This note contains some, but not all of the NICE guidance.
The full text is at
www.nice.org.uk
The recommendations in the guideline are graded (1) Generally
consistent finding in a majority of multiple acceptable studies (2) Based on a
single acceptable study, or a weak or inconsistent finding in multiple
acceptable studies (3) Limited scientific evidence. This includes expert
opinion.
The note below concentrates on recommendations of (2) and
above. There are, sadly, not all that many. It is obviously an area of practice
wide open for new research. Please note that the guideline contains many more
recommendations.
Risk assessment should be carried out by personnel who have
undergone appropriate training and know how to initiate and maintain correct and
suitable preventive measures (3).
The timing of risk assessment should be based on each
individual case. However, it should take place within six hours of the start of
admission to the episode of care (3).
All formal assessments of risk should be documented/recorded
and made accessible to all members of the inter-disciplinary team (3)
Risk assessment tools should only be used as an aide memoire
and should not replace clinical judgment (1).
Risk factors 2.3.1. An individual's potential to develop
pressure ulcers may be influenced by the following intrinsic risk factors which
therefore should be considered when performing a risk assessment (2): - 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 and
dehydration.
Extrinsic risk factors are involved in tissue damage and
should be removed or diminished to prevent injury: pressure; shearing and
friction (2).
The potential of an individual to develop pressure ulcers may
be exacerbated by the following factors which therefore should be considered
when performing a risk assessment: medication and moisture to the skin (2).
Skin inspection should occur regularly and the frequency
determined in response to changes in the individual's condition in relation to
either deterioration or recovery (3).
Individual patients who are willing and able should be
encouraged, following education, to inspect their own skin (3).
Individuals who are wheelchair users should use a mirror to
inspect the areas that they cannot see easily or get others to inspect them (3).
The following should NOT be used as pressure relieving
aids: water filled gloves; synthetic sheepskins; genuine sheepskins and
doughnut-type devices (3).
No seat cushion has been shown to perform better than
another, so this guidelines makes no recommendation about which type to use for
pressure redistribution purposes (3).
All health care professionals should receive relevant
training or education in pressure ulcer risk assessment and prevention (2).
Patient/carer education should include providing information
on the following (3): -the risk factors associated with them developing pressure
ulcers; -the sites that are of the greatest risk to them of pressure damage;
-how to inspect skin and recognise skin changes; -how to care for skin; methods
for pressure relief/reduction; -where they can seek further advice and
assistance should they need it; -emphasise the need for immediate visits to a
health care professional should signs of damage be noticed
