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TI S SUE VIAB I L I T Y


The risk of PU development may also be increased in the community setting as immobility will continue to be an issue in a care home or domestic settings. Those who are discharged from hospital with COVID-19 (who would have already been immobile for a while) are then experiencing further immobility due to social distancing measures.17


Furthermore, as COVID-19 is


debilitating, many people will be bedbound, further increasing the risk of PUs.18,19 Therefore, pressure ulcers could significantly increase in the hospital and community. This means that now, more than ever, it is critical that healthcare providers implement and adhere to best practice for the management of PUs for clinical efficiency as well as using the best resources available to deliver quality care to achieve optimal patient outcomes.7


Prevention and management Delivering optimal care will involve having a greater understanding of PUs, to know how to prevent them and how to treat them if they occur.7,20


many newly qualified or retired healthcare professionals have been deployed to specialist areas they may be unfamiliar with and some nurses may have had little experience managing PUs.9,21


their incidence and subsequent burdens.6,24 Hence, this is why tissue viability nurses have been set targets to reduce the incidence of PU damage by NHS programmes, such as Stop the Pressure.25,25


PU prevention is the most important step in their management.7


Prevention


involves early identification of risk factors for PU development and implementing interventions.20


For individuals that are


at risk of PUs, due to factors such as reduced mobility, prevention is focused on reducing episodes of prolonged pressure by either placing padding on pressure points such as the sacrum and heel or frequent repositioning of the patient, which should be done every 2-4 hours.7,20 However, if despite best efforts to prevent them, a PU has been identified, nurses should perform a full assessment of the wound. Wound assessment should focus on the location, size, depth of the wound and amount of exudate.7


PUs should also In light of COVID-19,


be graded or categorised to determine the extent of tissue damage and depth of the wound. According to the NPUAP, EPUAP and PPPIA grading system, PUs can fall into six categories, with six being the most severe.23


Nurses should


have a clear understanding of PUs and their causes as they hold the most responsibility for their prevention and management.20,22,23 As the factors that cause PUs are the targets for their management, it is crucial they are identified for an accurate diagnosis to inform an effective treatment plan.20 In addition, as 80-95% of PUs can be prevented, taking the appropriate preventative steps could significantly reduce


drainage and improve healing.


lWound dressings – to manage exudate. l Addressing the underlying cause for a holistic approach. 20,26


Accurate diagnosis and


categorisation is imperative if patients are to receive the best standard of care.20 For the treatment of PUs, some of the prevention strategies can also be applied.7 The treatment of PUs, according to NICE guidelines involves: l Offloading or pressure redistribution – to remove pressure from the site, by repositioning and applying padding to these pressure points.


l Debridement – to remove unwanted dead tissue from the wound to enable


80 l WWW.CLINICALSERVICESJOURNAL.COM


To mitigate the burden of a healthcare service already on the brink, PU preventative strategies, such as those previously mentioned, should be prioritised. Padding or dressings on areas that are likely to be exposed to pressure, such as the heels and sacrum in bedbound or at risk patients, should be used to reduce the risk.7,15 Healthcare providers should consider using dressings such as Mepilex Border Heel and Sacrum. They have been developed with ‘Deep Defence Technology’ to protect against forces that contribute to PU formation.15 The efficacy of Mepilex Border Sacrum and Mepilex Border Heel were reported in a study which investigated the effectiveness of multi-layered soft silicone foam dressings in preventing PU formation in critically ill patients. The patients in the intervention group that received the Mepilex Border Sacrum and Mepilex Border Heel dressings throughout their stay at hospital had significantly fewer sacral and heel PUs than those who received the control.15 Findings from this study suggest that the use of these dressings could help reduce the incidence of PUs in the hospital and the community. Preventing the formation of the PUs, in the first instance, would limit the financial and human burdens, which is now more important due to the current healthcare challenges.2,6


Once a PU has formed or is already present, it is important they are effectively managed to prevent them from deteriorating.23


PUs are commonly managed AUGUST 2020


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