Prevention of pressure ulcers
- Dan Berlowitz, MD, MPH
Dan Berlowitz, MD, MPH
- Boston University Schools of Public Health and Medicine
- Section Editors
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
- Hilary Sanfey, MD
Hilary Sanfey, MD
- Section Editor — General Surgical Principles; Quality and Safety
- Professor of Surgery
- SIU School of Medicine
Pressure ulcers are among the most common conditions encountered in hospitalized patients or those requiring long-term institutional care . Ulcer prevention is a cost-effective approach that positively impacts health status [2-6]. As of October 2008, guidelines from the Center for Medicare and Medicaid Services (CMS) in the United States state that hospitals will no longer receive additional payments when patients develop stage 3 or 4 pressure ulcers (table 1) . Failure to provide appropriate pressure ulcer prevention and care may also expose providers to liability .
The prevention of pressure ulcers will be reviewed here. The treatment, epidemiology, pathogenesis, clinical manifestations, and staging are discussed separately. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers" and "Clinical staging and management of pressure-induced injury".)
Risk assessment, which includes a comprehensive history and physical examination, should identify patients at risk for pressure ulcers who will benefit from preventive measures, as well as factors that are potentially correctable . The pathogenesis of pressure ulcers, risk factors for pressure ulcers, and risk prediction tools are discussed in detail separately. (See "Epidemiology, pathogenesis and risk assessment of pressure ulcers", section on 'Risk factors' and "Epidemiology, pathogenesis and risk assessment of pressure ulcers", section on 'Risk prediction'.)
Pressure redistribution is the most important factor in preventing pressure ulcers and may be accomplished in two ways: appropriate use of pressure-reducing devices and surfaces, and proper patient positioning [9-11].
Support surfaces — Many pressure-reducing support surfaces and products are available. These products are classified as follows by the National Pressure Ulcer Advisory Panel Support Surface Standards Initiative :
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- RISK ASSESSMENT
- PRESSURE REDISTRIBUTION
- Support surfaces
- Static positioning
- - Position and inclination
- - Repositioning
- - Repositioning interval
- Continuous rotation
- SUPPORTIVE INTERVENTIONS
- Improve mobility
- Improve skin perfusion
- Provide proper skin care
- - Minimize excess moisture
- Correct malnutrition
- QUALITY INITIATIVES
- PROVIDER EDUCATION AND STAFFING
- FAILURE OF PREVENTIVE MEASURES
- COST EFFECTIVENESS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS