Key elements in prevention

Key elements in prevention – adapted from National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure injuries: clinical practice guideline. Washington DC: National Pressure Ulcer Advisory Panel; 2009.1

  • Risk Assessment – not only should a risk assessment policy be implemented in a structured manner but importantly the health care team should be educated on both the use of the tool and the basics in pressure injury related issues. All risk assessment must be carefully documented and reassessments undertaken.
  • Skin assessment – condition of the skin such as moisture can increase the risk of damage; therefore a structured assessment as part of an overall risk assessment should be implemented and practical precautions initiated where needed
  • Nutrition – assessment of nutritional status, referral to dietician when required for nutritional support and assessment of hydration status are all key steps.
  • Repositioning – a key step in reducing the impact of pressure - frequency will depend upon individual's general health status, skin condition and support surface insitu. Repositioning should be undertaken in a manner that ensures pressure is relieved or redistributed whilst avoiding shear/ friction forces. Consider use of 30 degree tilted side lying position. Ensure documentation is meticulous and the health care team are educated correctly.
  • Support surfaces – select the appropriate device based on the individual's requirements – reassess frequently- pay particular attention to heels whereby they are relieved of pressure completely if possible by use of pillows correctly positioned. Note: The NPUAP has defined the characteristics of the various support surfaces.
  • Consider the implications of specialist groups – for example patients undergoing surgery, elderly, patients in critical care, paediatrics – all of whom may need additional care.