Safe Patient Handling Safe Patient Handling to Prevent Pressure to Prevent Pressure Ulcer DevelopmentUlcer Development

Linda Norton MSCH, OT Reg. (ONT)Linda Norton MSCH, OT Reg. (ONT)lnorton@shoppershomehealthcare.calnorton@shoppershomehealthcare.ca

Marian KeithMarian Keithmkeith@shoppershomehealthcare.ca

What is a Pressure Ulcer?

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

National Pressure Ulcer Advisory Panel (www.npuap.org)

Skin Tear “traumatic wounds due to separation of

epidermis from the dermis (partial-thickness wound) or of the epidermis and dermis from underlying structures” (full-thickness wound ). (Payne et al 1993)

1 .5 million skin tears occur in the United States each year, (Bryant 2001)

Where the cause is known 25% were caused by transfers (LeBlanc, 2008)

The Burden of Pressure Ulcers

In 2003, the CAWC funded a study to determine the extent of chronic wounds in Canada.

Results of the study indicated the prevalence of pressure ulcers was: 25% in acute care, 30% in non-acute care, 22% in mixed health-care settings, and 15% in community care The mean prevalence overall was 26%.

1 in 4- Woodbury MG, Houghton PE. Prevalence of pressure ulcers in Canadian health-care settings. Ostomy/Wound Management. 2004;50(10):22-38.

PreventionPrevention

Front line caregivers are essential in Front line caregivers are essential in the effort to prevent pressure ulcers.the effort to prevent pressure ulcers.

Pathway to Assessment/Treatment Pathway to Assessment/Treatment of Pressure Ulcersof Pressure Ulcers

Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. Best practice recommendations for the Keast DH, Parslow N, Houghton PE, Norton L, Fraser C. Best practice recommendations for the prevention and treatment of pressure ulcers: Update 2006. prevention and treatment of pressure ulcers: Update 2006. Wound Care CanadaWound Care Canada. 2006;4(1):31-43.. 2006;4(1):31-43.

How do I inspect the skin?

Head to toe Look for tears,

scraps, areas of discoloration, redness, or patches where the skin looks or feels different

www.epuap.org

Why are skin checks so important

Redness/changes in the skin are usually stage 1 pressure ulcers

Immediate implementation of preventative measures e.g. pressure management devices, turning schedules etc. have been shown to resolve the skin changes, and prevent the progression of the ulcerReference: VanderweeK., Grypdonck M., Defloor T. Non-Blanchable erythema as an

indicator for the need for pressure ulcer prevention: a randomized-controlled trial. J Clin Nurs 2005 Aug 30;(16):325-35)

What is pressure?What is friction?What is shear?

Pressure

Use pressure management surfaces Encourage frequent repositioning

Blood Flow When external pressure exceeds the

mean arterial pressure blood flow ceases

If this is true, why is there an If this is true, why is there an inverse relationship between inverse relationship between pressure and time? pressure and time?

Slow tissue deformation is due to Slow tissue deformation is due to interstitial fluid flow…tissues can interstitial fluid flow…tissues can creep for several hours causing creep for several hours causing increased deformation around increased deformation around bony prominences bony prominences

What do we know for sure? Minimize the use of incontinence pads. Use

of an incontinence pad was shown to increase peak pressure values by 20 – 25%. (Fader M, 2004)

Leg elevation at 10 degrees in the 30-degree head-up position is effective for reducing body displacement at the acrominon; it was not effective for reducing sacral interface pressures. (Harada C, 2002)

Any pressure management surface is better than a “standard hospital mattress” (Callum et al 2006)

What else do we know?

Nothing replaces good client care Consider the impact of the support surface

on bed mobility and transfers. The greater the immersion in the surface, the more difficult bed mobility and transfers will be for the client

People are individuals, there is no one surface which works for everyone

Friction and shear magnify the impact of pressure

Friction and Shear

Use devices which reduce friction and shear

Lift, don’t drag the patient

Undermining

Asymmetrical Undermining Shear

Symmetrical Undermining Fluid

Courtesy of D. Keast

Health Care Worker Injuries The health care sector in British

Columbia accounts for more worker injuries than any other sector, including forestry, construction and transportation 14 .”

In British Columbia, “patient handling activities account for almost 50% of MSK injuries in acute care and long term care settings 14 ”.

“Handle with Care: Patient Handling and the Application of Ergonomics (MSI) Requirements" from Worksafe BC.

Safe Patient Handling Program

Safe Patient handling Programs are typically composed of 5 key components. Policy & Procedure, Assessment, Equipment, Training & Education, and Program Monitoring.

How can safe patient handling programs prevent

skin injuries? Reduces friction and shear forces Makes repositioning easier, so

patients are more likely to get repositioned more frequently

Transfer Boards

Consider a more dependent transfer to reduce friction and

shear

Apply the sling without rolling the patient

One-way glides for repositioning

Repositioning Sling in bed

Multiglide

4-Way Bed Management System

Ergo Slide LTErgo Slide LT

Final Thoughts

Manage pressure, friction and shear forces everywhere all the time

Encourage frequent changes in posture, to promote weight shifting

Nothing replaces good client care

Questions and Thank You