2. Skin assessments should be done frequently to catch ulcers
before they progress.
3. Product selection to prevent decubitus ulcers should be tested
4. Pressure management protocols need to satisfy all factors that
contribute to pressure ulcers (pressure, shear, heat and humidity)
in order to be effective.
Montague says pressure ulcers are considered reasonably preventable, so prevention has become a priority across all inpatient settings.
“As a fundamental of value-based care, evidence-based pressure
ulcer prevention programs help institutions offset reimbursement
penalties,” Montague says. “Regular skin assessments, frequent
repositioning with the use of offloading devices, optimization of
nutrition, use of skin barrier creams, and the use of appropriate
bed and chair surfaces, all assist in the prevention of pressure
Unfortunately, Froloff does not see the frequency of pressure
ulcers declining in the future. Froloff has spent several years
advising hospitals throughout the world on positioning and pres-
sure ulcer management and assists medical facilities in maintain-
ing their zero tolerance goals.
“I see this as a problem that will continue to grow as our population
is getting older and experiencing more problems that contribute to
pressure ulcers like diabetes, obesity, cardiovascular disease, and nutritional deficiencies,” Froloff says.
Looking ahead, hospitals may decide to invest more into better patient handling practices to reduce and, hopefully, eliminate
“The prevention of pressure ulcers through the use of evidence-based pressure ulcer prevention programs is less costly than treating a pressure ulcer,” Montague says. “An acquired pressure ulcer
not only affects reimbursement, but is also a publically reportable
Ways to prevent pressure ulcers
Continuous movements - Continuous movement and re-postition-ing of the patient relieves the pressure on areas that are vulnerable to
pressure ulcers. There should be a repositioning timetable to record
the changes in position. A patient with an ulcer is made to lie in such
a way that there is no pressure on the ulcer to prevent its worsening.
There should be advice regarding correct sitting and lying positions,
good posture, foot support and use of equipment to prevent pressure.
Mattresses and cushions - There are various types to prevent pressure sores. Low-air loss beds may be used. These are waterproof but
absorb excess water. Some of these can also pulsate and oscillate from
time to time to redistribute pressure. There are also air-fluidized beds.
Here the patient floats on silicone coated glass beads that have heated
air forced among them. These reduce friction and shear.
Regular Skin assessment - The whole skin should be assessed
regularly to check for signs of pressure ulcer development. Scales and
tools are used to detect early changes. Some tell-tale signs include red
patches of skin that do not fade, blisters, warm or cool or hard skin
patches with or without swelling.
Self care - Regular skin inspection and posture change routine is
developed by the patient with the help of his or her care giver and
healthcare professional to prevent ulcers.
Diet - Patients are advised to eat a healthy and balanced diet. Some
supplements may be prescribed if there is a deficiency.