GRADE 1: Discolouration of intact skin not affected by light finger pressure (non blanching erythema)This may be difficult to identify in darkly pigmented skin .
Reducing the incidence of pressure sores and shearing damage for bed-bound individuals
Reducing the incidence of pressuresores and shearing damage for bed- bound individualsMHANZ 23rd March 2012 Melanie Sturman-Floyd, MSc, RGN. Moving and Handling Consultant
What are pressure ulcers and shearing damage? • A pressure sore/decubitus ulcer is a local injury to the skin or underlying tissue over a bony prominence, caused by prolonged, sustained pressure. • Shearing damage is caused by pulling/tearing of the tissue.
Pressure and Shear Pressure – presses tissue together Shear – pulls/tear tissue Shear and friction – cause pressure sores Blood vessel Skin layer 3 (dermis) Shear between Skin layer 2 (cutis) skin layers Skin layer 1 (epidermis)
Why does the pressure damage occur? • Poor Nutrition • Dehydration • Poor Circulation • Incontinence • Old Age • Immobility • Insufficient Moving/Turning in Bed, Chair or Wheelchair • Poor Moving and Handling Techniques • Unsuitable Mattress
Common Pressure Ulcer Sites• The areas most effected are:• Back of heels• Sacrum• Sometimes scapula area• Hip, when the patient is lying in the foetal position.
Pressure Ulcer Classification Grade 1. European Pressure Ulcer Advisory Panel. Pressure Ulcer Treatment GuidelinesNon-blanchable erythema (redness) ofintact skin.Discolouration of theskin, warmth, oedema, induration orhardness may also be used asindicators, particularly on individuals withdarker skin.
Pressure Ulcer Classification grade 2 • Partial thickness skin loss involving epidermis, dermis, or both. • The ulcer is superficial and presents clinically as an abrasion or blister.
Pressure Ulcer Classification Grade 3 • Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia.
Pressure Ulcer Classification Grade 4 • Extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures with or without full thickness skin loss.
In which environments do pressure sores occur? • 20 % service users in acute care (large hospitals) • 30 % people in community (own home and community hospitals) • 20 % people in nursing/residential homes
The annual cost of pressure ulcers in the UK The cost is 1.4 -2.1 billion/year = Mental Health or Community Health Services Budget The cost per service user ranges between £11k – £40kReferences:Bennett G., Dealey C. & Posnett J. The cost of pressure ulcers in the UK. Age and Ageing. 2004; 33(3): 217-218.Vanderwee K, Clark M, Dealey C et al. (2007). Pressure ulcer prevalence in Europe: a pilot study. Journal of Evaluation inClinical Practice. 13(2):227-235.Phillips L, Buttery J Exploring pressure ulcer prevalence and preventative care. [Journal Article] Nursing Times 2009 Apr28-May 4; 105(16):34-6.EPUAP (2009) European Pressure Ulcer Advisory Panel. EPUAP Review 2009; 10(1):1-28.
Pressure ulcer productivity calculatorSection A: Total number of pressure ulcers 350 How many pressure ulcers does your organisation treat? (enter a number and press ENTER)Section B: Pressure ulcers by grade Grade 1 122 How many pressure ulcers of each grade does your organisation treat? Grade 2 144 Grade 3 45 The default numbers are based on percentages Grade 4 39 from the academic research study. Please overwrite if you are confident your numbers are different. Total 350 (Total of section B must be the ) same as the number in section A)Section C: Results: Estimated cost of pressure ulcer care at 2008/09 prices(rounded to the nearest thousand £s) Central estimate Lower range Higher rangeGrade 1 177,000 143,000 214,000Grade 2 862,000 699,000 1,044,000Grade 3 449,000 363,000 543,000Grade 4 552,000 447,000 668,000Total 2,040,000 1,652,000 2,469,000Section D: Potential savings if the number of pressure ulcers is reduced Enter a planned percentage reduction in the green box, to see the impact on number of ulcers, and cost pressures: 25% A reduction of 25% in pressure ulcers would mean 88 fewer pressure ulcers and a potential cost saving of £510khttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid ance/DH_116669
How can pressure damage be reduced? • Activate the Service User when Possible • Improved Nutrition and Hydration • Pressure Relieving Mattresses and Cushions • Improved Standard of M/H Equipment • Reduce friction and shearing with equipment and manual handling techniques. • Well-Trained Staff • Change position regularly.
Preventative approach – Cost-benefits• Activate service user whenever possible• Work with minimal force• Reduce carer’s injuries• Reduce cost of care
Reducing the incidence and risk of pressure sores and shearing damage for bed-bound individuals. •An equipment evaluation conducted by: •Melanie Sturman-Floyd MSc RGN •Norfolk County Council & MSF Manual Handling & BackCare •www.manualhandlingconsultancy.co.uk
The Thesis“Does leaving a leave in bed positioning system under a person lying in bed exacerbate or increase the incidence of pressure ulcers?”• Other questions asked.“Does leaving a leave in bed positioning system reduce the number of carers for moving and handling tasks?”“Does leaving a leave in bed positioning system increase patient comfort?”
Study Inclusion• 110 clients evaluated.• Criteria for inclusion, predominately bedbound, tissue viability mattress.• Require assistance with moving and handling activities.• Support provided by family or employed handler.
Introduction of equipment.• Balance between managing manual handling risks and pressure ulcer incidence.• Discussed with Tissue Viability Nurse.• No previous research.• Wendy Lett systems introduced.• Record types of tissue viability mattresses used.• At start of trial record pressure ulcer incidence.• At start of trial record number of patient handlers.• At start of trial measure and record handler perceived rate of exertion.
Findings• Pressure ulcer incidence – start of trial 79 clients had pressure ulcers,• Grades Start 6 weeks 12 weeks• Grade 1 25 5 2• Grade 2 3 2 1• Grade 3 2 2 0• Grade 4 1 1 0Projected costs of pressure ulcer management for N79 at start £88,000 and at end of study £9,000.
Reducing handler costs and manual handling injuries• Reducing carer costs• Introducing system enabled a reduction of carers for 28 clients. Cost at start of trial £711,349, Cost at end of study was £422,276.• Reducing manual handling injuries• 232 carers were asked to rate perceived rate of exertion, at start of trial range was 14-17, (high risk). Changing technique and introducing the leave in systems reduced range to 5-9, (low risk).• Using systems with bariatric clients – reduces manual handling effort from positioning slide sheets.• Using systems with clients who have complex behavioural needs – reduces challenging behaviour.• Increased patient comfort and facilitated transfers/independence.