Reducing Decubitus Ulcers and Eliminating Restraints

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Reducing Decubitus Ulcers and Eliminating
Restraints

• Governor's Executive Order 2007-01 Ensuring
  Quality in Long Term Care
• Two sessions each day in Phoenix June 2, 5, 6,
• Sessions begin at 730 a.m. and 1 p.m.
• There will be two sessions in Tucson on June 24
• Due to space limitations registration is required
  
• No more than two representatives per facility

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Reducing Decubitus Ulcers and Eliminating
Restraints

• Phoenix Location
• ADOT Human Resource Development Center
• 1130 N. 22nd Ave., Phoenix
• Tucson Location
• ADHS Long Term Care Licensing
• 400 W. Congress, 158, Tucson

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Pressure Ulcers
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Pressure Ulcer

• Is an area of skin that breaks down, usually over
  a bony prominence (area where bones are close to
  the skin), when a person is in one position for
  too long without shifting their weight to
  relieve pressure.

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Pressure Ulcer

• Starts as an area of reddened skin, and without
  relief of pressure will progress to an open sore,
  and then a crater.

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The Effects of Pressure

• Constant pressure against the skin reduces the
  blood supply to that area, which supplies the
  skin/tissue with nutrients and oxygen. Without
  the nutrients and oxygen the tissue dies and a
  pressure ulcer forms.

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Other Causes

• Shear
• Occurs when skin moves in one direction, and the
  underlying bone moves in another. This type of
  movement stretches and tears cell walls and small
  blood vessels.

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Other Causes

• Friction
• Occurs when force is able to overcome the bodys
  resistance to movement, even slight rubbing or
  friction on the skin may cause minor pressure
  ulcers.

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Other Causes

• Moisture
• Caused by excessive perspiration or incontinence
  can irritate or soften the skin and contribute to
  the development of pressure ulcers

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Staging

• Pressure sores are categorized by severity, from
  Stage I (first sign) to Stage IV (worst)

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Stage I

• Intact skin with non-blanchable (does not turn
  white when pressed) areas of redness usually over
  a bony prominence. Individuals with dark
  pigmented skin may not have visible blanching,
  the area may appear discolored.

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Stage I
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Stage I
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Stage II

• Partial thickness loss, epidermis or topmost
  layer of the skin is broken, presenting as an
  abrasion or shallow open ulcer with a pink/red
  wound bed, without necrotic (dead) tissue. The
  ulcer may also present as an intact or open
  blister.

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Stage II
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Stage III

• Full thickness tissue loss, damage to the tissue
  extends through the dermis (second skin layer)
  into the subcutaneous and fat tissue. Slough
  (necrotic yellow or gray tissue that is
  separating from living tissue) may be present.

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Stage III
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Stage IV

• Full thickness tissue loss, damage to the tissue
  extends into the muscle and can extend as far
  down as the bone. Slough or eschar (thick black
  or dark brown leather like necrotic tissue) may
  be present on some parts of the wound bed.

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Stage IV
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Unstageable

• Full thickness tissue loss in which the base of
  the ulcer is covered by slough and/or eschar.

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Unstagable
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Unstagable
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Where

• Pressure ulcers most commonly develop over bony
  prominences like
• elbow, heels, hips, ankles, sides of the knee,
  shoulders blades, back, and the back of the head.

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Pressure Areas
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Pressure Areas
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Pressure Areas
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Identifying Who is at Risk

• Residents who are
• bedridden
• in a wheelchair most or all time
• unable to move certain parts of their body
  without assistance
• incontinent of bowel and/or bladder
• malnourished
• obese

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Identifying Who is at Risk

• Residents who have
• dementia, Alzheimer's disease or other mental
  disabilities
• Diabetes
• a history of pressure ulcers
• vascular disease (poor blood flow)
• fragile skin

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Preventive Measures

• Reposition residents at least every two hours to
  relieve pressure.
• Use items that can help reduce pressure --
  pillows, sheepskin, foam padding
• Provide healthy, well-balanced meals.
• Assist with daily range-of-motion exercises for
  limited mobility residents
• Limit moisture, residents who are incontinent
  should be kept clean and dry.

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Preventive Measures

• Residents who have any of the risk factors,
  should be checked for pressure sores every day.
  Look for reddened areas that when pressed, do not
  turn white, blisters and sores.

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Contact a Medical Professional

• When an area of skin
• turns red and does not blanch
• blisters
• forms an open sore

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Contact a Medical Professional

• When
• A foul odor from the ulcer is first noticed
• Redness and tenderness around the ulcer is
  noticed
• Skin close to the ulcer is warm or swollen
• - Color or amount of drainage from the ulcer
  changes

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R9-10-722.C.1/723.D

• C. A licensee shall provide to each resident
  receiving personal care services
• 1. Skin maintenance to prevent and treat bruises,
  injuries, pressure sores, and infections
• This also applies to residents at the directed
  level of care.

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R9-10-722.A.4/723.B.3

• In order to accept or retain a resident who has a
  stage 3 or stage 4 pressure sore, an Assisted
  Living licensee must ensure
• Written authorization for residency or continued
  residency is signed and dated by the resident or
  representative

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R9-10-722.A.4/723.B.3 (Cont)

• The residents primary care provider examines the
  resident, then signs and dates a statement
  authorizing residency at the facility
• This must be done every six months

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R9-10-722.A.4/723.B.3 (Cont)

• The residents service plan is revised to include
  the residents increased need for services
• The resident is under the care of a nurse,
  licensed home health agency or licensed hospice
  agency
• The facility is meeting the residents needs
• The facility documents the services provided

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Questions