Pressure ulcers

This is a summary of the peer-reviewed article: Implementing the PURPOSE T pressure ulcer risk assessment tool into clinical practice by Julie Tyrer

The article discusses pressure ulcers, which are a significant concern in healthcare and are one of the most reported patient safety incidents in England. They can cause serious physical harm, ranging from skin damage to life-threatening complications, and can affect a patient’s quality of life, often leading to pain, distress, depression and sleep disturbances.

Pressure ulcers may also have emotional effects on patients’ families, alongside considerable financial costs for healthcare organisations. Effective prevention requires identifying patients at risk, and this process is integral to the National Wound Care Strategy Programme.

Risk factors and assessment tools

The article explains that there are several risk factors for pressure ulcers, including immobility, sensory loss, cognitive impairment, nutritional deficiencies and previous pressure ulcers. These factors may interact in complex ways, making it essential to use validated risk assessment tools to help identify at-risk patients. The National Institute for Health and Care Excellence recommends that all patients, especially those in hospitals or care homes, are assessed for pressure ulcer risk within six hours of admission or during their first home visit.

Various risk assessment tools have been developed over the decades. The Norton scale, introduced in 1962, assesses five risk factors – physical and mental condition, activity, mobility and incontinence – scoring patients based on severity. The Waterlow score, developed in the 1980s, considers additional factors such as weight, appetite and skin condition. Another popular tool is the Braden scale, which evaluates risks based on sensory perception, mobility, activity and friction. However, despite the widespread use of these tools, research has questioned their effectiveness in preventing pressure ulcers, suggesting that clinical judgement is crucial alongside these tools.

PURPOSE T

The PURPOSE T (Pressure Ulcer Risk Primary or Secondary Evaluation Tool), developed by the University of Leeds, uses a colour-coded system rather than numerical scores to identify pressure ulcer risks, making it easier for nurses to implement preventive strategies. The PURPOSE T involves a three-step process:

• Screening patients for basic risk factors.
• Conducting a comprehensive assessment if risks are identified.
• Determining appropriate prevention pathways based on the identified risk levels.

This tool is noted for its simplicity and focus on actionable care plans, as well as the strong evidence supporting its use.

The PURPOSE T includes skin assessment as part of the overall risk assessment process, an important element that is often overlooked in other tools. It also addresses some issues identified with other tools, such as the subjective nature of scoring and the exclusion of some risk factors such as existing pressure ulcers. However, training and adapting the tool to electronic health records are necessary steps for broader adoption of the PURPOSE T.

Disclaimer
This summary was generated using an AI tool (ChatGPT) and checked via in-house editorial processes. While we strive for accuracy and quality, please note that we cannot guarantee this summary will be entirely error-free. We do not assume any responsibility or liability for the use or interpretation of this content and recommend referring to the original article.

Related articles

• RELATED: Podcast – Pressure ulcers: tips for avoiding preventable harm
• RELATED: Wound care in older people: overcoming the challenges of assessment and management
• RELATED: Prevention of pressure ulcers in older people with frailty