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Pressure Ulcers: Management and Prevention in Care Homes (Wales) Policy

Policy Statement

{{org_field_name}} aims to prevent pressure ulcers or sores and maintain healthy, intact skin in all people who use services wherever possible and to treat pressure sores effectively if they do occur.

The home has adopted a zero-tolerance policy in line with developments in NHS (Wales), which begins with a thorough assessment of a person’s tissue health and assessment of the risks to loss of tissue viability and development of pressure ulcers.

The policy is also written in line with the guidance on skin integrity in Regulation 21: Standards of Care and Support ― Overarching Requirements of the Regulated Services (Service Providers and Responsible Individuals) (Wales) Regulations 2017.

All health organisations in Wales need to report all avoidable and unavoidable serious incidents of pressure ulcers (grades 3, 4 and unstageable) developed in hospital and community settings to the Welsh Government. The current system requires a notification to the Welsh Government at the point of discovering the serious incident.

Procedures

Procedure for pressure sore prevention

Staff in {{org_field_name}} should adopt the following procedure.

1. Assess every person for pressure ulcer or sore risk on admission using an approved assessment scale such as the Waterlow Scale.
2. Re-assess weekly, or more often if condition deteriorates.
3. Never rub any area identified at risk.
4. Wash areas at risk only if the person is incontinent, obese or sweating profusely.
5. Use only mild soaps and ensure all soap residue is rinsed off afterwards and patted dry.
6. Encourage people to shift position regularly or to keep as mobile as possible. Use advice from physiotherapist where appropriate.
7. Encourage people to maintain a good nutritional status and to take adequate fluids.
8. Where necessary, use appropriate pressure relief aids (such as cushions, mattresses, etc) and inform the person and their carers, if any, of the rationale for this.
9. If necessary, turn the person two or three hourly in bed to ensure pressure relief on high-risk areas. Record turns in notes.
10. Reduce amount of time the person spends sitting in a chair if risk of sacral or pelvic sores is identified.

Procedure for pressure ulcer treatment/management

In the event of a pressure ulcer developing, staff in {{org_field_name}} should maintain the procedure above and, in addition, follow the procedure below.

1. Refer the person who uses services to a GP or other appropriate healthcare professional for advice, medication and treatment which will be discussed with the person and recorded in their care plan.
2. Adopt and implement the prescribed plan of care or a suitable treatment plan such as the SKIN Bundle Approach developed by NHS Wales (see Appendix) with tools available at www.wales.nhs.uk. The choice of treatment for pressure ulcers depends on the stage of the ulcer, the presence or absence of infection and/or necrosis, and the location of the ulcer. For ulcer dressings, staff should refer to the home’s policy on wound management.
3. Regularly document the position and grade of the ulcer or sore.
4. Turn the person in bed in line with the schedule set out in their plan of care and use preventive pressure relief aids to ensure pressure relief on high-risk areas, recording turns and positions in the person’s notes.
5. Provide appropriate and sensitive night-time care which is designed to maintain the requirements of the individual plan of care and to ensure that they get adequate rest and sleep.

Staff should use the following preventive aids, where fully trained to do so, and available in {{org_field_name}} as indicated below.

1. For very high-risk skin areas — specialised bed systems such as fluid beds and alternating air filled pressure mattresses; alternating pressure cushions for wheelchairs/chairs.
2. For high-risk skin areas — alternating pressure overlays, mattresses or bed systems; specialist cushions for wheelchairs/chairs.
3. For at risk skin areas — overlays or specialist mattresses; specialist cushions for wheelchairs/chairs.
4. General aids — bed cradles; monkey poles for people to lift themselves up in bed without friction rubbing; specialist cushions plus elbow and ankle protectors; hoists and transfer devices for lifting.

Training

All care staff should be fully trained in the recognition of the above pressure ulcer risks and in the use of the above aids. Staff providing direct care for a pressure ulcer area should be appropriately trained and should have access to regular continual professional development to update their knowledge of current best practice in wound care. All staff involved in turning or moving a person in bed or in a chair to relieve pressure areas should have received appropriate moving and handling training. All training should include relevant night staff who should also be trained in the specific aspects of night-time care.

Appendix: Outline of SKIN Bundle Approach

Surface: make sure that the person has the appropriate equipment and facilities to minimise the loss of tissue viability and development of pressure sores. The person should have:

• a suitable mattress and bottom sheets selected in line with their skin viability needs, risks of pressure sores and severity of any developing pressure sore
• a pressure reducing cushion when sitting up in a chair
• sheets that are free of wrinkles with the top sheet not too tight over the feet
• nothing to aggravate the condition such as not lying/sitting on tubing, telephones or call bells
• regular checks at repositioning of any air mattress/cushions being used, including any wiring and power box
• a frequent — if necessary daily — reassessment for pressure ulcer risk and equipment included in the care plan.

Keep Moving: there needs to be a constant focus on the affected areas by:

• repositioning the person in line with an agreed schedule (if in bed) at least every four hours
• shifting individual’s weight at least every two hours (if in chair)
• recording all position changes on a repositioning chart
• inspecting the affected areas and others that are at risk at every position change or at least daily if the person is mobile
• encouraging mobility
• providing advice on preventing pressure damage and working in partnership with any informal carers, who visit regularly.

Incontinence: people needing help with their toilet arrangements should:

• have a continence management plan and schedule in line with their individual needs
• be supplied with continence products that protect any affected or vulnerable area
• be attended to promptly when needing changing or after visibly soiling and have the affected areas washed
• not be given use of oil-based creams such as sudocrem with continence products.

Nutrition: skin viability issues should be linked to nutritional needs by:

• evaluating nutritional risk assessments for their impact on skin viability
• ensuring that the person eats well to promote skin viability
• ensuring that the person is well hydrated.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

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