ABSTRACTS FROM THE FIFTH EPUAP OPEN MEETING
Le Mans, France, 2001
PATHOLOGY AND AETIOLOGY OF EARLY STAGE PRESSURE ULCERS
- IS IDENTIFICA-TION OF NON-BLANCHING HYPERAEMIA THE KEY TO ACCURATE RISK
ASSESSMENT?
Nixon, J.
Centre for Evidence Based Health Care, University of Huddersfield
In the literature concerning the prevention and management
of pressure sores, baseline assessment is commonly associated with the
term 'risk assessment' and there has been a focus toward the development
and use of risk assessment scales to facilitate the identification of
'at risk' patients. Whilst limited in construction methods and validity,
they may provide a framework and appropriate prompts for assessment of
pressure sore risk but their use as a single instrument to assess risk
is not supported by current evidence.
Furthermore, recent research which identifies key prognostic factors using
multivariate methods identifies non-blanching erythema as an independent
predictor of pressure sore development and a key prognostic factor and
provides increasing evidence that skin assessment should play a central
role in the risk assessment process.
This presentation will provide an overview of the pathology and aetiology
of pressure sore development, with an emphasis upon early pressure sores
and risk factors identified by studies using multivariate statistical
analyses. It will also discuss the evidence base associated with the predictive
nature of blanching and non-blanching erythema and the implications of
recent research in relation to:
a) the classification and definition of pressure sores,
b) the role of skin assessment in determination of risk,
c) practical issues in current clinical assessment techniques.
References
Nixon, J. (2001) Predicting and preventing pressure sores in surgical
patients Unpub PhD Thesis, University of Newcastle
Nixon, J. (2001) The pathophysiology and aetiology of pressure ulcers
In Morison, M.J. (Ed.) The Prevention and Treatment of Pressure Ulcers,
Mosby, Edinburgh. pp. 17-36.
Nixon, J. and McGough, A. (2001) Principles of patient assessment: screening
for pressure ulcers and potential risk In Morison, M.J. (Ed.) The Prevention
and Treatment of Pressure Sores, Harcourt Brace, Edinburgh. pp. 55-74.
SHOULD STAGE I PRESSURE ULCERS BE INCLUDED IN AUDITS?
- THE UNITED STATES EXPERIENCE
Courtney H. Lyder
Adult, Family, Gerontological & Women's Health Division, Yale University
School of Nursing, New Haven, CT, USA
The identification of the Stage I pressure ulcers is critical
to early and cost-effective interventions. There remains much variance
in the accurate assessment and identification of Stage I pressure ulcers.
Thus, there is much intellectual discourse regarding the inclusion of
Stage I pressure ulcers in quality of care audits in the United States.
This presentation will review some of the challenges in identifying the
Stage I pressure ulcers (including its identification in darkly pigmented
skin) and its utility in quality of care audits.
DETECTING INCIPIENT PRESSURE SORE ONSET
Martin Ferguson-Pell, Graham Nicholson, Duncan Bain
Centre for Disability Research and Innovation, Institute of Orthopaedics
and Musculo-Skeletal Sciences, University College London
Introduction
Clinicians frequently observe changes in skin colour when soft tissue
viability is threatened by excessive weight bearing conditions. Usually
the skin is locally red, but does not resolve over time in the way that
reactive hyperaemia (RH) does. If the damage to the tissue is not severe,
or is caught early then the redness can be blanched with the finger (blanchable
persistent redness, BPR) and is due to an early inflammatory response.
On the other hand, if damage is more severe, skin micro-circulation may
be arrested, and the local redness will not be blanchable (non-blanchable
persistent redness, N-BPR). These three states of skin redness are monitored
by knowledgeable clinicians and disabled people to detect early tissue
distress. Unfortunately clinical observation of skin redness is not always
linked to an effective intervention to prevent further damage; readily
classified by degree of severity; is difficult to detect in black people
and others with deeply pigmented skin.
Methods
Tissue reflectance spectrometry (TRS) can be used to monitor skin micro-circulation
which in turn can identify adverse tissue status. The absorption spectrum
for white light of the skin yields dynamic information the blood content
and oxygenation of the skin in terms of blood content and oxygenation
of the superficial dermis.
