I recently had the opportunity to attend the 2015 Biennial Conference sponsored by the National Pressure Ulcer Advisory Panel (NPUAP). There, passionate researchers and clinicians from around the world attended. All held a shared goal of improving skin integrity and the health of those we serve.
The skin is the largest organ of the body, but many times it’s the least thought about or cared about until there is an issue. The goal is not having an issue.
When I attend a conference, I always look for pearls of knowledge I can utilize in my practice. The latest research held some fantastic PEARLS: P = Persevere, E = Eat, A = Assess, R = Roots, L = Lift, S = Special
Pearl One: Preserve
Role of Microclimate: Microclimate is the convergence of temperature, humidity, and airflow at the patient/support interface, or where the skin meets the point of contact. In essence, the best way to think about it is mini greenhouses occurring on the skin, except we know that the greenhouse effect is not a good thing for skin. It breaks the skin down, causing it to become more fragile and susceptible to breakdown. Learning: Keeping skin clean and dry has been well understood; keeping skin clean, dry, moisture-free and at the right temperature is the new work we must embark upon.
Pearl Two: Eat
Role of Nutrition: Protein is critical for the cells to stay strong and heal themselves. Proteins such as beef, pork, chicken and eggs have high levels of leucine, which is needed for tissue accretion. Researchers say protein supplements best for skin health and healing include whey. Utilizing lab values such as albumin levels is less important as a good assessment of eating habits and nutritional intake. Learning: Look at the person; watch what he or she is eating and not eating. Malnourishment happens at all ages, but more so with the elderly.
Pearl Three: Assess
Role of Assessment: Assessment must take three levels of risk into consideration. The first level is skin status and activity/mobility. What is the overall health of skin? Keeping your eyes on the skin and knowing its level of performance is the first step of understanding skin performance. Perfusion and oxygenation of the skin need to be assessed. Decreasing performance makes skin more vulnerable; throw in poor nutritional intake and increased moisture to the skin and the studies show the skin starts to break down and become more fragile. Lastly, the factors of increased age, health status and body temperature, along with decreased sensory perception and hematological measures are all risk factors that impact skin integrity. Learning: Assessment is more than a tool. It is taking multifocal contributors into account to determine the level of skin health of a person.
Pearl Four: Roots
While conducting a root cause analysis (RCA) is not new in theory nor in practice, the tool is not being utilized to assure quality improvement and advancement of standards of practice. Pressure ulcers have to be looked at in their totality. Learning: Look back in time to understand where the injury might have occurred. Do a tracer on the pressure ulcer. Follow backward to see where there might be opportunities for improvement. Study the Swiss cheese model: Did you have a series of events that contributed to the pressure ulcer? Do you have failure of your support surfaces due to age?
Pearl Five: Lift
Lifting saves skin. It is important to decompress the area that has pressure on it. So lift not only the cheeks (not the facial cheeks!), but also the heels, head and abdomen. Lift those areas that have pressure upon them. For those who are obese, you have to lift the skin off of the skin as well. That is where abdomen and other skin folds have to be lifted, allowing blood flow to nourish the skin. Learning: Lifting is essential for healthy skin and prevention of breakdown.
Pearl Six: Special
Skin needs to feel special, and hydration is critical for the skin to feel that way. Hydration needs to occur both internally and externally. Utilizing a skin moisturizer that is formulated to provide nutrients to the skin is one of the best preventative measures to be taken. Don’t massage or vigorously rub skin that is at risk for a pressure ulcer. Learning: Skin needs to be fed with the right moisturizer. Utilizing the right product replaces intercellular lipids and promotes moisture barrier functions of the skin.
The research is very clear around the PEARLS: Persevere, Eat, Assess, Roots, Lif, and Special. Utilization of the PEARLS can compel better skin health.
Martie Moore is chief nursing officer at Medline Industries and a member of NPUAP’s Corporate Advisory Council.