Preventing Pressure Ulcers

The federal government has published guidelines on the prevention of pressure ulcers.† In accordance with the federal guidelines, the following steps should be followed by the nursing home staff (or home care provider) to prevent pressure ulcers:

  • Complete a physical on admission to a facility (including skin condition and wounds).
  • Reassess whenever the patientís condition changes.
  • Use a reliable and standardized tool for doing a risk assessment such as the Braden Scale which is available at: www.bradenscale.com/braden.PDF.
  • Document risk assessment scores and implement prevention procedures and protocols.
  • Assess skin daily.
  • Clean skin at time of soiling–avoid hot water and irritating cleaning agents.
  • Use moisturizers on dry skin.
  • Donít massage bony prominences (that means tail bones, hips, heels, etc.)
  • Protect skin of incontinent patients from exposure to moisture (which means CHANGE the patient often!).
  • Use lubricants, protective dressings, and proper lifting techniques to avoid skin injury from friction/shear during transferring and turning of clients (donít drag skin across a bed, or chair Ė be careful!).
  • Turn and reposition bedbound patients every 2 hours if consistent with overall care goals and use a written schedule for turning and repositioning clients.
  • Use pillows or other devices to keep bony prominences from direct contact with each other.
  • Raise heels of bedbound patients off the bed — donít use donut-type devices.
  • Keep head of the bed at lowest height possible.
  • Reposition chair or wheelchair bound patients EVERY HOUR. In addition, if the patient is capable have them do small weight shifts every 15 MINUTES.
  • Keep the patient as active as possible, encourage mobilization.
  • Manage nutrition: Consult a dietician and correct nutritional deficiencies by increasing protein and calorie intake and provide A, C, or E vitamin supplements as needed.
  • Manage Hydration: Offer a glass of water with turning schedules to keep patient hydrated.