Pressure ulcers cause significant cost in terms of both reductions in quality of life and health care spending. We’ve highlighted a few recent research articles on different aspects of pressure ulcer prevention and treatment here.
Most pressure ulcers are preventable, but once they develop they can follow a difficult course to healing, and some may never heal. The ideal goal is to prevent pressure ulcers from developing at all. A common approach is to assess all patients and residents using validated risk assessment tools, which enables health care providers to take steps to prevent pressure ulcers from developing among patients at higher risk.
The Braden Scale for Predicting Pressure Ulcer Risk, developed in 1987, is one of the most commonly used pressure ulcer risk assessment tools. However, much of the data collected using this tool overlaps with data collected using the Resident Assessment Instrument-Minimum Data Set (RAI-MDS). To avoid duplication of data collection, Poss et al (2010) developed the Pressure Ulcer Risk Scale (PURS) to assess the risk of pressure ulcers using data that is already collected through the RAI-MDS. The PURS is now commonly used in long-term care homes.
Recently, Carreau et al (2015) compared the PURS with the Braden Scale for patients in complex continuing care to determine whether they provided a comparable assessment of risk. The authors found that the PURS may be an alternative risk assessment tool option that uses mandatory collected data and reduces workload duplication in the complex continuing care setting. Xie et al (2016) also recently validated the PURS in the acute care setting.
Another approach is to identify pressure ulcers as early as possible in their development so that preventive treatments can be provided. Typically, this is done by visual and tactile examination of the skin. However, the changes that can be detected through these examinations are actually preceded by changes within the skin. These changes within the skin can be measured using a subepidermal moisture scanner. The process is described in this review by Moore et al (2016).
This new technique is beginning to make its way into practice – Scarborough and Rouge Hospital noted in their 2018/19 QIP that they are the first in the province to use this new tool. In an article published in the International Wound Journal, Raizman et al (2018) described their implementation of this tool at their Centenary site of Scarborough and Rouge Hospital. The authors reported a 93% reduction in the incidence of hospital-acquired pressure ulcers, which they attribute to the use of the subepidermal moisture scanner to guide interventions.
Woo et al (2017) conducted a prospective cohort study using population-level administrative data for Ontarians. Among other interesting findings, this study revealed that only one-half of patients with pressure ulcers received nutritional interventions, which are a key component of pressure ulcer prevention and management as per the Registered Nurses Association of Ontario’s Best Practice Guidelines on prevention and management.
How does your organization improve the quality of assessment and treatments for pressure ulcers? Add your comments below!