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Pressure Ulcer Policy

Aim

Cavendish Homecare Professionals aims to prevent pressure ulcers wherever possible and maintain healthy, intact skin in all clients. Where pressure ulcers do develop, the aim of Cavendish Homecare Professionals will be to treat and manage them effectively using all current best practice.

Background

Cavendish Homecare Professionals understands a ‘pressure ulcer’ to refer to a localised damage to the skin caused by disruption of the blood supply to the area, usually caused by pressure, shear or friction, or a combination of any of these (Pressure ulcer risk assessment and prevention, National Institute for Health and Clinical Excellence, 2005). Such wounds have a range of effects on clients, including:

  • severe pain and discomfort
  • loss of mobility – isolation if bed-bound
  • loss of independence
  • depression

The organisation recognises that prevention is its primary goal in this area and understands that the key principles in pressure ulcer prevention and care are commonly understood to be:

  • Assessment of risk – the aim of risk assessment is to identify the presence of predisposing and precipitating factors which may influence the development of pressure ulcers and to identify people at risk. Once clients with risk factors are identified then the appropriate interventions can be put in place to help the client maintain their skin health.
  • Preventative measures – relief of pressure is the main method used in the prevention of pressure ulcers. This may be achieved by regular re-positioning of the patient and use of pressure relieving equipment where necessary.
  • Use of specialised equipment – pressure relieving equipment includes items such as pressure relieving mattresses and cushions.
  • Nutrition – poor nutritional status is strongly linked with the risk of developing a pressure ulcer. All clients should be assessed for nutritional risk as well as pressure ulcer risk.
  • Dressings and treatment – these have developed considerably in recent years and only modern evidence-based treatments should be used.
  • Monitoring and documentation – up-to-date and accurate recording of pressure ulcer assessment within patient care documentation is essential.
  • Education – not only should staff stay up to date with modern treatments and preventative strategies but clients themselves, and their families should have access to good-quality information in a format that they can understand. The more informed a client the more likely it will be that they will be able to comply with preventative strategies.

Policy

Every new client will be assessed for pressure sore risk using an approved assessment scale (such as the Waterlow Scale). Results will be recorded in the clients’ care plan which will be subject to regular re-assessment and review. Existing clients will also be monitored for any changes that might alter their risk profile. Where a change in condition occurs a new risk assessment will be conducted or an existing assessment reviewed and updated.

Factors which should be considered when performing a risk assessment include:

  • reduced mobility or immobility
  • sensory impairment
  • acute illness
  • level of consciousness
  • extremes of age
  • vascular disease
  • severe chronic or terminal illness
  • previous history of pressure damage
  • malnutrition
  • co-morbidities, for example diabetes, obesity

Clients with an identified risk should be encouraged to shift position in their bed or chair regularly or to keep as mobile as possible. If necessary staff will help clients to reposition themselves or to turn over at regular intervals as specified in the plan of care. All help given should be recorded in the client’s notes.

Repositioning should take into consideration other aspects of an individual’s condition – for example, medical condition, comfort, overall plan of care and support surface.

Staff should regularly inspect the skin of ‘at risk’ clients with the frequency of inspections determined in response to changes in the individual’s condition in relation to both deterioration or recovery.

Clients who are willing and able should be encouraged to inspect their own skin and will be shown how to do this. Staff will be vigilant to any signs which may indicate pressure ulcer development, including blisters, discolouration of the skin, localised heat or oedema. Any skin changes should be reported and documented immediately.

Specialist advice will be obtained from a qualified local tissue viability specialist nurse or physiotherapist where appropriate. Staff will work collaboratively in partnership with other medical or healthcare specialists involved in the care of any client.

Staff should encourage all clients to maintain a good nutritional status and to take adequate fluids, especially those with an identified pressure area risk.

When helping a client to wash, only mild soaps should be used and staff should ensure all soap residue is rinsed off afterwards and patted dry. A suitable moisturiser can be used if skin is very dry.

Where necessary, appropriate pressure relief aids should be utilised. Clients, their relatives and carers should be given adequate information and instruction about any adaptations or equipment so that they can use them effectively and understand the rationale for use. ‘At risk’ individuals should have access to adequate pressure relieving aids and should not be placed on standard foam mattresses.

Pressure Ulcers are classified as follows –

Grade 1:  Non-blanchable erythema of intact skin.  Discolouration of the skin, warmth, oedema, induration or hardness may also be used as indicators, particularly on individuals with darker skin.

Grade 2:  Partial thickness skin loss involving epidermis or dermis, or both.  The ulcer is superficial and presents clinically as an abrasion or blister.

Grade 3:  Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia.

Grade 4:  Extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures with or without full thickness skin loss.

NB: Pressure ulcers of Grade 3 or above trigger a Safeguarding investigation and become a CQC Notifiable incident.

In the event of a pressure ulcer developing staff should maintain preventative interventions and, in addition:

  • with the client’s consent, or their family’s agreement, refer the client to a GP or appropriate specialist for advice, medication and treatment which will be discussed with the client and recorded in their care plan
  • adopt and implement the prescribed plan of care or a suitable treatment plan in collaboration with the GP or any other healthcare professional involved; the choice of treatment for pressure sores depends on the stage of the ulcer, the presence or absence of infection and/or necrosis, and the location of the ulcer
  • regularly document the position and grade of the sore and all treatments/interventions applied, for instance turning the client in bed and utilising appropriate preventative pressure relief aids
  • only use approved evidence-based methods of pressure area care as specified in training – never rub any area identified at risk.

Preventative pressure relief aids used will include:

  • specialised bed systems such as fluid beds and alternating air filled pressure mattresses
  • alternating pressure cushions or other specialist cushions for wheelchairs/chairs
  • alternating pressure overlays, mattresses or bed systems or other specialist mattresses or overlays
  • bed cradles
  • poles for clients to lift themselves up in bed without friction rubbing
  • specialist elbow and ankle protectors
  • hoists and transfer devices for lifting

All care staff will be trained in the safe use of preventative pressure relief aids. Water filled gloves, sheepskins and doughnut-type devices should not be used.

Regular audits will be run to focus on the organisation’s pressure ulcer care and the incidence and severity of pressure ulcers within the organisation will be closely monitored to ensure that managers and staff are aware of any trends and can use the information to identify potential problems or issues. ‘Incidence’ refers to the number of pressure ulcers developing over a period of time.

Management duties

Cavendish Homecare Professionals has a duty to ensure that:

  • appropriate policies, procedures and protocols are in place, are effectively implemented and are clearly understood by all members of staff, and are regularly reviewed and revised in light of the most recent best practice guidelines and reported incidents
  • appropriate professional advice is sought and provided
  • appropriate information is provided to clients, their families and representatives, in a format that all clients can understand
  • all staff are aware of and implement this policy
  • an effective incident reporting process is in place, ensuring that any continence or care related incidents or near misses are accurately reported and that regular scrutiny of reports is conducted to identify if risks are being effectively controlled
  • adequate and suitable training programmes are carried out which include induction training for new staff

Staff duties

Staff have a duty to:

  • comply with all relevant policies, procedures and guidelines at all times, properly utilising any personal protective equipment provided and carrying out their duties in accordance with their training and good practice
  • attend appropriate training

Training and information

All new staff should attend basic pressure ulcer awareness training and should read the policy on pressure ulcer prevention as part of their induction process.

Staff with additional responsibilities will be expected to attend additional training appropriate to their role

 

 

Date: January 2024

Version: 9 (Revision)

Source: Expert Care Manager