Skin matters Preventing Pressure Ulcers: a Guide for Patients and Carers

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1 Skin matters Preventing Pressure Ulcers: a Guide for Patients and Carers We recommend that you follow the advice within this leaflet and provided by your healthcare provider. However if anything changes or you require further advice or support please refer back to your healthcare provider. Tel: Name of Practitioner: Signature: Date: What is a pressure ulcer? Name of patient NHS number Further to our assessment we have found that there is: a risk of developing a pressure ulcer a pressure ulcer which is close to the skin surface (state location) a pressure ulcer which extends into the deeper tissues (state location) A pressure ulcer is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. (EPUAP 2014) Pressure ulcers are most likely to develop over bony areas, but can also occur if something is pressing against the skin such as a splint or poorly fitting footwear. How does a pressure ulcer occur? The first sign of tissue damage is redness. Pressure ulcers can occur over a short period of time if a large amount of pressure is applied, but they can also occur over a longer period of time when less pressure is applied. Bone Blood Vessels Soft Tissue Skin Layers A larger amount of pressure increases the damage from shearing force. 2

2 Pressure from bone against the firm surface Who is at risk? Anyone is at risk of a pressure ulcer but the people most at risk are: Pressure Firm Surface Pinching off of blood vessels When skin and tissues are directly compressed between two hard surfaces such as bone and bed, or bone and chair, the blood supply is disrupted and the area is starved of oxygen and nutrients and tissue damage begins. people who have trouble moving and cannot change position themselves people who cannot feel pain over part or all of their body people who are incontinent people who are seriously ill, or have had surgery people who have a poor diet and don t drink enough water people who are very young or very old people who have damaged their spinal cord or have a neurological condition older people who are ill or have suffered an injury like a broken hip people who have physical disabilities that may affect their posture people who have had a pressure ulcer before people who have poor or reduced circulation Friction and shearing add additional complications to pressure Shear When tissues are stretched in different directions, the skin stays static and the tissues underneath are pulled in opposing direction causing internal tissue damage. Example When a person slides down the bed or chair Friction When two surfaces rub together the top layer of skin gets stripped away contributing to tissue damage. Example When a person s heels rub on a surface such as mattresses, footstools or ill-fitting footwear. 3 What you must do? Areas of red skin are an early warning sign that pressure, shear or friction are occurring. Usually by removing the cause the skin will recover. This is the most effective way to prevent skin damage. If you find an area of redness or discolouration that does not blanch please report this to your healthcare provider. What to look and feel for: Red or dark patches that do not disappear within 1-2 hours Pain or soreness Warmer or cooler area Boggy feeling or hardened area Broken skin/ulcer 4

3 The Skin Tolerance Test also known as the Blanch Test There is a simple test you can do to see if there is skin damage and a possible pressure ulcer developing. SURFACE A pressure relieving equipment will help relieve pressure. The following pressure relieving/redistributing equipment is recommended/ provided: Mattress Cushion Other Other Please consider the following in relation to the equipment provided. Normal skin response to pressure, like your elbow when you lean on it. Press finger over reddened area for 5 seconds, then lift up finger. If the area blanches, it is not a pressure ulcer. If it stays red, it is the start of pressure damage pressure ulcer. Please take any removable equipment such as cushions or heel protectors on all journeys Please ensure equipment is cleaned down with soapy water and dried thoroughly if it becomes contaminated. Check for tears/splits and faults. Please make sure that the mattress is plugged in at all times and set in accordance with manufacturers guidance. What else can you do? NOTE: Darkly pigmented skin does not blanch. Signs to look for in early tissue damage include purple discolouration, skin feeling too warm or cold, numbness, swelling, hardness or pain. Ensure that footwear is well fitting and not marking the feet or toes. Ensure that any medical devices/glasses/hearing aids etc. are not causing redness. If a specialist wheelchair/wheelchair cushion has been provided, please refer back to wheelchair services with any concerns. If you think that any pressure relieving equipment is damaged or faulty please contact your equipment provider straight away or contact your healthcare provider. If the equipment is not suitable please discuss with your healthcare provider, there may be an alternative. 5 6

