Pressure Ulcers: Beyond the Risk Scales

When it comes to pressure ulcer prevention and treatment, traditional risk assessment tools don’t always tell the whole story. Find out what does.

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As wound care professionals, we know how pressure ulcers can negatively effect patients’ lives. This serious skin condition can not only lead to further complications and higher costs, but can also inhibit a patient’s ability to participate in rehabilitation and ultimately lead an active role in their community.

So the more we can do to properly assess pressure ulcers from the very beginning, the more we can do to help promote healing, reduce hospital stays and accelerate recovery time. Obviously, this involves the use of valuable tools, such as the Braden Scale. But we should also implement a good dose of clinical judgment once pressure ulcer risk is determined. Here’s how:

It’s more than just a Risk Score

The 2014 International Guidelines on the Prevention and Treatment of Pressure Ulcers stress the importance of looking at other factors, and not just the Risk Score when establishing risk levels and interventions for your patients. As mentioned earlier, in order to accurately determine your patient’s risk, the use of traditional tools alone (like the Braden Scale) is no longer considered to be enough.

Since the current condition of the skin is a key factor to consider when determining risk levels and interventions, the Guidelines recommend that both risk and skin assessments should be completed within eight hours of admission.  And anytime a risk assessment is completed, a skin assessment must be done and documented right along with it.  This applies throughout the patient’s stay within your care setting.

What else should you do?

When examining your patient’s chances for developing a pressure ulcer, taking note of their current skin condition is crucial. Are there reddened areas that barely blanch, and are they frequently recurring over the same boney prominence? Answering questions like these is important.

We must always look at the bigger picture of risk, and then factor in additional information such as psychosocial status, size, care setting, support surface, lab data and other sources. According to the National Pressure Ulcer Advisory Panel’s Prevention and Treatment of Pressure Ulcers: Quick Reference Guide, risk factor assessment recommendations include:

  • Use a structured approach to risk assessment that includes assessment of activity/mobility and skin status.
  • Consider the impact of the following factors on an individual’s risk of pressure ulcer development: perfusion and oxygenation; poor nutritional status; and increased skin moisture.
  • Consider the potential impact of the following factors on an individual’s risk of pressure ulcer development: increased body temperature; advanced age; sensory perception; hematological measures and; general health status

In addition, the Reference Guide includes the following recommendations when conducting skin and tissue assessments:

  • In individuals at risk of pressure ulcers, conduct a comprehensive skin assessment: as soon as possible but within eight hours of admission (or first visit in community settings); as part of every risk assessment; ongoing based on the clinical setting and the individual’s degree of risk; and prior to the individual’s discharge.
  • Inspect skin for erythema in individuals identified as being at risk of pressure ulceration.
  • Include the following factors in every skin assessment: skin temperature; edema; and change in tissue consistency in relation to surrounding tissue.
  • Inspect the skin under and around medical devices at least twice daily for the signs of pressure-related injury on the surrounding tissue.

Are you on board?

Using your clinical judgment, along with traditional assessment tools, is a must when it comes to skin and risk assessment for pressure ulcers. We’d love to hear how you have learned to implement both within your facility. Have you noticed a difference in patient recovery? Do you think that this broader approach to assessment is well-known and practiced among your peers? Please leave your stories or comments below.

 

What do you think?

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When it comes to pressure ulcer prevention and treatment, traditional risk assessment tools don’t always tell the whole story. Find out what does.

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