Pressure ulcers, also known as bedsores or decubitus ulcers, are a significant concern in long-term care settings, particularly among residents who are bed-bound or have limited mobility. These ulcers form as a result of prolonged pressure on the skin, especially over bony areas, and can lead to serious complications if not properly managed.
Risk Assessment
The first step in preventing pressure ulcers is identifying at-risk individuals. Any resident who is unable to reposition themselves should be considered at risk. A valid, reliable, and age-appropriate risk assessment tool should be used for every resident upon admission and reassessed regularly. Identifying individual risk factors—such as immobility, incontinence, or poor nutrition—allows for tailored prevention strategies.
Skin Care
Daily head-to-toe skin assessments are critical, focusing especially on pressure points. Bathing routines should be individualized, using mild cleansers, avoiding hot water and excessive scrubbing. After bathing, apply lotion to maintain skin moisture. For incontinent residents, cleanse the skin promptly after soiling and apply protective topical barriers to minimize irritation and breakdown. Dry skin should be treated with moisturizers, and caregivers should avoid massaging over bony prominences to prevent damage.
Nutrition and Hydration
Adequate nutrition supports skin integrity and healing. Identify and address factors that compromise calorie and protein intake. Nutritional supplements may be considered for at-risk individuals, and hydration should be encouraged—offering water during repositioning can be a helpful routine. Multivitamins and minerals should be administered as per the physician’s orders to support overall health.
Mechanical Loading and Support Surfaces
Frequent repositioning is essential: bed-bound residents should be repositioned at least every two hours. Consider alignment, weight distribution, and stability when changing positions. A written repositioning schedule is recommended. Chair-bound individuals should be encouraged to shift their weight every 15 minutes if able. Use pressure-redistributing mattresses and avoid devices like donut cushions or sheepskins. Use pillows or foam wedges to prevent skin-to-skin contact over bony areas, and never position patients directly on the trochanter. Keep the head of the bed at or below 30 degrees and utilize lifting devices during transfers to avoid dragging.
Education and Inspection
A strong educational program for staff is vital. These programs should include clear guidelines, prevention techniques, and systems for evaluating effectiveness. Staff should be vigilant in inspecting residents’ skin for early signs of pressure ulcers. Reddened areas that persist after pressure relief or signs like blisters and puffiness over bony areas should be reported immediately.
Regular inspection by nurses—during personal care routines—is one of the most effective ways to catch pressure ulcers in their early stages, ensuring prompt intervention and improved outcomes for residents in long-term care.