hospital acquired pressure ulcers
Post on 23-Feb-2016
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Hospital Acquired Pressure Ulcers
Background – Harm
• Incidence of Stage II or greater > Hospital-Acquired Pressure Ulcers ranges from 5% - 9%
• 60, 000 die from pressure ulcer complications each year
Background – Harm
• Decrease quality of life and functionality
• Increase risk of other complications
• Increase hospital mortality
• Increase need for skilled care and rehab after discharge
Who get’s pressure ulcers?
• Spinal cord injuries & elderly
• Higher incidence in hospitals (38%) not nursing homes (23.9%)
• Pressure ulcers do not always signify poor care
Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: A systematic review. JAMA. 2006;296:974-984.
Co-Morbidities
Diabetes Heart disease
Renal disease
Dementia Malnutrition
Age 70 or greater
Impaired mobility
Physical restraints
Pathogenesis for HAPU
Friction Shear Force
Moisture Temperature elevation
Sensory impairment
Oxygen deprivation
Friction
AIM
• Reduce the prevalence of hospital acquired Stage II or greater pressure ulcers from 2010 baseline rate by 50% by December 31, 2013
Suggested Measures
Outcome• Patients with at least one
Stage III or greater hospital acquired pressure ulcer
Process• Skin assessment
documented within 24 hours of admission
• HAPU risk assessment completed within 24 hours of admission
Reduce HAPU by 50%
Conduct Skin/Risk AssessmentHead-to-toe skin & risk assessment
Assess on admission & reassess daily
Manage MoistureKeep skin dry & protected
Optimize Hydration & NutritionAssess weight
Assess nutrition & hydration status
Minimize Pressure, Shear, & FrictionTurn & reposition patients every 2 hours
Early mobility/ambulation
AIM Primary Driver Secondary Driver
Primary Driver: Conduct Skin & Risk Assessment
Head to Toe Risk Assessment
• Within 4 hours of admission
• At least every day• Check skin during
routine care, i.e. turning, bathing
Take Action!
• Plan of care & interventions based on skin & risk assessment
Include Skin Risk in Handoffs
Primary Driver: Manage Moisture
Balance Need for Dry but Moisturized Skin
Use Under Pads to Keep Skin Dry
Will hold up to 1 liter
& Keep skin dry!
Use ‘Reminders”
P = PainP = PottyP = Position or Pressure
3 P’s
Primary Driver: Optimize Hydration & Nutrition
Monitor…
• Weight• Hydration status
Offer Appetizing Food & Drink Choices
• Tempt patient with food & drink they like
• Consider cultural food preferences
Additional Interventions:
• Consult a registered dietician
• Consider nutritional supplements
Primary Driver: Minimize Pressure, Shear, & Friction
Turn! Turn! Turn!
• Turn & reposition at least every 2 hours
Pressure Relieving Special Surfaces & Tools
• Foam wedges to position patients
• Special pressure redistributing/relieving mattresses
• Use pillows only for limbs
• Heel boots
Early Mobility & Ambulation
Staff driven protocol Get patients moving!• Includes assessment of
patient strength & weaknesses
• Includes ‘opt out’ for contraindications
• Triggers referral to physical therapy based on criteria
Minimizing Shear & Force
• Use lifts to reposition• Breathable glide sheets• Limit linen layers to no
more than 3• Foam sacral dressing
Key Resources
• AHRQ Toolkit: Preventing Pressure Ulcers in Hospitals• AHRQ Guideline Synthesis on Preventing Pressure Ulcers• National Pressure Ulcer Advisory Panel• IHI: How to Guide on Reducing Pressure Ulcers• Hughes RG (ed). Patient Safety and quality: An evidence-
based handbook for nurses. AHRQ Publication No. 08-0043, Rockville, MC: Agency for Healthcare Research and Quality; April 2008
• Gibbons W, Shanks HT, Kleinhelter P, Jones P. Eliminating facility-acquired pressure ulcers at ascension health. JC J Qual Pt Safety. 2006;32(9).488-496.
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