Journal of Community Nursing - page 52

52 JCN
2013,Vol 27, No 4
ngoing changes to the NHS
(Department of Health
[DH] 2010a–c) mean that
clinicians responsible for the delivery
of wound care need to reduce
expenditure while meeting the
increasing demand for the provision
of quality care (DH 2010a–c). The
high impact action (HIA),
Your Skin
identified‘no avoidable
pressure ulcers’ in NHS care settings
as a vital improvement to the quality
of patient experience and cost-
effectiveness (NHS Institute for
Innovation and Improvement, 2010).
Treating pressure ulcers represents
a significant cost to the health and
social care system in the UK. They
occur in any patient but are more
likely in high-risk groups, such as
Pressure-reducing pads effectively
prevent and reverse signs of category 1
pressure damage
the elderly, people who are obese,
malnourished or have continence
problems, and people with certain
skin types. As the population is
ageing and living longer, so are the
number of nursing and care home
residents with multiple comorbidities
and other factors, such as immobility,
which put them at increased risk of
pressure ulceration.
It has been estimated that 20%
of people in nursing and residential
homes may be affected by pressure
ulceration, although figures are
difficult to obtain in this population,
compared to between 4% and 10%
of patients admitted to hospital, and
30% of the population in general
(Clark et al, 2004).
Dealey et al (2012) determined
that at 2011 prices the cost of
healing a category 1 pressure
ulcer was £1,214, with this figure
reaching £14,108 for a category 4
ulcer (
Table 1
It is clear from these figures
that the most obvious action in
terms of both reducing costs and
improving patient experience
is to prevent pressure damage
from occurring in the first place.
A category 1 ulcer can cost more
than £1,000 to resolve. Moreover,
once the damage has occurred,
the patient is quickly put at risk of
developing complications that delay
healing and send costs spiralling.
The presence of pressure ulcers has
been associated with an increased
risk of secondary infection (Bo et
al, 2003); an ulcer that develops
cellulitis adds between £1,380
and £3,722 to costs of care, while
osteomyelitis can add £30,000 per
episode (Dealey et al, 2012).
Against this backdrop, successful
outcomes require a strategic
approach to preventative care
delivery built on evidence-based
practice that includes the use of
pressure-reducing products, along
with risk assessment, mobilisation,
repositioning, nutritional and skin
assessment (Costa, 2013). These are
high-sensitivity areas of care, where
professional input can determine
the risk of developing pressure
ulcers. Although the earliest phases
of pressure ulcer development may
show no outwardly visible signs of
damage, they can develop quickly,
sometimes within the hour and, in
vulnerable groups, progress can be
life-threatening (National Institute
for Health and Clinical Excellence
[NICE], 2005; Costa, 2013).
Pressure Reducing
Pads (Crawford Healthcare;
Knutsford) can be used to dissipate
pressure and protect intact or
recently healed skin from pressure
damage. The pads are available in a
range of shapes and thicknesses to
protect skin over bony prominences,
Aaron Knowles,Tissue Viability Podiatrist; Richie
Skinner, Senior Tissue Viability Podiatrist, both at
Wound Healing Centres, Eastbourne; SteveYoung,
Managing Director, Cambridge Health Technology;
Sylvie Hampton,Tissue Viability Consultant,
Wound Healing Centres, Eastbourne
The strategic prevention of pressure damage is a key part of
preventative care delivery when dealing with patients at increased
risk of pressure ulceration. This article reports on the interim results
of a four-week evaluation, which was carried out to determine the
ability of KerraPro
Heel pressure-reducing pads to reduce pressure,
prevent further damage and improve viability of damaged skin
in patients with category 1 pressure damage. Its performance was
also compared with the usual pressure-relieving product used.
High frequency diagnostic ultrasound scans were performed at the
start and completion of the evaluation to determine the condition
of the damaged skin and to capture any subclinical changes, e.g.
the development of oedema associated with inflammatory skin
changes. Results in all five patients demonstrated that KerraPro
Heel was effective at preventing deterioration and improving the
skin condition of patients with category 1 pressure damage, and was
more effective at resolving oedema over the course of the four-week
evaluation than the usual pressure-preventing products.
Pressure ulcers
Heel pressure-reducing pads
Aaron Knowles, Richie Skinner, Steve Young, Sylvie Hampton
1...,42,43,44,45,46,47,48,49,50,51 53,54,55,56,57,58,59,60,61,62,...116