Sample Program

Sample Program

A comprehensive pressure ulcer prevention program includes the following:

1. Risk assessment to identify the resident at risk
   • On admission, at defined periodic intervals, and with any significant change in status. Designated frequency may need to be increased if residents’ status deteriorates.
   • Utilize pressure ulcer risk assessment tool such as the Braden Scale or the Norton Scale
   • Analyze risk factors
2. Individualized plan of care
   • Problem identification based on risk factors
   • Realistic, time-framed goals
   • Interventions that address risk factors
3. Education of patients/residents, family and staff.
   Responsibility for pressure ulcer prevention is shared by the healthcare personnel, patient/residents, and families. Education provides an important opportunity to enlist partners in prevention. Appropriate educational programs should be provided prior to planned intervention, and at periodic intervals.
4. Implementation and documentation of interventions
   1. Maintain personal hygiene and care
      • Maintain skin in a clean and lubricated condition, free of excess moisture, with daily skin inspection and documentation.
      • Provide for toileting, including perineal care, a toileting program based on individual needs, and incontinence care.
      • Provide and encourage nutrition and fluids
   2. Relieve or reduce pressure (pressure redistribution) via use of:
      • Support surfaces
      • Specialty beds or mattresses
      • Turning and repositioning – every two hours or more often based on risk, if patient/resident is in bed or chair.
      • Consider assistive devices when positioning to avoid friction, i.e. lift sheets
      • Bridge heels (or float) and avoid positioning on bony prominences.
      • Do not elevate head of bed more than 30 degrees. (NOTE: At mealtime, elevate head of bed to sitting position as the tray arrives; return HOB to 30° or less immediately after meal.)
      • Encourage mobility
   3. Inspect skin daily
      • Note any changes in color, temperature, or signs of tissue damage.
      • Document, report, and intervene promptly on identified changes.
5. Periodic measurement (assessment) of impact of interventions.
6. Modification of interventions as indicated by evaluation of assessment.
   
   (Program used/modified with permission of Michigan Antibiotics Resistance Reduction (MARR) Committee 2008. LTC Tool Kit - In Press)

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