Pressure ulcer prevention, patient positioning and protective equipment.

Pressure ulcer (PU) prevention is a high priority for health professionals in all settings. While PU incidence is expected to rise given the ageing population in the UK and Europe, PUs can occur in people of any age. It is therefore imperative that all practitioners know about the causes and consequences of PUs and be aware of up-to-date guidance on the prevention and management in patients who have developed a PU or who are at risk of developing a PU. Health professionals should also be aware of preventive equipment highlighted in national and local guidance, prevention strategies and protocols. This article discusses these issues and the Devon (Cardinal Health) prevention and repositioning product range.

Development and integration of a wound cleansing pathway into clinical practice.

Wound bed preparation has come into sharper focus over the past decade, with strategies identified to improve wound condition. This article focuses on implementing a wound cleansing policy and measuring, through audits, how this change affected rates of wound infection. From 2016 onwards, the Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust took steps to revise and improve wound care practices. This resulted in the introduction of a wound cleansing pathway incorporating a surfactant-based cleanser in place of saline, with subsequent staff training and other changes made to practice. This study details the steps taken to implement the new pathway, which brought a reduction in wound infections of 84.3% between 2017 and 2019.

Benefits of an NHS trust collaborating with the wound care industry.

The principle of collaborative working was widely promoted by the World Health Organisation (WHO) in 2010 when they wrote 'that professionals who actively bring the skills of different individuals together, with the aim of clearly addressing the health-care needs of patients and the community, will strengthen the health system and lead to enhanced clinical and health related outcomes'. As a result of this, the development of a multidisciplinary team approach to the management of patients with wounds was actively promoted by various International organisations, such as the European Wound Management Association (EWMA) in 2014, however this article illustrates an example of how a collaborative working protocol has been incorporated within Tissue Viability and wound care environments within an NHS Trust for the past two decades.

Pressure ulcers: The challenge of monitoring in hospital context.

AIM: To describe and analyse the PUs problem based on data from hospital electronic health records. METHODS: A retrospective cohort descriptive study was performed based on electronic health records (medical and nursing) from adult patients (≥18 years) admitted to medical, surgical and orthopaedics wards during 2016 after implementation of National Strategy of Patient Safety 2015-2020. Ethical approval was obtained. RESULTS: A sample of 3904 patients was obtained, 66% (n = 2575) were older than 65 years, 24.6% (n = 962) at admission and 21.2% (n = 829) at discharge stay at high risk of develop PUs and 88.6% (n = 3458) has no visual skin assessment. PUs identification, categorization and localization are inconsistent between nurses and doctors. CONCLUSION: The creation of a unified minimum dataset for PUs monitoring to standardize data on the occurrence of PUs and assessed the effectiveness of preventive strategies in patient at risk of PUs development at national level is need. Current Portuguese guideline of PUs needs a review and an innovating upgrade with zero tolerance for PUs.

Minimising pain and medical adhesive related skin injuries in vulnerable patients.

The skin is the largest and one of the most important organs of the body and as such it is essential that skin integrity is maintained to preserve normal body functions as much as possible at all times. Health professionals must endeavour to minimise any pain and trauma likely to be encountered by their patients through the use of a variety of medical products and devices that are designed to adhere to the skin, especially as the use of dermatological and wound-management products in particular, that incorporate adhesives to help keep them secure and in place, has grown in line with the increasingly ageing population and changing demographics throughout the UK. This article reviews the literature related to the causes of medical-adhesive-related skin injuries (MARSIs) and the reported patient effects, in particular pain and skin trauma and highlight some 'at-risk' patient groups and potential actions to minimise risk. A sterile silicone medical adhesive remover-Appeel Sterile-is introduced and the clinical benefits highlighted through the discussion of clinical evidence and case studies undertaken on a range of patients with varied aetiologies.

Managing tissue viability issues in patients with cancer approaching the end of life.

This article provides an overview of tissue viability issues related to the care of patients with cancer who are approaching the end of life. Altered physiology as a result of various factors, including nutrition, medication and radiotherapy, is identified. The article discusses the presentation and treatment of cutaneous radiation injury, malignant wounds, pressure ulcers and Skin Changes At Life's End (SCALE), an acronym used to describe a set of clinical phenomena associated with skin changes in patients approaching the end of life, and makes recommendations for practice.

Protecting vulnerable skin from moisture-associated skin damage.

The skin, the body's largest organ, has several functions. Its barrier role can be undermined if it is in contact with urine, faeces and other sources of excess moisture; overhydration can also increase the likelihood of injury from friction through contact with clothing, incontinence pads or bed linen. If skin has been damaged by moisture or is at risk of this, its health can be supported through cleansing to maintain its acid mantle followed by protection with barrier products. Barrier preparations are available in different forms, and their effectiveness varies. A new product, Medline Remedy Moisturising Barrier Cream, has been trialled in adults, children and neonates in a variety of healthcare settings.

