A study conducted in 2008 published by the National Institute of Health showed a substantial correlation between pressure ulcer history and hospital admission. Hospital admissions of patients with pressure ulcers were 26.2 percent among nursing home admissions. The rate of patients with prior pressure ulcers admitted from home or other living situations was 4.8 percent.
Causes and Prevention
The Braden Scale for Predicting Pressure Sore Risk gives health care workers a guide in determining risk and how to prevent the occurrence of pressure ulcers. The physical and psychological capabilities of the patient play a role in the creation of pressure ulcers. One risk is sensory perception and how well the patient can see, hear or feel. Nutrition is another factor that is important in the prevention of pressure ulcers. Poor nutrition can cause the breakdown of skin as well as constant moisture. Mobility and activity keeps a patient from stagnating in one spot and creating pressure points on the skin. A constant friction can also cause pressure ulcers to develop. The majority of patients at risk of developing pressure ulcers are elderly but preventative treatment can avoid the risks.
Pressure ulcer history and hospital admission can be prevented. In 2002 the New Jersey Hospital Association formed the Institute for Quality and Patient Safety in order to identify the best practices in health care. One of the elements of quality care that was recognized was the prevention of pressure ulcers among elderly patients. After several years of conducting a study on the subject with the cooperation of 150 organizations the findings were published. It read that nursing staff were not conducting a thorough evaluation of the patient’s skin upon admission by removing all clothing and examining all areas of the skin. The study also revealed that many nurses were not aware of the Braden Scale for Predicting Pressure Sores and therefore, remained inadequate in their skin assessments. The final revelation of the study revealed that nursing staff were unable to access necessary equipment within 24 hours of admission for reasons beyond their control. In some cases equipment was locked and supplies were unavailable.
Stages of Pressure Ulcers
There are four stages to describe a pressure ulcer. The first stage presents as a red mark on the skin while the second stage shows an open wound such as a blister or abrasion. The third stage can be serious because the ulcer has invaded the layer beneath the skin. The fourth stage is very severe, involving the soft tissue, muscle and bone. Most areas affected are the tail bone, back of the arms and legs and shoulder blades if the patient is wheelchair bound. For patients that bedridden the pressure points to look for are the bony parts of the body such as the tail bone, hips, knees, ankles, elbows. Also included in high risk pressure points are the head, around the eyes and ears.
Maintaining skin integrity is important and part of the overall health of a patient. By conducting a full skin survey upon admission, pressure ulcers can receive the aggressive treatment necessary. Preventive measures can avoid advancement of the condition. Pressure ulcers can lead to death by creating infections in bones and joints, cellulitis, sepsis and cancer according to the Mayo Clinic. A pressure ulcer can occur very quickly and can progress in less than 24 hours. If you suspect a pressure sore take precautions and contact a physician.
Pub Med Centeral: Prevalence of pressure ulcers on hospital admission among nursing home residents transferred to the hospital
Lippincot Nursing Center:Evidence-based Nursing Another Look: Best practices for pressure ulcer prevention
U.S. Department of Healthcare Research and Quality: Pressure ulcers are increasing among hospital patients
Agency for Healthcare Research and Quality: Braden Scale for Predicting Pressure Sore Risk