How to Prevent Pressure Ulcers: Expert Opinion

Clinical Issue Summary

The term pressure ulcer (also known as the “bed sore”) is an acute condition when pressure contributes to the development of additional health issues in an immobile person. The source of the problem is the lack of blood flow that could prevent the soft tissues from destroying under pressure applied by the weight of the body itself. Moreover, pressure ulcers may be typical of patients who are confined to wheelchairs. It makes it essential for the care providers to receive adequate training in order to be able to respond to all kinds of potential complications and establish an environment where long-term care is viewed as one of the most viable options. Prevention and treatment pieces of training are essential because they help reduce the impact of ulcers on patients and reduce the amount of time required to treat certain conditions that only affect immobile individuals.

As the evidence on the subject suggests, pressure ulcers are a critical healthcare concern that has to be addressed on a statewide level to help providers prioritize accordingly and engage in learning activities (Smit et al., 2016). There is also an opinion in Smit et al.’s (2016) article that pressure ulcers contribute to the development of patient education and require care providers to review their decision-making methodology prior to assessing any risks related to pressure ulcer consultations. Accordingly, an additional way to resolve the issue of pressure ulcers in patients could be to provide the latter with wound care team consultation sessions intended to decrease the risk of getting exposed the above-mentioned condition. Appropriate learning initiatives could help care providers and patients develop a unified approach to the problem and create more opportunities for the deployment of consultation-based strategies intended to prevent pressure ulcers in all types of patients.

PICOT

Are patients in a nursing home who have wound care team consultation at decreased risk for pressure ulcers compared with those receiving standard protocols over 3 months?

Literature Review

Qualitative Research Articles

The research completed by Moore et al. (2015) focused on the idea that eHealth applications could be used to improve consultations held by the wound care team (including the sessions related to pressure ulcers). Even though the amount of qualitative evidence on the utilization of eHealth applications is still limited, the researchers found that wound care teams could significantly benefit from consultations with patients with pressure ulcers. The main idea behind such improvised training sessions would be to implement technology and experience the cost reduction while also educating patients and helping the latter discover more approaches to preventing and treating pressure ulcers. As per the information presented by Moore et al. (2015), it may be concluded that eHealth applications can be implemented to the existing care environments in order to help the wound care team transfer important factual data to patients via consultations. Future enhancements should be focused on the idea that patient satisfaction stems from their care experiences and, therefore, could be influenced by excellent communication (online and offline consultations). Moore et al.’s (2015) suggestion was to implement eHealth tools in clinical practice to prevent the occurrence of pressure ulcers.

In the article written by Ousey et al. (2016), the researchers investigated the manifestation of pressure ulcers in different patients and explored the potential tools intended to help the care team prevent and treat this condition. One of the propositions introduced by the researchers was to innovate the reporting mechanisms to shorten the path that ulcer-related information has to travel prior to getting to care providers. Ousey et al. (2016) claimed that care specialists should receive training in managing skin integrity and learn to report skin traumas promptly. This could improve pressure ulcer preventive procedures and fundamentally transform the process of care provision. According to the review completed by Ousey et al. (2016), the members of a wound care unit could initiate consultations with patients to promote patient health and an improved level of quality of life. In turn, patient education and consultation could help the care team reduce the costs of treatment and protect patients from negative outcomes of the inability to report pressure ulcers or engage in self-treatment activities.

Rafter’s (2016) research focuses on palliative care patients, as he outlines that this population is at most risk of developing pressure ulcers. The complexity of care that has to be provided also contributes to the lack of prioritization among the care team. With the intention of protecting palliative patients, the wound care unit could consult them and their families to ensure that each participant of the care provision process gains enough insight into the problem of pressure ulcers (Rafter, 2016). Similarly to Moore et al. (2015), Rafter (2016) suggested that eHealth systems could be beneficial to patients with pressure ulcers, as they would have a chance to report their condition at any given moment with no delays. Online patient assessment and consultations could be completed in line with the SSKIN model, and additional wound assessments required to track the progression of pressure ulcers. An expert review completed by Rafter (2016) outlines an evidence-based approach to preventing pressure ulcers with the help of the wound care team consultations intended to improve patients’ reporting capability.

