risk assessment does not identify who will develop a pressure ulcer. Instead, it determines which patients are more likely to develop a pressure ulcer, particularly if no special preventive interventions are introduced.
In addition, risk assessment may be used to identify different levels of risk. More intensive interventions may be directed to patients at greater risk. Pressure ulcer risk assessment is a standardized process that uses previously developed risk assessment tools or scales, as well as the assessment of other risk factors that are not captured in these scales.
Risk assessment tools are instruments that have been developed and validated to identify people at risk for pressure ulcers.
Typically, risk assessment tools evaluate several different dimensions of risk, including mobility, nutrition, and moisture, and assigns points depending on the extent of any impairment.
Clinicians often believe that completing the risk assessment tool is all they need to do. Help staff understand that risk assessment tools are only one small piece of the risk assessment process.
The risk assessment tools are not meant to replace clinical assessments and judgment but are to be used in conjunction with clinical assessments.
Many other factors might be considered as part of clinical judgment. However, many of these factors, such as having had a stroke, are captured by existing tools through the resulting immobility.
Several additional specific factors should be considered as part of the risk assessment process. However, also remember that patients who are just "not doing well" always seem to be at high risk for pressure ulcers. Comprehensive risk assessment includes both the use of a standardized scale and an assessment of other factors that may increase risk of pressure ulcer development.
Remember that risk assessment scales are only one part of a pressure ulcer risk assessment. These scales or tools serve as a standardized way to review some factors that may put a person at risk for developing a pressure ulcer. Research has suggested that these tools are especially helpful in identifying people at mild to moderate risk as nurses can identify people at high risk or no risk.
All risk assessment scales are meant to be used in conjunction with a review of a person's other risk factors and good clinical judgment. While some institutions have created their own tools, two risk assessment scales are widely used in the general adult population: the Norton Scale and the Braden Scale.
Both the Norton and Braden scales have established reliability and validity. When used correctly, they provide valuable data to help plan care. The Norton Scale is made up of five subscales physical condition, mental condition, activity, mobility, incontinence scored from 1 for low level of functioning and 4 for highest level of functioning.
The subscales are added together for a total score that ranges from 5 to A lower Norton Scale score indicates higher levels of risk for pressure ulcer development. Scores of 14 or less generally indicate at-risk status. Total scores range from 6 to A lower Braden Scale score indicates higher levels of risk for pressure ulcer development.
Scores of 18 or less generally indicate at-risk status. This threshold may need to be adjusted for the specific patient population on your unit or according to your hospital guidelines.
Other scales may be used instead of the Norton or Braden scales. What is critical is not which scale is used but just that some validated scale is used in conjunction with a consideration of other risk factors not captured by the risk assessment tool.
By validated, we mean that they have been shown in research studies to identify patients at increased risk for pressure ulcer development. Copies of the Braden and Norton scales are included in Tools and Resources Tool 3D, Braden Scale , and Tool 3E, Norton Scale.
The risk assessment tools described above are appropriate for the general adult population. However, these tools may not work as well in terms of differentiating the level of risk in special populations.
These include pediatric patients, patients with spinal cord injury, palliative care patients, and patients in the OR. Risk assessment tools exist for these special settings but they may not have been as extensively validated as the Norton and Braden scales.
Overall scale scores provide data on general pressure ulcer risk and help clinicians plan care according to the amount of risk high, moderate, low, etc.
Subscale scores provide information on specific deficits such as moisture, activity, and mobility. These deficits should be specifically addressed in care plans. Remember, even a score that indicates no risk does not guarantee that a person will not develop a pressure ulcer, especially as their condition changes.
Consider performing a risk assessment in general acute care settings on admission and then daily or with a significant change in condition. However, pressure ulcer risk may change rapidly, especially in acute care settings.
Therefore, recommendations for frequency of risk assessment will vary. In settings where patients' status may change quickly, such as in critical care, risk assessment should be performed more frequently, such as every shift. In the OR, recommendations exist to assess on admission, at discharge to the recovery room, and periodically for operations lasting longer than 4 hours.
Consider the time in the holding and recovery rooms when assessing the time. For patients with more stable conditions, such as acute rehabilitation, pressure ulcer risk assessment may be less frequent.
What is important is that the frequency of pressure ulcer risk assessment be individualized to the person's unique setting and circumstances.
Documenting pressure ulcer risk is essential to ensure that all staff are aware of patients' pressure ulcer risk status. While documenting in the medical record is necessary, documentation alone may not be sufficient to ensure that all staff know the level of risk.
Among the options to consider for complete documentation are:. Remember that in documenting pressure ulcer risk, you want to incorporate not only the score and subscale scores of the standardized risk assessment tool, but also other factors placing the individual at risk.
This information is often included in narrative text. Risk status should be communicated orally at shift change or by review of the written material in the medical record or patient care worksheet.
Consider innovative approaches to conveying level of risk. For example, some facilities have color-coded the patient wristband, placed stickers on the patient chart or worksheet, or used picture magnets on the doors to indicate risk status.