Results
The data presented illustrates changes in blood content and oxygenation
during a period of loading applied to the tissues by an air bladder at
160 mmHg. The resting, occluded and hyperaemic response phases are evident.
In this presentation a number of applications of tissue reflectance spectroscopy
will be discussed with the view to using this technology as a tool for
evaluating the interaction of support surfaces and the body, and detecting
adverse tissue conditions.
AN ANALYSIS OF THE WOUND RELATED FACTORS THAT INFLUENCE
NURSES CHOICE OF DRESSING FOR PRESSURE SORE MANAGEMENT
Holloway S, Price P, and Jones V
Wound Healing Research Unit, Cardiff, Wales
The factors that should be considered when assessing a
wound, including pressure sores are well documented and recommendations
for dressing choice are often linked with this to guide the nurse's choice
of product.
The aim of this two-part study was to identify the most important factors
that influence dressing choice for all grades of pressure sores. The European
Pressure Advisory Panel Guidelines for classification of pressure ulcers
were used to undertake an audit of pressure ulcers1. Participants from
both a teaching hospital and a specialist unit were asked to rank wound
related factors in order of importance with regards to deciding on the
type of dressing used. These factors included; stage of sore, size of
wound, exudate level, location, pain, odour, condition of surrounding
skin and wound bed.
The study indicated a wide variation in the use of dressings across all
grades of pressure sores. However, there appears to be consistency in
the key factors that influence dressing choice, these included stage of
sore, condition of wound bed and condition of surrounding skin.
The next stage of this study will be extended into the community setting
with the aim of identifying factors that affect dressing choice in this
environment.
1. European Pressure Advisory Panel (1999) Pressure Ulcer
Treatment Guidelines. EPUAP. Oxford
EUROPEAN PRESSURE ULCER PROGRAMME IN PRESSURE ULCER
CARE - DEMONSTRA-TIONS OF EDUCATION / TEACHING MATERI-ALS BEING USED THROUGHOUT
EUROPE
Mr Mark O'Brien
The Royal London Hospital, London, England
There are often few educational opportunities for trained
and untrained nursing staff within private nursing and residential homes.
Yet these nurses are caring for an increasingly dependent elderly population
with complex healthcare needs. The Nursing Home Education Programme was
developed to meet the needs of this professional group in respect to pressure
area care and wound management. The project involves ten one-hour Power-Point-based
lectures covering:
- The skin and ageing
- Pressure sore development
- Pressure relieving devices
- Pressure sore risk assessment
- Pressure sore classification
- Practical positioning
- The wound healing process
- Wound assessment
- The aetiology and treatment of lower limb ulceration
- General wound management
The lectures are designed for delivery with a data presenter
and include animated graphics and photographic patient case studies. Each
lecture is accompanied by student workbooks and can be delivered to groups
by a speaker (supported by accompanying notes) or accessed by individual
nurses using a PC for private study. The programme is currently being
evaluated in the Tower Hamlets area of East London.
RISK ASSESSMENT. A REALITY TOO COMPLEX TO GRASP?
T. Defloor, L. Schoonhoven, M. Clark, R. Halfens
and J Nixon
Based on an extensive literature review, and evidence
based 'state of the art, on pressure ulcer risk assessment is formulated.
The following topics are discussed: actual risk; risk assessment scales;
and elements of risk analysis.
The first part of the text reflects on actual pressure ulcer risk, and
the distinction between risk factors and risk indicators. The importance
of that distinction for the choice of appropriate measures is stressed.
Do risk assessment scales sufficiently discriminate between patients at
risk and not at risk, and is it possible to recommend a specific risk
assessment scale, are the topics of the second part of the text.
The risk factors, the combination of risk assessment scales and clinical
judgement, the continuous process of risk analysis, and the need for preventive
(and therapeutic) measures are the elements that are discussed in the
third part of the text.
The propositions, formulated in the text, will be discussed at the EPUAP
meeting. During this meeting each participant will have the opportunity
to express his or her approval or disapproval of each proposition by vote.
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