The Mölnlycke O.R. blog
Pressure ulcers are a patient safety issue
Jacqui Fletcher, Clinical Strategy Director, Welsh Wound Innovation Centre, United Kingdom
We know, as healthcare professionals, that pressure ulcers are a real issue facing both patients and the healthcare facilities in which we work. At the heart of all the research and recommendations in pressure ulcer prevention is the patient – his or her care, safety and comfort. For these reasons alone, pressure ulcer prevention is important – and we know prevention is possible. After all, we dedicate a lot of time and resources to spreading the word about pressure ulcer prevention (the annual Stop Pressure Ulcer Day just passed, in fact). Putting the research and evidence into widespread practice is the next step to ensuring both better outcomes and patient safety.
When thinking of pressure ulcers, hospital-associated conditions and wounds from a patient perspective, though, I wonder how aware they and their families are of the risks. Pressure ulcers are painful and can occur frequently in patients in long-term care who suffer from reduced mobility – often in older patients. The awareness that pressure ulcers can lead to much more serious damage, including a heightened risk of life-threatening infections, leaves no doubt that the occurrence of pressure ulcers is a serious patient safety issue1. Mortality risk aside, a pressure ulcer can lead to significantly longer hospital stays, delayed recovery and reduced quality of life, making demands on hospital staff and resources2, and critically, on patients and their families.
A growing body of clinical and scientific evidence demonstrates that prevention is a proven strategy for reduction (and possible elimination) of pressure ulcers. Most recently we have seen the battery of clinical evidence about prophylactic dressing application reducing the incidence of hospital-acquired pressure ulcers grow to include the findings of a new study that cites zero incidence of pressure ulcers in a study group of 150 high-risk ICU patients3. Finite-element modelling has also shown the mechanisms that make prophylactic dressings work (how they protect the skin and underlying tissue from deformation)4. These are just two recent examples of studies that have provided evidence to show the efficacy of prophylactic dressings when used as a component of pressure ulcer prevention regimes.
Evidence, though, is not enough without putting it into practice that is backed by policy to support patient safety measures. To make this happen and see clear long-term results within a rapidly aging population, we will need to adopt and support treatment and prevention protocols and recommendations into standard practice5,6. Raising awareness with the general public is challenging as many do not know or fully appreciate their or their family member's risk until it is too late. The Stop the Pressure Day is one example of a public campaign to raise awareness that pressure ulcers can happen to anyone – not just the frail elderly.
For further information, take a look at the evidence summary "Proven prevention – clinical and scientific evidence proving the effectiveness of preventive pressure ulcer care".
- Lyder CH, Ayello EA. Pressure Ulcers: A Patient Safety Issue. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 12.
- Posnett, J et al. The resource impact of wounds on healthcare providers in Europe. JOURNAL OF WOUND CARE VOL 1 8 , NO 4 , APRI L 2 0 0 9.
- Santamaria, N., Gerdtz, M., Liu, W., Rakis, S., Sage, S., Ng, AW., Tudor, H., McCann, J., Vassiliou, T., Morrow, F., Smith, K., Knott, J., Liew, D. Clinical effectiveness of a silicone foam dressing for the prevention of heel pressure ulcers in critically ill patients: Border II Trial. Journal of Wound Care 2015; 24(8).
- Levy A., Frank M.B., Gefen A. The biomechanical efficacy of dressings in preventing heel ulcers. Journal of Tissue Viability 2015.
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Clinical Practice guideline. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014.
- Panel on the Prediction and Prevention of Pressure Ulcers in Adults. Pressure ulcers in adults: prediction and prevention Clinical Practice Guideline No 3 . Rockville, MD: Agency for Health Care Policy and Research; 1992. AHCPR Publication No 92-0047.