Pressure ulcers or Bed Sores Prevention
Pressure injuries are also called pressure ulcers, bed sores or decubitus ulcers. They result from prolonged pressure that cuts off the blood supply to the skin, causing the skin and other tissue to die. The damage may occur in as little time as 12 hours of pressure, but it might not be noticed until days later when the skin begins to break down.
People of all ages, including babies and children are at risk of developing pressure injuries. They can occur in people who lie in bed or sit in chairs for long periods without moving; people who aren’t eating well, have problems with skin wetness (such as with loss of bowel or bladder control), have a medical condition that restricts their ability to move or don’t feel pain from pressure. Pressure, especially over a bone, can block blood flow, which can damage the skin as well as the tissue and muscle under the skin leading to these sores.
There are four stages of pressure sores. The first stage is the mildest, marked by pain, burning, or itching in a specific area. The second stage begins when the sore begins to form below the surface of the skin, forming open wounds or blisters. In stage three, the sore reaches the fat tissue under the skin. Signs of infection may occur at this stage. The final stage is the most severe; the sores may begin to affect muscles and ligaments and express with symptoms such as black skin, deepening of the sore, and further signs of infection.
Pressure ulcers can lead to pain, loss of function, infection, delayed healing, altered body image, anger, depression, increased mortality and morbidity, longer hospital stays and ACC treatment injury claims and care costs. It can also create a toll on the person affected, carers and their families/whānau.
Evidence shows most pressure injuries are preventable through early identification of people at risk and subsequent careful management. A pressure injury is much easier to prevent than treat.
There are key actions that are globally recognised and promoted to reduce the risk and impact of pressure injuries. For example, the SSKIN bundle provides a useful approach to ensure that no prevention element is missed. It includes considering or undertaking the following:
Surface – provide a supportive and pressure relieving surface
Skin Inspection – undertake regular checks for discolouration and pain on bony prominences (such as hips and heels) and under or around medical devices
Keep moving – change position often
Incontinence– keep skin dry and clean
Nutrition – eat healthily and drink plenty of fluids.
What is happening nationally?
- ACC, the Health Quality and Safety Commission and the Ministry of Health are working together and with the health sector to reduce pressure injuries in New Zealand. Each agency has responsibility for a different area.
- ACC is working with DHBs to ensure the principles for the prevention and management of pressure injuries are implemented. The guiding principles document can be found here: ACC7758 A guide to preventing pressure injuries.
- The Ministry is providing clinical oversight (particularly from a nursing perspective) and have been focused on pressure injury management across aged residential care. Click here to access the the ministries website on pressure injuries.
- The Health Quality and Safety Commission is leading work on developing and promoting patient stories and case studies for the purpose of raising the profile of the impact of the harm from pressure and ensuring a consistent approach to the measurement of pressure injuries. Click here to see more about the HQSC pressure injury program.
What is happening locally?
ACC and Hauora Tairāwhiti are working together to ensure the principles for the prevention and management of pressure injuries are implemented. Hauora Tairāwhiti was successful in receiving two years funding from ACC to do the work and we have appointed a Clinical Project Coordinator for Pressure Injuries to help us with this. You can contact the Clinical Project Coordinator for Pressure Injuries, Elke Saeys for support or advice on: email@example.com
Unlike other DHBs, Hauora Tairāwhiti is working collaboratively with all the services in the primary and secondary sector to improve outcomes for its populations. A Pressure Injury Steering Committee of primary and secondary care providers has been established and they meet monthly. As a collective, they are looking at a consistent approach to how we identify, assess risk, and implement pressure injury strategies in our rohe. They have an action plan of things they have to achieve for ACC as well as things they want to achieve for our rohe. One thing they want to achieve for our rohe is to share resources. You can access these resources below.
The New Zealand Wound Care Society Inc: https://www.nzwcs.org.nz/resources/stop-pi-day
New Zealand Spinal Trust: https://nzspinaltrust.org.nz/resources/pressureinjuryprevention/
The Royal Children’s Hospital Melbourne: https://www.rch.org.au/kidsinfo/fact_sheets/Pressure_injury_prevention/