Preventing Pressure Ulcers

Transcription

1 A Guide for Patients and Carers Preventing Pressure Ulcers CAN I HELP? WHAT IS A PRESSURE ULCER? HOW DO YOU GET THEM? Leighton Hospital Middlewich Road Crewe Cheshire CW1 4QJ Telephone: Tissue Viability Office Direct Line:

2 Preventing pressure ulcers a guide for patients and carers Pressure ulcers (formerly known as bedsores) are often a preventable complication of illness. Pressure ulcers are a serious problem that can lead to: Pain - some pressure ulcers maybe painful and restrict movement A longer stay in hospital Slower recovery from health problems Anyone who becomes immobile due to illness or injury and must stay in bed, chair or wheelchair, can get pressure ulcers. Some chronic diseases, such as diabetes and hardening of the arteries, loss of sensation or feeling, make it hard for pressure ulcers to heal because of a poor blood supply to the area. These guidelines provide information on what, when, where and how pressure ulcers can develop. They also offer advice on how to prevent them. What are pressure ulcers? A pressure ulcer : Is an injury to the skin and underlying tissues caused by unrelieved pressure May range in severity from reddening of the skin, to deep craters down to muscle and bone 2

3 is usually caused by sitting or lying in one position for too long. This puts pressure on certain areas of the body. Unrelieved pressure squeezes the tiny blood vessels in the skin which supply the tissues with oxygen and nutrients. The tissues die when deprived of oxygen and nutrients for too long. Other factors can cause pressure ulcers: if a person slides down the bed or chair, blood vessels can stretch and distort, leading to pressure ulcers. friction or rubbing of the skin may cause pressure ulcers. moisture on the skin due to incontinence or sweating will reduce the protective properties of the skin. Where can pressure ulcers form? Pressure ulcers most often form where there is little padding over a bony point, eg where bony parts of the body press against a chair or bed, or other bony parts. In bed, pressure ulcers form on the: lower back below the waist hip bone heels buttocks In a chair, the exact spot where the ulcer develops depends on the sitting position. Other areas that can be affected are: knees shoulder blades 3

4 spine ankles back of head ears and nose (from a naso-gastric tube) The time it takes for a pressure ulcer to develop differs between individuals, but damage can occur in acutely ill immobile patients or with prolonged chair or wheelchair use, in as little as half an hour. In a chair, the exact spot where the ulcer develops depends on the sitting position. 4

5 Who is at risk of developing pressure ulcers Patients who are or have: Acute illness Reduced mobility Inability to move Loss of bladder/bowel control Poor nutrition Lowered mental awareness These are some of the risk factors which increase your chance of getting pressure ulcers. If confined to bed/chair the risk of developing pressure ulcers can be high 5

6 How do these reasons increase the risk? Patients spending a lot of time in a bed/chair for long periods. If you are unable to move your position without help you are at great risk. Those people who suffer a stroke, are in a coma or paralysed, or suffer a fractured hip. Your skin should be kept free of urine, stool or perspiration. If you are unable to eat a balanced diet your skin will not be properly nourished and healthy pressure ulcers are more likely to form. When mental awareness is lowered, a person cannot act to prevent pressure ulcers eg health problems, medications or anaesthesia. How to prevent pressure ulcers The following advice is based on research, professional judgement and practice. The most important step to prevent pressure ulcers is to avoid prolonged pressure on one part of your body, especially the pressure points mentioned previously. If you are unable to do so, your carer or nurse should help you to. Your skin : Should be inspected daily for redness (you can use a mirror) A mirror can help when looking at areas which are difficult to see. Special attention should be paid to your heels, elbows, ankles, hips and bottom. 6

7 The aim is to detect problems and correct them before they worsen. Clean and dry skin carefully as soon as it is soiled. A mild soap and water should be used to prevent over-drying of the skin. If you are unable to control your bladder, use pads or briefs that absorb urine and have a quick-drying surface that keeps moisture away from the skin. How to protect the skin from injury Avoid massaging your skin over bony points. Limit pressure by changing position or having your carer change your position: If bedfast change position at least every 2 hours Prolonged chair or wheelchair use change position at least every hour. Careful transfers between bed and chairs will avoid damage from friction. Avoid the use of rubber/foam rings, which may cause pressure damage. If confined to bed Special mattresses are available. If possible, the head of the bed should not be raised for long periods as you may damage your skin by sliding down the bed. 7

