The cost of hospital-acquired pressure ulcers is staggering. Due to under-reporting, determining...
Pressure ulcers – also called pressure injuries – cause millions of hospitalizations and health issues every single year. But they CAN be prevented with proper care. So, what is a nurse’s role in pressure ulcer prevention?
For caregivers and loved ones at every level, the question is: What steps can we take for pressure ulcer prevention?
In any medical discipline, nurses have some of the highest rates of patient interaction. This is why nurses are key in helping to prevent and treat pressure ulcers as they occur. Their close relationship with patients puts them in the perfect position to prevent and care for pressure ulcers.
So what steps can nurses take to limit the occurrence of this preventable ailment? Today we will look at how pressure ulcers can be prevented with some simple practices.
A nurse’s role in pressure ulcer prevention - in 10 steps
A nurse’s role in pressure ulcer prevention is extremely important, and here are just a few of the things you can do to keep your patients pressure-ulcer free.
1. Look for early signs of pressure ulcers
Pressure ulcer prevention starts as soon as a patient is admitted to care. During admission, any diseases that could increase the risk of a patient developing a pressure ulcer should be noted.
Some of these comorbidities may include:
- Cardiovascular disease
- Type 1 and type 2 diabetes
- Chronic pulmonary disease (CPD)
- Kidney disease
- Musculoskeletal and neurodegenerative disorders
- Malnutrition
- Anemia
- Incontinence
The nurse’s role in pressure ulcer prevention then continues with monitoring the patient for early signs.
This means watching for areas with different texture or temperature to the surrounding skin, or red patches in patients with pale skin and purple or blue patches in patients with darker skin.
Should these patches not turn white when pressed, you likely have a stage one pressure ulcer on your hands.
2. Educate patients and their families
The earliest sign of pressure ulcers is irritation, such as pain or itchiness in the affected area. Since this isn’t something that nurses can monitor, the nurse’s role in pressure ulcer prevention must include education.
Encourage patients to speak up if they feel pain or itchiness that may be caused by the position they’re in. Should the patient have difficulty speaking up, educate the patient’s family on what you’re looking for and encourage them to share concerns.
Educating and involving patients in their care not only helps to prevent pressure ulcers, it also gives patients enhanced health outcomes, quality of life, and satisfaction rates.
Considering that hospital-acquired pressure injuries cause more than 17,000 lawsuits each year, higher satisfaction can only be a plus.
3. Move patients frequently
Next, is the most common advice on how to prevent pressure ulcers: movement.
Frequent movement can seem out of reach as hospitals deal with constant understaffing. While understaffing makes regular movement more difficult, this is still a huge part of the nurse’s role in pressure ulcer prevention.
The general rule of thumb is to move a patient every two hours, but this advice hasn’t been scientifically proven. Since this is the case, working on a case-by-case basis is best. This will ensure that patients are getting the care they need without unnecessary extra work for the medical staff or disruption of the patient’s rest.
This is where education comes into play again. Patients who have some degree of movement may be more open to moving themselves when they understand why it’s so critical.
Even patients who have little to no range of movement will likely be more cooperative when involved in the decision for regular movement.
4. Follow safe movement standards to decrease friction
Moving a patient regularly can do more harm than good when safe movement practices aren’t followed. This is because dragging or rolling a patient causes unnecessary friction, which may agitate already fragile skin.
The nurse’s role in pressure ulcer prevention includes movement, but this doesn’t mean you should attempt to move a patient on your own. Always follow safe patient handling guidelines to ensure that neither the caregiver nor the patient is harmed.
These guidelines include:
- Moving a patient with help (never alone)
- Using assistive technology where available
- Getting the patient’s cooperation before beginning a transfer
5. Prevent irritants
Another thing that can increase the rate of pressure ulcers forming is irritants. The first thing that may come to mind is the patient’s clothing, but that isn’t the only irritant to be on the lookout for.
Part of the nurse’s role in pressure ulcer prevention is an awareness that the cleanliness of bedclothes and medical devices can also contribute to the formation of pressure ulcers.
Anything that exerts consistent pressure can cause an ulcer, which includes medical devices and beds. One way to help with this is by making small movements or adjustments to the equipment as much as possible without interfering with care.
Again, encourage patients to speak up when something is irritating them. One person – even when that person is part of a care team – can’t remember everything. Keeping a mental checklist helps, but self-reporting is the gold standard in keeping patients comfortable.
6. Keep the patient clean and dry
Friction is one contributing factor to pressure ulcers, but another big player is moisture.
Existing literature shows a strong link between high moisture levels and pressure ulcers. The risk of ulcer development and infection grows even greater when the patient’s skin is exposed to something other than water – such as sweat or urine.
The nurse’s role in pressure ulcer prevention also includes managing this moisture. Anywhere there’s risk for a pressure ulcer, there is also some degree of moisture – most frequently from sweat buildup.
Keeping patients in a cool environment, and drying their skin when you move them, can help mitigate this risk. Keeping the skin clean will decrease the risk of infection, especially when the skin is thoroughly dried afterwards.
