A Complete Guide on How to Prevent Pressure Ulcers in Nursing Homes

According to the Agency for Healthcare Research and Quality, a significant portion of long-term care residents are at risk for developing pressure ulcers. Preventing these painful and serious injuries is a critical aspect of resident safety and quality of life. This guide will provide comprehensive strategies on how to prevent pressure ulcers in nursing homes, detailing everything from risk assessment to specialized equipment.

Quick Summary

Preventing pressure ulcers in nursing homes requires a multi-faceted approach, including consistent and proactive risk assessment, strict repositioning schedules, attentive skin hygiene, optimal nutrition, and the strategic use of pressure-relieving support surfaces and equipment.

Key Points

• Regular Risk Assessment: Utilize tools like the Braden Scale to identify residents at the highest risk for developing pressure ulcers upon admission and regularly thereafter.

• Scheduled Repositioning: Implement a strict turning and repositioning schedule (e.g., every 2 hours in bed, more frequently in a wheelchair) to relieve pressure on vulnerable areas.

• Meticulous Skin Care: Perform daily skin inspections, manage moisture effectively with pH-balanced cleansers and barrier creams, and moisturize dry skin.

• Specialized Equipment: Use pressure-relieving support surfaces such as special mattresses and seat cushions to aid in pressure redistribution.

• Optimal Nutrition: Ensure residents receive a diet rich in protein, vitamins, and minerals, along with sufficient hydration, to maintain skin health.

• Staff Education: Provide continuous training for all care staff on proper prevention techniques, assessment tools, and documentation protocols.

• Promote Mobility: Encourage and assist with ambulation and range-of-motion exercises for residents who are able to move, improving circulation.

Understanding the Basics of Pressure Ulcers

Pressure ulcers, also known as bedsores or pressure sores, are localized injuries to the skin and underlying tissue, usually over a bony prominence. They result from prolonged pressure, combined with friction and shear forces, that restrict blood flow to the area. For nursing home residents with limited mobility, this can become a serious and dangerous issue.

The Importance of a Proactive Strategy

Preventing these injuries is always better than treating them. A proactive, interdisciplinary approach is the most effective method for protecting residents. It involves the entire care team—nurses, dietitians, and physical therapists—working together with the resident and their family.

Comprehensive Risk Assessment and Early Identification

Identifying residents at risk is the first and most critical step in prevention. This should be a systematic and ongoing process, starting upon admission and continuing with regular reassessments.

Best practices for risk assessment include:

• Initial Evaluation: A thorough skin and risk assessment should be completed for every new resident upon admission to the facility.
• Validated Tools: The Braden Scale is a widely used and validated tool that helps predict pressure ulcer risk by evaluating factors such as sensory perception, moisture, activity, mobility, nutrition, friction, and shear.
• Ongoing Monitoring: Reassessments should be performed regularly, or whenever a resident's condition changes, to adjust the prevention plan as needed.
• Daily Skin Checks: Caregivers should perform daily skin inspections, paying special attention to bony areas such as the heels, hips, tailbone, elbows, and back of the head.

Strategies for Repositioning and Mobility

Relieving and redistributing pressure on the skin is fundamental to prevention. This is achieved through scheduled repositioning and encouraging mobility whenever possible.

1. Scheduled Repositioning: Establish and adhere to a strict turning schedule. For bedridden residents, this typically means repositioning at least every two hours. For wheelchair users, it means shifting their weight or being assisted to reposition every 15 to 30 minutes.
2. Use of Support Surfaces: Incorporate specialized mattresses and seat cushions designed to redistribute pressure. Options range from foam and air mattresses to fluid-filled pads.
3. Encourage Mobility: If a resident is able, promote and assist with ambulation and range-of-motion exercises to improve circulation and strength. Even small movements can make a significant difference.
4. Proper Positioning Techniques: When repositioning a resident, avoid dragging the person across the bed or chair, as this can cause harmful friction and shear. Use proper lifting and turning techniques, often with the assistance of a friction-reducing sheet.

Meticulous Skin Care and Moisture Management

Maintaining the integrity of a resident's skin is crucial, as moist, irritated skin is more prone to breakdown. Consistent and gentle skin care is vital.

Effective skin care practices include:

• Gentle Cleansing: Use mild, pH-balanced cleansers to wash the skin. Avoid harsh soaps and hot water, which can dry out and damage delicate skin.
• Prompt Incontinence Care: Cleanse and dry the skin promptly after episodes of incontinence. Use high-quality absorbent products and moisture barrier creams to protect the skin from prolonged exposure to urine and stool.
• Moisturize: Apply moisturizers to dry skin to keep it supple and elastic, reducing the risk of cracking and injury. Avoid moisturizing between the toes.
• Manage Equipment Pressure: Regularly check the skin under any medical devices, such as oxygen tubing, catheters, and braces, to ensure they are not causing pressure points.