Quantitative Research Articles

The article written by Chen et al. (2015) dwells on the process of improving the quality of care with the help of wound care consultations. They conclude by stating that establishing a wound care unit might have a positive influence on patients’ condition and motivate them to get back to their daily activities after getting rid of pressure ulcers. This also means that the biopsychosocial health of patients with pressure ulcers may be dependent on consultations with the wound care team. According to Chen et al. (2015), the approach that involves consultations might be used to reduce the costs of care and diminish the burden on the healthcare system. Patients with pressure ulcers could see improved clinical outcomes in the case where they follow the new guidelines and see the relevant factors associated with chronic wounds. Chen et al. (2015) also outlined the idea that non-protocol nursing should not be implemented when treating pressure ulcers. It was not deemed as cost-effective and wound care consultations would be essential if the facility expected to improve its wound healing initiatives and decrease the negative impact of inappropriate treatments on patients’ daily lives.

On the other hand, Choi et al. (2016) proposed a PUSH (Pressure Ulcer Scale for Healing) framework that was based on the idea that patient education could be one of the biggest contributors to quicker patient discharge. The effect size of the statistics proposed by the researchers was large because the responsiveness to the PUSH tool was validated. In addition to treating pressure ulcers, wound care team consultations could be utilized with skin tears, venous ulcers, and traumatic wounds (Choi et al., 2016). In order to confirm the effectiveness of the PUSH framework, the researchers also controlled study subjects for age and gender. It allowed Choi et al. (2016) to highlight the changes in scores among the members of the “healed” and “not healed” groups. Wound care team consultations have been deemed as rather important by the investigators due to the changes that it was able to bring to the table. With an increased level of external responsiveness, consultations should be considered essential because they helped patients improve their participation in the treatment process. Educated patients would significantly cut the costs of pressure ulcers treatment.

The article written by Feng et al. (2016) discussed the possibilities of developing an educational campaign for patients with pressure ulcers. That program was intended to enable nurses to take part in the consultation activities and learn more about how pressure ulcers could be prevented. Wound care should be considered an essential element of pressure ulcer treatment because patients have to be aware of the outcomes of their condition and ready to collaborate with the consultation team to deploy the most appropriate treatment plan (Feng et al., 2016). Nurses that are exposed to pressure ulcers on a daily basis should also benefit from wound care team consultations because it would provide them with additional knowledge and help establish positive relationships with patients. As Feng et al. (2016) suggested, the occurrence of pressure ulcers could be reduced with the help of consultations. It means that the wound care team could become an essential asset intended to advance healing and prevent the future occurrence of pressure ulcers. The new regimens and procedures related to treating pressure ulcers could be a valuable addition to the existing prevention campaigns ran within any given facility.

References

Chen, Y. T., Chang, C. C., Shen, J. H., Lin, W. N., & Chen, M. Y. (2015). Demonstrating a conceptual framework to provide efficient wound management service for a wound care center in a tertiary hospital. Medicine, 94(44), 1-7.

Choi, E. P., Chin, W. Y., Wan, E. Y., & Lam, C. L. (2016). Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds. Journal of Advanced Nursing, 72(5), 1134-1143.

Feng, H., Li, G., Xu, C., & Ju, C. (2016). Educational campaign to increase knowledge of pressure ulcers. British Journal of Nursing, 25(12), 30-35.

Moore, Z., Angel, D., Bjerregaard, J., O’Connor, T., McGuiness, W., Kröger, K.,… & Yderstrœde, K. B. (2015). eHealth in wound care: From conception to implementation. Journal of Wound Care, 24(Sup5), S1-S44.

Ousey, K., Kaye, V., McCormick, K., & Stephenson, J. (2016). Investigating staff knowledge of safeguarding and pressure ulcers in care homes. Journal of Wound Care, 25(1), 5-11.

Rafter, L. (2016). Employing e-health in the palliative care setting to manage pressure ulcers. Wounds UK, 12(1), 114-123.

Smit, I., Harrison, L., Letzkus, L., & Quatrara, B. (2016). What factors are associated with the development of pressure ulcers in a medical intensive care unit? Dimensions of Critical Care Nursing, 35(1), 37-41.

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