Prevention

Prevention of pressure sores is certainly a worthwhile pursuit - their incidence can be reduced by approximately 50%.

In consideration of adults.

Prevention involves:

• identification of high risk patients
  • risk assessment:
    • be aware that all patients are potentially at risk of developing a pressure ulcer
      
      
    • carry out and document an assessment of pressure ulcer risk for adults: being admitted to secondary care or care homes in which NHS care is provided or receiving NHS care in other settings (such as primary and community care and emergency departments) if they have a risk factor, for example:
      • significantly limited mobility (for example, people with a spinal cord injury)
      • significant loss of sensation
      • a previous or current pressure ulcer
      • nutritional deficiency
      • the inability to reposition themselves
      • significant cognitive impairment
        
        
    • consider using a validated scale to support clinical judgement (for example, the Braden scale, the Waterlow score or the Norton risk-assessment scale) when assessing pressure ulcer risk
      
      
    • reassess pressure ulcer risk if there is a change in clinical status (for example, after surgery, on worsening of an underlying condition or with a change in mobility)
      
      
• prevention of high risk situations, for example being left on a trolley for long periods of time
  
  
• repositioning of patients (1):
  • 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
  • encourage adults who have been assessed as being at high risk of developing a pressure ulcer to change their position frequently and at least every 4 hours.If they are unable to reposition themselves, offer help to do so, using appropriate equipment if needed. Document the frequency of repositioning required
    
    
• at least daily skin hygiene measures: wash, thorough drying of skin. Do not use talcum powder
  • consider using a barrier preparation to prevent skin damage in adults who are at high risk of developing a moisture lesion or incontinence-associated dermatitis, as identified by skin assessment (such as those with incontinence, oedema, dry or inflamed skin) (1)
    
    
• massage - NICE state that '..do not offer skin massage or rubbing to adults to prevent a pressure ulcer...' (1)
  
  
• pressure relieving devices which redistribute loads. Options include:
  • foam PVC blocks
  • 'sheepskin'- synthetic sheet with large amounts of air trapped by fibres causing redistribution of pressure over larger surface area
  • padding mattresses
  • alternating pressure air mattresses e.g. 'ripple beds'
  • air flotation beds
    
    
• nutritional supplements and hydration (1)
  • do not offer nutritional supplements specifically to prevent a pressure ulcer in adults whose nutritional intake is adequate
  • do not offer subcutaneous or intravenous fluids specifically to prevent a pressure ulcer in adults whose hydration status is adequate

Reference:

• NICE (April 2014). Pressure ulcers: prevention and management of pressure ulcers