Pressure Ulcers and other Wounds in the Post-Acute and Long-Term Care Setting

Publication Date: November 1, 2017

Key Points

Key Points

Table 1. Summary of Recommendations and Their Grading


Recognition

Select and consistently use one predictive scale to identify patients at high risk for the development of pressure ulcers or other wounds. Although predictive scales vary in their predictive value, the consistent use of one scale is the most reliable way to detect change over time. ( Strong , Moderate )
704
Write a care plan to address identified risk factors based on minimum data set (MDS) variables. ( Weak , Moderate )
704

Assessment

Develop a structured program for timely skin assessment. ( Strong , High )
704
Assess nonhealing wounds for infection or biofilm using a tool such as NERDS (Nonhealing, inflammatory Exudate, Red granulation tissue, Debris, and Smell) or clinical observation. ( Insufficient , Low )
704
Classify/characterize pressure ulcers based on MDS criteria. ( Weak , Low )
704

Treatment/Prevention/Monitoring

Employ preventive measures such as promoting hydration and avoiding excessive skin moisture. ( Strong , Moderate )
704
Employ repositioning or offloading measures as needed (includes support surfaces).

PREVENTION
  • Repositioning
  • Support surfaces:
  • Advanced static mattress
  • Alternating air
  • Sophisticated wheelchair cushion
TREATMENT
  • Support surfaces:
  • Air-fluidized bed
  • Alternating-pressure bed
  • Low-air-loss mattress
( Strong , Moderate )
704
Cleanse wounds with nontoxic products. ( Insufficient , Low )
704
Patients with a pressure ulcer nearing the end of life require the balance of best practice in wound treatment and prevention while promoting patient dignity and quality of life. ( Strong , Low )
704
Write a facility policy for assessment and treatment of pressure ulcers and other wounds with the goal of using it to develop realistic, individualized, interdisciplinary care plans. ( Strong , Low )
704

Recognition

...ognition

...e Patient Have Risk Factors for Pre...


...e 2. Surveyor Guidance: Risk Facto...


...2: Examine the Patient's Skin Thoroughly t...


Assessment

Assessmen...

...he Patient's Overall Physical and...

...able 3. Risk Factors to Consider in...


...Identify Factors That Can Affect Ulcer Treat...

.... Assessing Risk Factors for Pressure UlcersHav...


...5: Characterize the Pressure Ul...

...ssure Ulcer Staging — MDS and National...


...Identify Priorities in Managing The Ulce...


Management/Treatment

...ement/Treatment

...7: Establish a Realistic, Individual...

...sical Factors That May Influence Pressure Ul...


...8: Provide General Support for the Patient...


...able 8. Nutritional Supplementation to Promote S...


...TEP 9: Manage Pressure...


...teristics of Available Support Surfac...


STEP 10: Manage Colonized or Infected...


...Necrotic Tissue from the Ulcer...


...ethods of DebridementHaving trouble viewing t...


...P 12: Cover and Protect the Ulcer and Surrounding...


.... Options for Pressure Ulcer Dressings ...


...gnize and Manage Ulcer Complications...


...4: Consider Adjunctive Therapies when Standard Th...


...Manage, Venous, Arterial, Neuropathic, and...

...lcers  Compression is the mainstay of trea...

...l Wounds  For non-healing ulcers or in...

...Diabetic Wounds  The most common cause of n...

...he most important issue with skin tears...


...2. Recommendations on the Use of Interventions t...


...r The Progress of Both Patient and Ulcer...


Table 13. Recommended Components of Press...


...cide Whether to Change Approaches...


...Monitor the Facility's Managemen...


...able 14. Sample Performance Measurem...


Glossary

...ofilm: Aggregate of microorganisms in which cel...