Clinical placements

Importance of preventing pressure ulcers was highlighted by training

Improved understanding of skin integrity and the consequences of pressure ulcers is invaluable

A nursing student on placement gained confidence after being trained to manage pressure ulcers in older patients

Picture: Tim George

I am on placement at a trust where I work on a medical ward for older people.

Many of the patients are at risk of developing pressure ulcers, with some already having them on admission, so I was glad of the chance of training from a tissue viability nurse on the prevention and management of these ulcers.

All of the patients are aged 60 or over, and many have multiple comorbidities. Reasons for admission include general deterioration manifesting as multiple falls, increased confusion or poor management of long-term conditions, such as chronic obstructive pulmonary disease and diabetes.

Many of the patients have thin skin and cachexia, and require assistance to adjust their position or transfer from bed to chair.

‘I needed to know more’

I was helping a patient to wash when the tissue viability nurse came to see him to review a grade 3 sacral pressure ulcer which was at high risk of progressing to a grade 4.

Observing the nurse, I realised I needed to know more about caring for patients with pressure ulcers if I was to deliver evidence-based, quality care, so when she told me about the training I was keen to attend.

The training session was very comprehensive and covered the anatomy and physiology of the skin, including skin damage, hypoxic tissue and how pressure ulcers develop. It also covered which patients are most at risk of developing pressure ulcers and how to help prevent them, such as doing skin integrity checks and ensuring patients are turned regularly.

Ideal turnaround time

While a pressure ulcer may not be immediately life-threatening, a compromised skin barrier is a potential source of infection that can lead to sepsis. It is imperative that pressure ulcers are prevented where possible, and that the multidisciplinary team is made aware of all patients diagnosed with pressure ulcers so they can be treated promptly and effectively.

Maintaining skin integrity in older people at risk of developing pressure ulcers is paramount, so following the training I thought about how I could help ensure this was being achieved.

The trust follows a two-hour turnaround policy, rather than the four-hour turnaround recommended by the National Institute for Health and Care Excellence (NICE). But this is not always easy to achieve on a busy ward, especially an older people’s ward where the patients require a lot of nursing care.

How to prioritise

The morning routine is a particularly challenging time to ensure two-hour turnarounds. After handover, the healthcare assistants start helping patients to eat breakfast and wash, while the nurses start administering medications. The time taken for these tasks means that not all of the patients will have had a wash, used the toilet and been turned by the two-hour window.

I started to think about how we could do this differently so that pressure area care could be prioritised for these patients, while also ensuring care is person-centred and that patients maintain their independence as much as possible.

Although a two-hour window is the ideal for all patients, perhaps those most at risk of developing pressure ulcers could be identified in morning handover to ensure they are turned every two hours, and those less at risk could be turned every four hours in line with NICE guidelines.

Devastating consequences

In the NHS, where resources are scarce and equipment can be spread thinly across a trust, planning needs to be considered on how best to share equipment so that it is available when staff need it to help turn patients.

The training I attended was invaluable in giving me a deeper understanding of issues concerning skin integrity, and how vital it is that we do all we can to help prevent the development of pressure ulcers, the consequences of which can be devastating for patients.

The confidence I have gained from being able to identify and manage pressure ulcers will help me to provide better care and treatment for my patients in my future practice.

Clare McCullagh is a second-year adult nursing student at the University of Southampton

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