Geriatric Quick Consult       Pressure Ulcers      DOs and DON'Ts

Pressure Ulcers and Wound Care

Pressure ulcers are a common and costly problem in acute care, nursing facilities, and home care settings. Incidence and prevalence rates in acute care facilities have ranged from 2.7 to 29.5 percent and 3.5 to 29.5 percent, respectively1.

A pressure ulcer is a lesion caused by unrelieved pressure, generally occurring over bony prominences. Pressure ulcers are graded according to the degree of tissue damage1. Click here to view pressure ulcer staging .
Cost of treatment increases with the severity of the wound. The wound care product industry offers hundreds of wound care products. General principles guide use of specific categories of products.

Pressure ulcers are being used as an indicator of the quality of care in all health care settings. A complete assessment of the patient with a pressure ulcer is the basis for developing a plan of care. The idea that all pressure ulcers are the result of poor care is incorrect. Even optimum care may not prevent development of pressure ulcers or achieve healing in the high-risk patient2. The following chart has basic first steps, "DOs" and "DON'Ts." Click on them for more details.


DO all of these DON'T do any of these
Perform a nutritional assessment. underestimate protein needs.
Perform a pain assessment. forget to turn the patient over.
A complete initial wound assessment. send a surface swab for culture or x-ray every wound.
Order appropriate wound care. give systemic antibiotics routinely.
Be aware of potential complications. use donut cushions.
Assess need for special support surface. assume a mattress alone will work.
Be sure goals of wound care are
consistent with overall goals of care.		 use povidone-iodine or hydrogen
peroxide on wound.
Remember prevention. debride all "heel caps".


References:

  1. Bergstrom N, Bennett A, Carlson CS, et al. Clinical Practice Guideline Number 15: Treatment of pressure ulcers. Rockville, MD: U.S. Dept. of Health and Human Services. Agency for Health Care Policy and Research. 1994. AHCPR publication 9500652.
  2. Walker P. Management of pressure ulcers. Oncology 2001; 15(11): 1515-6.
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