EUROPEAN PRESSURE ULCER ADVISORY PANEL

KNOWLEDGE AND EFFECTIVENESS

Inge C. Buss MHS, RN and Ruud J.G. Halfens PhD
Department of Nursing Science,
University of Maastricht,
Maastricht, The Netherlands

Pressure sore prevention was, and still is an important issue in the Netherlands. In 1985 the guidelines ‘Pressure sore consensus’ were developed at the request of the CBO, a national organization for quality assurance in health care. These guidelines were revised in 1992 into the guidelines ‘Revision Pressure Sore Consensus’. The information of the guidelines is meant to be used in daily nursing practice, to improve nursing acting with regard to the in prevention of pressure sores. For this reason it is important that health care workers have knowledge about the content of this guidelines. It is known from previous studies, however, that nurses knowledge about pressure sore prevention is not adequate (Halfens & Eggink, 1995; Hill. 1992; Pieper & Mott, 1995), Therefore it was decided to investigate to what extent knowledge about the effectiveness of preventive interventions described in the guidelines, is available by enrolled nurses in Dutch nursing homes. The questionnaire developed by Halfens et al was used in this study. This questionnaire was distributed in twenty-three nursing homes in the Netherlands to a convenience sample of enrolled nurses, enrolled nurses in charge, physicians, and members of the management team. The results of this study will be presented at the conference.

PREVENTING PRESSURE ULCERS DURING AND POST SURGERY

Maarten J. Lubbers
Department of Surgery AJVLC University of Amsterdam, Holland

Before, during and post surgery, the patient is at risk due to immobility, circulation disorders and other problems resulting in hypoxia, necrosis and pressure ulcers. The relationship between operating room table surfaces and pressure ulcers is well known, but there is a wide variance in the frequency: pressure ulcer development has been reported to range from 12% to 17%1,2,3,4,5. Most pressure damage could be pre­vented and it is important to have prevention and educational strategies in place6,7. Three strategies are necessary: preoperative, peroperative and postoperative.

Preoperative: Identify “at risk” patients, Risk factors are well known (table 1) and the use of scoring systems well established (table 2). Risk assessment should be used as an adjunct to clinical judgement.

Peroperative: Little information is available on the genesis of intra-operative pressure ulcers1*8, but several risk factors are identified (table 1). A complicating factor is that these intra-operative lesions are usually not evident until several days postoperative1,9,10.

Postoperative: Use the best available products and mobilize the patient as quickly as possible. The problem is that pre- and post surgery the use of dynamic devices is feasible in high risk patients, but during surgery static devices are preferred to insure stability at the surgical site4,5,10.

Table 1: Risk factors

Patient
Preoperative risk score
Age> 40*
Duration OR > 2 hour*
Type OR
Cardiovascular*
Anesthesia  Immobility
Temperature
Cooling / warming up 
Position
Orthopaedy
OR mattress Type  

Table 2: Scoring systems

Braden
Norton
CBO  

References

1. Bridel, J., Pressure sore risk in operating theatres. Nursing Standard, special supplement 1993; 7 (32): 4–10.
2. Kemp, M.G. et al. Factors that contribute to pressure sores in surgical patients. Research in Nursing and Health 1990; 13 (5): 293–301.
3. Hoskowsky, V.M. et al. Intraoperative pressure sore prevention: an analysis of bedding materials. Research in Nursing and Health 1994; 17 (5): 333–9.
4. Pearce, C.A. Intraoperative pressure sore prevention. British Journal of Theatre Nursing 1996; 6(4): 31.
5. Lubbers, M.J. The pressure-relieving operating table equipment: UTOPIA. Proceedings of the First European Pressure Ulcer Advisory Panel Open Meeting. Oxford 1997.
6. EPUAP. Pressure Ulcer Prevention Guidelines. Oxford 1998.
7. NPUAP. Statement on Pressure Ulcer Prevention. Silver Spring 1992.
8. Waterlow, J. Operating table. The root cause of many pressure sores? British Journal of Theatre Nursing 1996; 6 (7): 19–21.
9. Vermillion, C. Operating room acquired pressure ulcers. Decubitus 1990; 3 (I): 26–30.
10. Webster, C.I. A pressure care survey in the operating theatre. Australian Clinical Review 1993; 13 (I): 29–37.