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March 2010, Volume 40 Number 3 , p 44 - 47


  • Wendy D. Blaney RN


EACH YEAR in the United States, thousands of patients die from complications of preventable hospital-acquired pressure ulcers.1 Psychologically and physically devastating for patients, pressure ulcers also cost billions of dollars in treatment and litigation and put a strain on an already burdened healthcare system.Implementing evidence-based practices and effective prevention policies and procedures can help hospitals prevent pressure ulcers and comply with Centers for Medicare & Medicaid Services (CMS) regulations, which no longer reimburse hospitals for Stage III and Stage IV pressure ulcers acquired while patients are hospitalized.2 (For assessment guidelines, see Staging pressure ulcers.)Many patients in my facility's cardiovascular progressive care unit are at high risk for acquiring pressure ulcers because of cardiovascular disease, older age, compromised circulatory status, immobility, and comorbidities, such as obesity and diabetes (see Who's at risk for pressure ulcers?). To prevent pressure ulcers, our unit implemented several practices based on current research and recommendations from the National Pressure Ulcer Advisory Panel. These recommendations can be used by all clinicians, whether working in an acute care facility, the home, or a long-term-care setting.At admission, assess the patient's skin from head to toe. The skin is an indicator of the patient's general health. Inspect and palpate for changes in skin integrity, texture, turgor, temperature, consistency (such as bogginess or induration) and moisture, color changes, non-blanchable erythema, and edema. Blanchable erythema is an early indicator that pressure needs to be redistributed; non-blanchable erythema suggests that tissue damage has already occurred.Take the patient's history related to pressure ulcers. Ask about areas with lack of sensation, areas of pain, location of current or previous pressure ulcers, location of fragile skin or easy bruising, and any medications

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