Pressure Ulcers - NPSG - Goal 14 - 14.01.01
Revised | November 24, 2008
Risk assessment tools
Q. How should staff assess the risk of a resident developing a pressure ulcer?
A. A validated risk assessment tool such as the Braden Scale or the Norton Scale should be used to identify residents at risk for developing pressure ulcers (see EP 3). Initial assessment should be done on the resident at the time of admission to the long term care facility. Recommendations for subsequent reassessment are weekly as well as whenever the resident’s condition changes or deteriorates.
Q. What are some actions staff can take to prevent pressure ulcers in high risk residents?
A. A multi-component approach is recommended. The plan of care for a resident at risk for developing a pressure ulcer should include the following:
- Skin inspection, skin cleansing, care for dry skin, use of moisture barriers and massage
- Nutritional support based on an individualized nutritional needs assessment
- Avoidance of skin injury from friction or shear forces through the use of positioning, transferring and turning techniques
- A plan to maintain and, when appropriate, to increase mobility and activity level
- Improvement in positioning, repositioning, transferring and turning techniques to reduce skin injury caused by friction and shear force
- Use of repositioning devices, and mechanical loading and support surfaces to reduce skin injury caused by friction or shear force
- Staff educational programs on the assessment, prevention, and treatment protocols.
In addition, any hand off communications should include relevant information about the resident’s risk of developing a pressure ulcer, or the treatment and status of any existing pressure ulcers.
Decubitus ulcers vs. pressure ulcers
Q. NPSG 14 talks about the prevention of “healthcare-associated pressure ulcers” in the long term care population. What is the difference between “pressure ulcers” and “decubitus ulcers?”
A. “Pressure ulcer” is a broader term that includes decubitus ulcers but also includes any ulcerations associated with pressure (e.g. prosthetic limbs or dental prostheses). “Decubitus ulcer” refers to the breakdown of skin and subcutaneous tissue due to prolonged, unrelieved pressure over a bony prominence, often associated with malnutrition, paralysis, or physical deformity.