Many patients, particularly those who are very young or very old, are frail, undernourished and dehydrated, those who are unconscious and patients who have an illness or disability that restricts their movement, are vulnerable to developing pressure ulcers.
Pressure ulcers occur when the blood supply to an area of skin and the tissues underlying it (including muscle) gets obstructed by external pressure, commonly from a hard surface such as a chair or a firm bed mattress. When the blood supply gets cut off, the area is deprived of vital oxygen and nutrients, and the skin and muscle literally ‘dies’, leaving an unsightly mass of dead tissue.
Normally, we adjust our sitting or lying position automatically to counteract this, even when we’re sleeping. But patients such as those mentioned above may be unable to do this for themselves, so are vulnerable.
Pressure ulcers are painful, difficult to cure, put the patient at risk of infection and of losing independence, and are expensive to treat. At the extreme end, some patients’ ulcers are so serious that they need operations and perhaps skin grafts to deal with them.
Preventing pressure ulcers relies most importantly on regular observation and taking preventive action. Our focus here is on the observation part and in particular a system that has been devised to help health care staff monitor and assess the condition of patients’ skin – the SSKIN five-step model for pressure sore prevention.
SSKIN stands for:
Surface: make sure your patients have the right support
Skin inspection: early inspection means early detection
Keep your patients moving
Incontinence/moisture: your patients need to be clean and dry
Nutrition/hydration: help patients to take the right diet and plenty of fluids.
SSKIN is now being used by health care staff throughout the UK. You can read more about it at Bapen.
You should find out if your organisation has access to a tissue viability nurse (that is, a nurse who specialises in preventing pressure ulcers and treating wounds), who would be able to guide, advise and provide training on this vital topic.