8 Pillows or foam wedges can be used to keep knees and ankles from touching each other. Avoid lying directly on your hip bone; a position which spreads weight evenly is better. Pillows can be used along the length of the legs to keep heels off the bed. When sitting do not sit in the same position for longer than 2 hours Use pillows to protect bony points, and along the length of the legs to keep heels off the bed 8

9 If you are a wheelchair user or spend long periods in a chair Special pressure-reducing cushions should be used. Avoid sitting without moving for long periods. Good posture and comfort are important. Sleep is important Contact : The Wheelchair Assessment Unit Leighton Hospital Tel: Ext 2348 or 2541 Or you can contact the Unit direct on How to improve your diet Aim to include more protein, zinc and vitamins in your diet (meat, eggs, fish, poultry, fruit and vegetables). These nutrients are necessary for tissue repair, and will help you achieve good wound healing and healthy skin. If you are struggling with your dietary intake and would like some help with it, please request a dietitian referral from your doctor. Eat a well balanced diet 9

10 How to be active in your care Ask questions. Each person has their own individual needs and goals in care. Express your own needs, goals wants, concerns. Understand what and why things are being done. You can HELP to prevent pressure ulcers. The extra effort can mean better health. If you need further advice before your discharge, please contact; Maureen Benbow Tissue Viability Nurse Mid Cheshire Hospitals NHS Trust/Leighton Hospital on extension 2041 After discharge for details of equipment or special mattress contact the Community Tissue Viability Nurse, Sally Walsh, your doctor or district nurse. There are people who can help - ask your doctor to refer you to the Continence Adviser, Frederick House Nantwich. Tel:

11 Notes / any questions you may have Additional information Your Mobility and Comfort in Hospital - available from your ward or the PALS office. This leaflet has been reviewed by the Patients Readers Panel. 11

12 KEY A&E - Accident & Emergency CCU - Coronary Care Unit DIET - Dietitians ECG - Medical Investigations Unit ENT - Ear, Nose & Throat GUM - Genito - Urinary Medicine HDU - High Dependency Unit ICU - Intensive Care Unit MAU - Medical Admissions Unit (Ward 3) OT - Occupational Therapy PALS - Patient Advice and Liason Service WAU - Wheelchair Assessment Unit - Disabled parking spaces are available on all car parks - Car Park - Entrance LEIGHTON HOSPITAL January 2004 Michael Heal Department of Urology (Urology Outpatients Clinic) GUM LIFT Medical Day Unit TO MIDDLEWICH 6 6A 7 LIFTS 1st Floor - Orthopaedic Unit Wards Surgical, Urology 4 5 WARDS SOUTH CHESHIRE PRIVATE HOSPITAL MENTAL HEALTH A Children's and Adolescent Unit WARD 21B 1st Floor Ward 18, MAU Paediatric Out Patients Khrishan Chandra Children s Unit 1 1st Floor ICU/HDU CCU Renal Dialysis Unit Dining Room 1st Floor Security Office TOILETS LIFTS A530 CHAPEL B MAIN ENTRANCE PALS PORTERS SHOP CASHPOINT PHARMACY PATHOLOGY 1st FLOOR Medical Imaging Department Lift to Patrick Murphy Unit POST GRADUATE MEDICAL CENTRE PHYSIO WAU OT ECG DIET BREAST CARE UNIT X-RAY JAMES CROSS DAY CASE UNIT ENTRANCE TO: MATERNITY 22,23 (NEO Natal Unit Ward 24) Central Delivery Labour Ward 26 WOMEN S HEALTH UNIT Patrick Murphy Unit (Ward 25) Gynaecology Outpatients Clinic ENTRANCE OUTPATIENT ANTE NATAL CLINIC Ante Natal Clinic & Ante Natal Day Assessment Unit entrance only Bus Stop A G E TO NANTWICH OUTPATIENT CLINICS F TOILETS ENT AND EYE CARE CENTRE A & E ORTHOPAEDIC FRACTURE CLINIC C A SMITHY LANE TO CREWE Impressions