Prevention Mechanisms for Pressure Ulcers
In recent years, the number of inpatient services, especially for the elderly clients who are at risk for skin breakdown, admitted ED (emergency department) staff has been on the increase. The ED environment was meant for short-term care in response to emergent situations. However, pressure related injuries originating in the ED have led to both financial and physical afflictions. Some actions have been put in play to handle this issue, one such measure is the PUP (Pressure Ulcer Prevention) which may not be largely embraced in the ED environment. However, the Pus is within the scope of the nursing practice and can be amended to improve the standard of healthcare. It is for the reason that this hub seeks to translate the current evidence for the PUP and bring out the best practice in emergency nursing.
The hub will take a kin interest in the population of adults that are 75 years and above. While 65 years is considered the universal retirement age, most adults between the 65 to 75 years are still active. However, those 75 years and above are a better indicator of the fragile elderly population of interest. Moreover, the inclusion criteria were a minimum ED visit length of 2 hours followed by an inpatient admission. According to (Pham, 2011), National Medicare Patient Safety Monitoring System Survey, 4.5% of Medicare patients develop a new PU while admitted in hospitals. Moreover, stage IV HAPUs cost about $129,000 to treat a single complication. Besides, insufficient staff and lack of time were also some of the challenges that the ED facilities had to cope with.
Lucas et al., (2008) argues that some of the problems facing the ED are overcrowding, boarding of patients pending admission and long wait times. He points out the average waiting time nationally is 4 hours and 13 minutes. The situation gets worse when it comes to an older patient who has to wait up to 5 hours and 9 minutes on average. These lengthy periods of immobility escalate the risk of tissue damage. Worse still, the ED environment shows many other challenges that prove to be a set up to progress. For instance, the ED stretchers are narrow with mattresses that are meant to serve only for short-term purposes. The protracted pressure over bony prominences threatens tissue feasibility. Damaged perfusion for just 30 minutes can cause hypoxic tissue injury and deep muscle injury that may be to diagnose for up to seven days (Andres et al., 2010).
Nonetheless, the use of PUP strategies is hardly ever considered early in the patient’s hospital stay. Although all patient with immobility is at risk of being affected by this problem, the patients at the highest risk for skin breakdown mainly reveal the following characteristics. They are 65 years or older, they are male, dry skin bony prominences, low body mass index, hospitalization in the past six months, moderate to high nutritional risk, nursing home residency prior to admission and moisture due to incontinence. The development of a PU (pressure ulcer) can result in unwanted suffering and increased morbidity, resource consumption, mortality, readmission rates within the critical 30-day window after discharge, and duration of hospitalization (Lyder et al, 2012). As a result, nursing practice and care have amended its priority to preventions of PUs and other related poor patient outcomes and improving the standard of care.
To achieve this, a practice inquiry dissertation was conducted with the aim of translating the current data on pressure ulcer prevention to sustainable best practice in emergency nursing. Some of the interventions included using ED mattresses with at least 5 inches PRF (pressure redistributing foam) which was effective for reducing the ED acquired (Pham et al., 2011). Moreover, repositioning of geriatric clients was another inversion taken as an effective strategy, as the number amount of times the patient was required to turn in PFR mattresses was increased to four hours (Defloor, Debacquer, & Grydonck, 2015 ). The medical backboard was noted as another cause of skin integrity, therefore, (Bledsoe, 2013) recommends that the time spent on the surfaces should be reduced. Moreover, tissue viability is affected by HOB (Head of Bed elevation) as all elevations from 30 to 75 degrees increased peak sacral interface when compared to supine. As a result, the HOB elevation should be maintained at 29 degrees in the absence of acute respiratory distress.
According to (Santamaria et al., 2013), the prophylactic application of multifaceted silicone covering in the ED is the best practice as it helps to redistribute pressure and reduce the friction and sheer forces. Moreover, the dressing utilization maintains skin integrity through microclimate control, including temperature, pH, moisture, and humidity. The application of a silicone based protective dressing has shown significant reduction the incidence of sacral pressure injuries in populations that are at a higher risk (Clark et al., 2014). Besides, the Braden scale is another strategy to prevent PUs that has been adopted over the years. The instrument is used to assess the risks of developing skin breakdown and is known to generate the best mix of sensitivity and specify the most accurate risk estimate when compared with other similar tools (Cubit, McNally, & Lopez, 2012). The overall performance of the instrument is that it increases both the frequency and intensity of prevention measures.
Tachibana and Nelson-Peterson (2007), describe Virginia Mason’s implementation of an alternative strategy of the CNL (Clinical Nurse Leader) role that is focused on the management of a complex patient population in the acute care setting. That resulted to a reduced length of patient’s stay at the hospital by up 7%, better coordination, and continuity and higher patient satisfaction among the elderly population was reported. Moreover, the CNL handled the gap for patients with complex care needs by providing a graduated level nurse who could coherent the plan of care across shifts and disciplines, improve patients satisfaction and provide expertise to patients and staff.
The acknowledging dry sacral skin and IAD (incontinence associated dermatitis) as risk factors for PU development, the paper supports the application of a moisturizer or skin protection preparation in this vulnerable area every now and then. The use of zinc based protective creams and moisturizing incontinence wipes appear to be prudent, non-invasive, and economical preventative strategies. The above measures are a true reflection of the most recent evidence and are seen as ground-breaking strategies for application in the ED environment.