7. Check for and manage every level of incontinence
Since bodily fluids like urine increase the risk of pressure ulcer formation, managing incontinence is an important part of pressure ulcer prevention. Patients will require different care depending on the severity of their incontinence.
Patients with incontinence are about 4 times more likely to develop a pressure ulcer. This makes incontinence management a crucial part of the nurse’s role in pressure ulcer prevention.
For nurses, a key part of this management is checking and double-checking whether a patient has some level of incontinence. Many patients feel embarrassed or ashamed of their incontinence, making them reluctant to come forward about it.
This means you may have to ask more leading questions, such as:
- Do you ever “leak” urine? Perhaps when you sneeze, cough, or startle?
- Do you ever struggle to make it to the bathroom in time? How often would you say that happens?
- Have you ever been diagnosed with transient incontinence? Can you tell me more about that time?
8. Apply barrier creams
Barrier creams can be helpful in pressure ulcer prevention in a number of situations. The problems caused by irritants and moisture decrease with the use of a barrier cream.
This is because many barrier creams are oil-based. This means they can act as a “second skin”. Moisture problems are solved due to the oil-based barrier cream repelling water.
The nurse’s role in pressure ulcer prevention here includes both applying the barrier cream and replacing it. Cream will need to be replaced for two reasons.
First, keeping the skin clean is crucial, especially in cases of incontinence. Cleanliness may not necessarily prevent pressure ulcers on its own, but it certainly prevents the infection of existing ulcers.
Second, the cream is likely to break down. Since it’s acting as a “second skin”, the barrier cream is taking all of the friction, acidity, and moisture of the environment. This means it may rub away fairly quickly and will need to be replaced.
The nurse’s role in pressure ulcer prevention with a barrier cream must include cleaning and drying the skin thoroughly between each replacement.
9. Keep patients hydrated and well-nourished
The final two tips on our list can help not only with prevention, but with pressure ulcer recovery in the unfortunate case that an ulcer has already developed.
Keeping patients hydrated and well-nourished is critical to overall well-being, and pressure ulcers are no exception.
Dehydration interferes with cell metabolism, as well as blood circulation. Since pressure ulcers are primarily caused by a lack of blood flow to the area, dehydration increases the risk of pressure ulcers developing. Once developed, dehydration slows recovery significantly.
One place the nurse’s role in pressure ulcer prevention shines is adequate hydration. Again, since nurses have more daily interactions with a patient, monitoring hydration from day to day or hour to hour is much easier than it may be for other members of the care team.
Next, nutrition. How does nutrition affect pressure ulcers? Simply put, nutrition affects every stage of pressure ulcer prevention and development.
Malnutrition poses a risk factor for ulcer development, because the tensile strength of the skin is negatively affected. Essentially, the patient’s tissue can’t take the same amount of pressure as someone who has sufficient nutrition.
Another example of the nurse’s role in pressure ulcer prevention is introducing interventions as needed. For example, some patients may be resistant to eating high-nutrient foods. In these cases, oral nutrition supplements can reduce incidence of pressure ulcers by as much as 25%.
10. Consider collagen for pressure ulcers
One of the best supplements you could give a patient for pressure ulcer prevention might be collagen.
Collagen protein is one of the major building blocks for healthy skin. Introducing collagen into a patient’s diet can help with both pressure ulcer treatment and prevention.
In the treatment of existing pressure ulcers, collagen speeds healing significantly when compared with standard care and nutrition. Collagen for pressure ulcers can be added to a patient’s care in two ways.
The patient can take collagen orally through a collagen supplement. This is often in a liquid or powder form, and can be incorporated into a patient’s diet in whatever way makes them most comfortable.
In more severe cases of pressure ulcers, the patient can also have a collagen dressing applied to the site. In one study, collagen dressings helped 56% more patients with ulcers heal compared to the control group.
When discussing the nurse’s role in pressure ulcer prevention, using collagen dressings and supplements in your patients’ regular care can make a huge difference.
Collagen for pressure ulcers, from a prevention standpoint, can be incorporated as a routine vitamin for a patient. Taking collagen regularly can significantly improve the skin's elasticity, strength, and hydration – three factors that contribute to the formation of pressure ulcers.
The nurse’s role in pressure ulcer prevention when it comes to collagen supplements is about education. When you have a patient at a high risk for pressure ulcers, inviting them to begin a collagen supplement is one way for nurses to help prevent them.
Be active in pressure ulcer prevention
The cost of hospital-acquired pressure ulcers in the US is currently estimated at $9.1 - 11.6 billion each year. Comparatively, taking active steps in pressure ulcer prevention is significantly less expensive.
The nurse’s role in pressure ulcer prevention is huge, and covers many different aspects of care - but the whole care team should be involved, even at the executive level.
Pressure ulcers decrease a patient’s quality of life, open a hospital up to lawsuits, and damage that hospital’s reputation. This is because pressure ulcers are largely preventable, especially when the whole care team is dedicated to that prevention.
A nurse’s role in pressure ulcer prevention is paramount, and ensuring your patients are comfortable, clean, dry, hydrated, and taking regular medical-grade collagen supplements like ProT Gold can help prevent pressure ulcers from rearing their heads.
