Are all pressure ulcers preventable?
Expert opinion varies regarding whether all pressure ulcers are preventable. However, the majority agree that there can be circumstances where pressure ulcers are unavoidable.
Consideration must be given to the fact that a resident’s risk status and ability to heal may be affected by co-morbid illnesses such as peripheral vascular disease, diabetes mellitus, malignancies, or immune diseases. There also may be times that the facility attempted to implement proactive measures but the resident was non-compliant or refused to follow the care plan.
Organ decompensation and failure in the final days or weeks of life can result in large and unusual presentations of skin breakdown. As the body organs shut down, the body naturally shunts blood to vital organs in a last resort attempt to maintain internal organ system function, leaving little, if any, to support the skin.
Widespread and deep tissue breakdown over stressed areas may be a visual biomarker that skin breakdown is neither preventable nor treatable.
As with any skin care interventions, aggressive and detailed charting is invaluable in determining whether a pressure ulcer was unavoidable. Charting must reflect that all standard prevention, nutrition and pressure reducing interventions have been used, along with changes based upon the residents’ individual needs.
From the November 01, 2009 Issue of McKnight's Long-Term Care News