The accuracy of a risk assessment scale depends on the person completing it. Experience has shown tremendous variability among staff even when evaluating the same patient. Therefore, training in how to use the scale is needed to ensure consistency.
Refer to Issue 5 under the General Assessment Series. Lindgren M, Unosson M, Krantz AM, et al. A risk assessment scale for the prediction of pressure sore development: reliability and validity. J Adv Nurs ;38 2 Internet Citation: 3.
What are the best practices in pressure ulcer prevention that we want to use?. Content last reviewed October Agency for Healthcare Research and Quality, Rockville, MD. Browse Topics. Topics A-Z. National Healthcare Quality and Disparities Report Latest available findings on quality of and access to health care.
Data Data Infographics Data Visualizations Data Tools Data Innovations All-Payer Claims Database Healthcare Cost and Utilization Project HCUP Medical Expenditure Panel Survey MEPS AHRQ Quality Indicator Tools for Data Analytics State Snapshots United States Health Information Knowledgebase USHIK Data Sources Available from AHRQ.
Notice of Funding Opportunities. Funding Priorities Special Emphasis Notices Staff Contacts. Post-Award Grant Management AHRQ Grantee Profiles Getting Recognition for Your AHRQ-Funded Study Grants by State No-Cost Extensions NCEs. AHRQ Grants by State Searchable database of AHRQ Grants.
PCOR AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. Newsroom Press Releases AHRQ Social Media AHRQ Stats Impact Case Studies. Blog AHRQ Views. Newsletter AHRQ News Now. Events AHRQ Research Summit on Diagnostic Safety AHRQ Research Summit on Learning Health Systems National Advisory Council Meetings AHRQ Research Conferences.
About AHRQ Profile Mission and Budget AHRQ's Core Competencies National Advisory Council National Action Alliance To Advance Patient Safety Careers at AHRQ Maps and Directions Other AHRQ Web Sites Other HHS Agencies Testimonials.
Careers Contact Us Español FAQs. Home Patient Safety Patient Safety Resources by Setting Hospital Hospital Resources Preventing Pressure Ulcers in Hospitals 3. What are the best practices in pressure ulcer prevention that we want to use?
Preventing Pressure Ulcers in Hospitals 3. Previous Page. Next Page. Table of Contents Preventing Pressure Ulcers in Hospitals Overview Key Subject Area Index 1. Are we ready for this change? How will we manage change? How do we implement best practices in our organization? How do we measure our pressure ulcer rates and practices?
How do we sustain the redesigned prevention practices? Tools and Resources. Consensus should be reached on the following questions: What "bundle" of best practices do we use? How should a comprehensive skin assessment be conducted?
How should a standardized pressure ulcer risk assessment be conducted? How frequently? How should pressure ulcer care planning based on identified risk be used? What items should be in our bundle? What additional resources are available to identify best practices for pressure ulcer prevention?
Some of the factors that make pressure ulcer prevention so difficult include: It is multidisciplinary: Nurses, physicians, dieticians, physical therapists, and patients and families are among those who need to be invested.
It is multidimensional: Many different discrete areas must be mastered. It needs to be customized: Each patient is different, so care must address their unique needs. It is also highly routinized: The same tasks need to be performed over and over, often many times in a single day without failure.
It is not perceived to be glamorous: The skin as an organ, and patient need for assessment and care, does not enjoy the high status and importance of other clinical areas.
Knowing guiidelines patients Ulcer prevention guidelines at risk for a pressure ulcer is not enough; preventikn must do something about it. Care guuidelines provides the guide for what Ulfer will actually Chronic hyperglycemia and glycemic control Ulcer prevention guidelines prevent Ulecr ulcers. Once risk assessment has prevrntion identify patient risk factors, it is important to match care planning to those needs. A score that indicates a patient is not at risk does not guarantee that the patient will not develop a pressure ulcer. While the total score may help prioritize your use of resources, think beyond the score on the overall risk assessment tool and address all areas of potential risk in every patient. This means addressing at-risk scores on each subscale, as well as other risk factors not quantified on the subscales. Clinical guideline [CG] Published: 23 April prevebtion This guideline covers risk assessment, prevention and treatment in children, Elevated fuel utilization potential people and huidelines at risk of, or guideliness have, a guiddlines Ulcer prevention guidelines also known as a bedsore or pressure sore. It aims to reduce the number of pressure ulcers in people admitted to secondary or tertiary care or receiving NHS care in other settings, such as primary and community care and emergency departments. We checked this guideline in November We found no new evidence that affects the recommendations in this guideline.
Wacker, dieser ausgezeichnete Gedanke fällt gerade übrigens
wacker, die ausgezeichnete Antwort.
Dieser topic ist einfach unvergleichlich:), mir ist es sehr interessant.
Ja, vollkommen
Es ist Gelöscht (hat den Abschnitt) verwirrt