Management of Patients With Venous Leg Ulcers: Challenges and Current Best Practice.

Introduction It is well documented that the prevalence of venous leg ulcers (VLUs) is increasing, coinciding with an ageing population. Accurate global prevalence of VLUs is difficult to estimate due to the range of methodologies used in studies and accuracy of reporting. (1) Venous ulceration is the most common type of leg ulceration and a significant clinical problem, affecting approximately 1% of the population and 3% of people over 80 years of age (2) in westernised countries. Moreover, the global prevalence of VLUs is predicted to escalate dramatically, as people are living longer, often with multiple comorbidities. Recent figures on the prevalence of VLUs are based on a small number of studies, conducted in Western countries, and the evidence is weak. However, it is estimated that 93% of VLUs will heal in 12 months, and 7% remain unhealed after five years. (3) Furthermore, the recurrence rate within 3 months after wound closure is as high as 70%. (4) (-6) Thus, cost-effective adjunct evidence-based treatment strategies and services are needed to help prevent these ulcers, facilitate healing when they occur and prevent recurrence. The impact of a VLU represents social, personal, financial and psychological costs on the individual and further economic drain on the health-care system. This brings the challenge of providing a standardised leg ulcer service which delivers evidence-based treatment for the patient and their ulcer. It is recognised there are variations in practice and barriers preventing the implementation of best practice. There are patients not receiving appropriate and timely treatment in the initial development of VLUs, effective management of their VLU and preventing recurrence once the VLU has healed. Health-care professionals (HCPs) and organisations must have confidence in the development process of clinical practice guidelines and have ownership of these guidelines to ensure those of the highest quality guide their practice. These systematic judgments can assist in policy development, and decision making, improve communication, reduce errors and improve patient outcomes. There is an abundance of studies and guidelines that are available and regularly updated, however, there is still variation in the quality of the services offered to patients with a VLU. There are also variations in the evidence and some recommendations contradict each other, which can cause confusion and be a barrier to implementation. (7) The difference in health-care organisational structures, management support and the responsibility of VLU management can vary in different countries, often causing confusion and a barrier to seeking treatment. These factors further complicate the guideline implementation process, which is generally known to be a challenge with many diseases. (8).

PRESSURE ULCER PREVENTION: FUNDAMENTALS FOR BEST PRACTICE.

This introduction has highlighted both the complex nature of the aetiology of pressure ulcer development and the complex nature of the assessment process intended to identify those patients who are or might be at an enhanced risk of pressure ulcer development. The latter statement assumes that all patients cared for in any healthcare setting are vulnerable to pressure ulcer development. Whilst it is acknowledged that the use of a risk assessment tool can be important in an overall pressure ulcer prevention strategy, it is important that the limitations of these tools are acknowledged and that they are not an finite assessment in themselves and that they should be used by a practitioner with a fundamental breadth of relevant knowledge and an appreciation of the range of appropriate preventative equipment/techniques available and the role of the multi-disciplinary team in the prevention of all avoidable pressure ulcers.

A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers.

AIMS: To assess the cost effectiveness of two repositioning strategies and inform the 2014 National Institute for Health and Care Excellence clinical guideline recommendations on pressure ulcer prevention. BACKGROUND: Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications. Repositioning is a key prevention strategy, but can be resource intensive, leading to variation in practice. This economic analysis was conducted to identify the most cost-effective repositioning strategy for the prevention of pressure ulcers. DESIGN: The economic analysis took the form of a cost-utility model. METHODS: The clinical inputs to the model were taken from a systematic review of clinical data. The population in the model was older people in a nursing home. The economic model was developed with members of the guideline development group and included costs borne by the UK National Health Service. Outcomes were expressed as costs and quality adjusted life years. CONCLUSION: Despite being marginally more clinically effective, alternating 2 and 4 hourly repositioning is not a cost-effective use of UK National Health Service resources (compared with 4 hourly repositioning) for this high risk group of patients at a cost-effectiveness threshold of £20,000 per quality adjusted life years. These results were used to inform the clinical guideline recommendations for those who are at high risk of developing pressure ulcers.

Use of a coverlet system for the management of skin microclimate.

Pressure and shear are the two key extrinsic factors that cause pressure ulcer damage. However, if the resilience of the skin and soft tissue deteriorates, the individual's susceptibility to such pressure damage will increase. The risk is greater if the microclimate at the interface between the skin and the support surface is impaired. This will occur when the skin temperature is elevated and there is excess moisture on the skin surface. Microclimate management therefore plays an important role in pressure ulcer prevention. This article describes how use of a new coverlet system (Skin IQ Microclimate Manager, ArjoHuntleigh) can avoid the accumulation of heat and moisture at the patient/support-surface interface.