TISSUE VIABILITY Monitoring
l Inspect the dressing at least once daily.
l Use risk status, local protocol and manufacturer’s instructions to determine frequency of skin assessment: skin assessment should fully visualise all of the skin at risk including the skin over any bony prominences. For non- transparent dressings this may require the dressing to be peeled back.
l The skin underneath dressings applied beneath medical devices should be assessedwhen and if the device can be moved or removed.
l Document findings of skin assessments and be specific, e.g. state whether or not erythema, blistering, skin denudation or breakdown, or bruising are visible, and whether or not any erythema is blanchable.
l Cleanse the skin covered by the dressing at each dressing change.
l Change the dressing earlier than planned if it is no longer fully adherent, is dislodged, rolled at the edges, wrinkled, creased or damaged, soiled, saturated or compromised in some other way.
l Do not leave the dressing in place for longer than stated in the manufacturer’s instructions.
l Document dressing selected, skin inspections, dressing changes, and timing and reason for discontinuation.
Table1.
For more information and to view a webinar on the document visit: l
http://www.molnlycke.co.uk/events/ stop-pressure-ulcer-day/
l
http://www.wuwhs2016.com/documents
References 1 NHS. Stop the pressure. Helping to prevent pressure ulcers.
http://nhs.stopthepressure.co.uk (Last accessed: 9 November 2016).
2 Dealey, C., Posnett, J., Walker, A. The cost of pressure ulcers in the United Kingdom. Journal of Wound Care 2012; 21 (6):261-266.
3 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline. In: Haesler, E. (ed). Cambridge Media, 2014.
4 National Pressure Ulcer Advisory Panel, European
Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline. In: Haesler, E. (ed). Cambridge Media, 2014
5 Costing statement: Pressure ulcers Implementing the NICE guideline on pressure ulcers (CG179) April 2014
6 Clark M, Bours G, de Fleur T. Summary report on the prevalence of pressure ulcers. Oxford: European Pressure Ulcer Advisory Panel (Europe); 2002. 49 p. Report no.: Volume 4, issue 2. 2. 3.
7 Vangilder C. Results of nine international pressure ulcer surveys: 1989-2005. Ostomy Wound Management. 2008; 54(2).
8 Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian healthcare settings. Ostomy Wound Management. 2004; 50 (10): 22-38
9 Prentice JL, Stacey MC. Pressure ulcers: the case for improving prevention and management in Australian health care settings.
62 I
WWW.CLINICALSERVICESJOURNAL.COM Primary Intention. 2001; 9: 111-120.
10 Zhao G, Hiltabidel E, Liu Y, Chen L, Liao Y. A cross-sectional descriptive study of pressure ulcer prevalence in a teaching hospital in China. Ostomy Wound Manage. 2010 Feb 1;56(2):38-42.
11 McIntyre L. A strategy to reduce avoidable pressure ulcers. Nursing Times. 2012; 108 (29): 14-17.
12 World Union of Wound Healing Societies. Consensus document. Role of dressings in pressure ulcer prevention. Wounds International, 2016.
13 International Wound Journal, March 2013 14 Posnett J, et al. The resource impact of wounds on health-care providers in Europe. Journal of Wound Care. 2009; 18:4.
15 Bennett G et al. The cost of pressure ulcers in the UK. Age and Ageing. 2004; 33: 230–235.
16 NHS Stop the Pressure. Pressure ulcer care best practice
http://nhs.stopthepressure.co.uk/ docs/Pressure_ulcer_care_best_practice.pdf
MARCH 2017 Dressing selection
l Select a dressing proven to reduce pressure ulcer occurrence in the patient group/clinical setting and position of use, e.g. at the anatomical location or under the medical device in question.
l Select a dressing that is suitably shaped for the anatomical location.
l Select a dressing that is large enough to cover the area at risk with a margin of overlap on to the surrounding skin of at least 2cm.
l Consider a dressing constructed of several layers
l When used to protect the skin under a medical device, select a dressing that will: Not interfere with the function of the device. Not increase pressure under the device, i.e. is not too thick.
Absorb excess moisture and/or transfer moisture to the environment (i.e. has a high moisture vapour transmission rate).
Dressing application
l Where possible, ensure the patient and carer(s) consent to dressing application and understand why a dressing is being applied.
l Follow manufacturer’s instructions for application – the skin will usually need to be clean and dry; creams and lotions should be avoided.
l Ensure the dressing: Fits and conforms closely to the anatomical location. Is properly adherent over its entire area and will not roll at the edges.
Extends beyond the area at risk (in some cases it may be possible to use several dressings that abut side by side to ensure adequate coverage of large areas at risk). Does not impede mobility.
l In a patient who is perspiring heavily (diaphoretic), only use a dressing after drying the skin and if confident that it will adhere.
l If used under a medical device, ensure the dressing fits under the device without leaving gaps and does not cause additional pressure or interfere with the functioning of the device.
l Where possible, medical devices should continue to be lifted and repositioned regularly when a dressing is used to allow skin examination and pressure relief.
Discontinuation
l Consider discontinuing a dressing that is being used for pressure ulcer prevention once no longer indicated or the risk of pressure ulcers has reduced, e.g. the patient is walking and/or moving purposefully when in a bed or a chair. Increased, but not full, mobility may result in increased shear and friction, e.g. when a totally immobile patient starts to move but cannot lift themselves clear of a support surface when changing position.
Transfer or discharge
l When the patient is moved or discharged from the department or healthcare setting that implemented the dressing, ensure documentation and clear communication regarding whether and how continued use of the dressing should occur accompanies the patient.
Stepping up care
l If pressure damage occurs, reassess the patient and skin, and manage according to local pressure ulcer treatment protocol.
Contraindications/ precautions
l Do not use a dressing that contains components to which the patient is sensitive or allergic.
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