4 SSKIN - Inspection of the skin is advised to allow for early detection of any pressure damage. Please check all the BESTSHOT and vulnerable pressure areas every A mirror may be useful to see out of reach areas. We have found pressure damage/vulnerable pressure areas to the following areas: If any red areas are found, apply pressure to the area for 5 seconds and release, If the area stays red then contact your healthcare provider as soon as possible. B - BUTTOCKS E - ELBOWS/EARS S - SACRUM (bottom) T - TROCHANTERS (hips) S - SPINE/ SHOULDERS H - HEELS O - OCCIPITAL AREA (back of the head) T - TOES O - OTHER KEEP MOVING - One of the best ways to prevent a pressure ulcer is to regularly change position and keep moving as this allows for the blood supply to return and recover. This can be as simple as standing and walking on the spot for a few minutes every hour or transferring into a different position. It is important to AVOID putting pressure on vulnerable or existing skin damage. Regime recommended: Please reposition fully at least every hours during the day and at least every hours at night. AVOID repositioning over existing pressure damage/redness. AVOID sitting or lying in the same position for a prolonged amount of time try to move other areas of the body in-between times for comfort when necessary. Transfer aids: are recommended/provided to reduce friction and shear when repositioning. Semi recumbent 30 degree Transferring Walking with or without help Elevating legs and offloading heels 7 8

5 INCONTINENCE/ MOISTURE - An excess of moisture will delay healing and increase the risk of skin breakdown Moisture damage can occur to the skin by prolonged contact of moisture to the skins surface. This can be in the form of sweat, wound exudate, urine/faeces and saliva. Excessive moisture can result in a moisture lesion developing. This is where the skin has become inflamed due to moisture. It will look red and sore and be spread over a large area or found in skin creases or folds. We have identified the risk of excess moisture due to sweat incontinence/ wound exudate. We have identified moisture damage to due to sweat/ incontinence/wound exudate. We recommend that you use which should be applied every Always wash skin with PH friendly products (not soap) pat the skin dry avoiding rubbing and ensure that skin is dried properly to avoid further moisture damage. If you identify or experience a change in moisture or continence management please contact your healthcare provider for further advice or signposting. If an appropriate assessment has been carried out please follow the guidance you were offered or refer back to your healthcare provider. 9 NUTRITION - A healthy nutritious diet can help prevent skin damage and promotes good wound healing. Anyone who is malnourished, underweight or overweight is at increased risk of pressure damage. Aim for 3 meals a day with a good variety of fruit and vegetables and drink at least 2 litres of fluid a day. If appetite is reduced then consider eating smaller meals or nutritious snacks, but more regularly. We have identified that nutritional intake is reduced and advise a high calorie/fortified diet to boost calorie intake and have provided leaflet to offer additional advice. The following supplements have been provided/recommended and should complement a normal diet. (Alternative flavours/brands can be provided so please discuss this with the GP if these are required) A specific feeding regime has been acknowledged: e.g. soft diet/ thickened fluids/diabetic diet/renal diet/gastric feeding regime/ Please follow the specialist diet as instructed by the specialist team. We have referred/or recommend a dietitian referral as discussed because If you have any concerns regarding nutritional intake, notice a reduced appetite, unexplained weightloss, please inform your healthcare provider. Further information can be obtained from:

6 - Skin matters Preventing Pressure Ulcers - A guide for patients and carers We recommend that you follow the advice within this leaflet and provided by your healthcare provider. However, if anything changes or you require further advice or support please refer back to your healthcare provider. Tel: Name of Practitioner: Signature: Date: Recipient s Signature: Print Name: Date: Patient s Name: Date of Birth: NHS Number: 11 NH286v Tissue Viability Team Nottinghamshire Healthcare NHS Trust May 2016