Nutrition, Hydration, and Overall Health

Proper nutrition and hydration play a direct role in maintaining skin integrity and promoting healing. Malnutrition is a major risk factor for pressure ulcer development.

• Nutritional Assessment: A registered dietitian should assess residents' nutritional status, especially those at high risk, to create a personalized nutrition plan.
• Protein and Vitamin Intake: Ensure residents receive adequate protein, vitamins (especially C and A), and minerals (like zinc), which are essential for skin health and tissue repair.
• Hydration: Encourage residents to drink plenty of fluids and monitor their hydration status to prevent dehydration.
• Medical Conditions: Effectively manage underlying chronic conditions like diabetes, which can affect circulation and increase risk.

Comparison of Pressure-Relieving Surfaces

Feature	Standard Foam Mattress	Alternating Pressure Mattress	Low-Air-Loss Mattress
Mechanism	Static support with consistent pressure on contact areas.	Cycle inflation and deflation of air cells to vary pressure points over time.	Circulates air to wick away moisture and maintain a dry, constant low pressure.
Risk Level	Low to moderate risk.	Moderate to high risk.	High risk, and for treating existing ulcers.
Moisture Control	Poor breathability, can trap moisture.	Moderate control, but less effective at managing moisture.	Excellent moisture control, ideal for incontinent residents.
Cost	Low cost, basic option.	Moderate cost, more advanced than foam.	High cost, provides a superior level of care.
Best For	Residents with some mobility who can reposition themselves.	Immobile residents who need constant pressure redistribution.	Immobile residents with complex needs or existing ulcers.

The Role of Staff Training and Protocols

Even the best equipment and care plans will fail without a well-trained and consistent staff. Training and accountability are key to success.

• Ongoing Education: Provide regular training on the latest pressure ulcer prevention protocols, proper repositioning techniques, and risk assessment tools.
• Documentation: Ensure all prevention and care activities are meticulously documented to track progress and maintain accountability.
• Interdisciplinary Communication: Foster an environment where staff from all departments can communicate and collaborate effectively regarding resident care plans.

A Culture of Accountability and Care

Ultimately, preventing pressure ulcers relies on fostering a culture of proactive and compassionate care throughout the entire nursing home organization. From leadership to direct care staff, everyone must prioritize resident safety and well-being. By implementing these comprehensive strategies, facilities can drastically reduce the incidence of pressure ulcers and improve the quality of life for their residents.

For more detailed information on best practices and clinical guidelines, consult resources from authoritative bodies such as the National Pressure Injury Advisory Panel (NPIAP) National Pressure Injury Advisory Panel Website.

Frequently Asked Questions

What is the Braden Scale and how is it used?

The Braden Scale is a risk assessment tool used to predict the likelihood of a patient developing a pressure ulcer. It assesses six factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear. A lower score indicates a higher risk, prompting staff to implement more intensive prevention strategies.

How often should a nursing home resident be repositioned?

The frequency depends on the resident's mobility and risk level. For bedridden residents, repositioning is generally recommended at least every two hours. For wheelchair users, weight shifting should occur every 15 to 30 minutes, with assistance for full repositioning at least every hour.

What is the difference between a standard mattress and a pressure-relieving mattress?

A standard mattress provides static support and can create consistent pressure points, while a pressure-relieving mattress uses specialized technology (like air cells or foam) to redistribute pressure and reduce the risk of skin breakdown. Low-air-loss and alternating pressure mattresses are examples of pressure-relieving surfaces.

Does a resident's diet affect their risk of getting pressure ulcers?

Yes, nutrition and hydration are critical factors. A diet lacking in adequate protein, vitamins (especially C and A), and zinc can compromise skin integrity and hinder the body's ability to repair tissue. Dehydration can also negatively impact skin health.

How should nursing home staff manage a resident's skin to prevent pressure ulcers?

Staff should perform daily skin checks, cleanse the skin gently with pH-balanced products, manage moisture promptly (especially from incontinence), apply barrier creams to at-risk areas, and avoid dragging the resident during transfers to prevent friction.

Can pressure ulcers be entirely avoided in nursing homes?

While some pressure ulcers may be unavoidable due to complex medical conditions, the vast majority are preventable with proper and diligent care. Implementing comprehensive prevention protocols and maintaining high standards of care significantly reduces the incidence of these injuries.

What role does resident mobility play in prevention?

Mobility is a key factor in preventing pressure ulcers. Encouraging and assisting with movement, no matter how small, helps improve circulation and prevents prolonged pressure on any single area. For immobile residents, constant and proper repositioning is the substitute for natural movement.

Are bedsores and pressure ulcers the same thing?

Yes, 'bedsores' and 'pressure ulcers' are terms used to describe the same condition. 'Pressure injury' and 'pressure wound' are also used, particularly in clinical settings.