Risk assessment Resources

As the UK population ages and greater numbers of people are living with long-term conditions (Office for National Statistics [ONS], 2014), increasing numbers of people are subsequently at risk of developing pressure ulcers (PUs). PUs are painful, costly and can negatively affect patient quality of life. They are particularly prevalent in the community setting, leading to high-costs in treatments, especially in those suffering from a chronic condition (Jaul et al, 2018). The prevention of PUs is therefore a key global care quality indicator, which is the focus of considerable quality improvements in primary care. Identifying a patient at risk of developing PUs is an action that should be undertaken at the first community visit. Nursing care to prevent PUs needs to be systematically planned, implemented and evaluated, following assessment of the patient and their
circumstances. As demonstrated by Clarkson et al (2019), integrating an interprofessional approach can reduce the severity of PUs in the community. There are a wide range of resources required to help prevent PUs, including nursing time, ensuring effective patient repositioning and risk assessment, as well as delivering the most appropriate pressure-relieving surfaces (Dealey et al, 2012).

The second part in our series on pressure ulcer prevention and management looks at
risk assessment tools or scales which can be used across all clinical settings in primary
and secondary care. It presents the case of Mrs Smith and how the different tools can assess her risk of pressure ulcer development. The scores and risk levels  vary according to the scale used so an explanation of how her risk level was assessed
is given.

This article, the first in a series on pressure ulcer prevention and management, looks
at undertaking risk assessment as the first step in preventing pressure damage. It
discusses the most popular tools in clinical practice, as well as how reliable they are in
predicting patient risk. Legal aspects of pressure ulcer risk assessment documentation
are also explored, together with future developments in producing a risk assessment
tool which can be used across all clinical settings in primary and secondary care.

It is estimated that there are currently 944,000 older people living with dementia in the UK, and that 593,200 of those people are living with advanced symptoms. People living with advanced dementia have a significantly higher prevalence of pressure ulcers (PUs), compared to those living without dementia with similar comorbidities. The care and support required to prevent pressure ulcers in people living with dementia needs to be individualised, following a holistic and person-centred assessment of the person and their unique circumstances. An improved understanding of the increased risk and causal factors of developing pressure ulcers in high risk groups, such as people living with advanced dementia, can support practitioners to conduct a more through and person-centred risk assessment and management plan, including choosing the most appropriate products to meet a person’s needs.

Rheumatoid arthritis (RA) is a condition which causes inflammation in synovial joints. Patients experience pain, stiffness and swelling commonly in their hands and feet, but it can also be a systemic disease which affects the heart, lungs and eyes in some patients. It is more common in women than men, and the peak age for diagnosis is around 70 years; however, it can affect all ages. Early diagnosis and treatment should be prompt to reduce the chance of permanent damage to the joints, as this will cause functional impairment and affect quality of life, and work/leisure activities (Heidari, 2011).
A treat-to-target strategy aims to achieve remission or low disease activity by up-titrating medication from the point of diagnosis, thus minimising the impact of the disease (National Institute for Health and Care Excellence [NICE], 2018).This strategy only works
if patients take the prescribed medication. The nurse’s role is vital in supporting patients’ understanding of the medications and advising on how to manage side-effects.

Pressure ulcers were the largest proportion of patient safety incidents in 2011–2012, accounting for 19% of all reports (National Institute for Health and Care Excellence [NICE], 2014). Developing strategies and incentives to help reduce pressure ulcer incidence by stressing the importance of improving nurses’ knowledge in areas of skin care and encouraging carers/relatives, together with patients, to take an active role has been shown to improve outcomes in reducing the development of pressure ulcers (NHS Commissioning Board, 2013). With guidance focusing on prevention as well as treatment, it is important that community services understand both the risks and how to stage pressure ulcers appropriately to provide timely and cost-effective treatment.

Pressure ulcer prevention is a challenge both in acute care and in community care, although prevalence is hard to determine due to differing ways of assessing and reporting both ulcers and risk of ulceration. Those who are acutely ill or have compromised mobility, or are older, or who have multiple co-morbidities are at greater risk of pressure ulcer development.

Acknowledgements:
All District Nursing Staff, Greater Glasgow & Clyde

­Lynne Watret, MN, PGCertTLHE, MA, RGN, CNS Tissue Viability
Fiona Middler, BA, Master in Primary Care, Clinical Effectiveness Coordinator, Primary Care, Greater Glasgow & Clyde

Article accepted for publication: August 2012

Sylvie Hampton gives an overview of the siting of IV cannulae and the administration of IV solutions
Sylvie Hampton MA, BSc (Hons), DpSN, RGN is a Tissue Viability Consultant, Eastbourne Wound Healing Centre
Article accepted for publication: March 2008

Keith Cutting discusses the renaissance of honey as a therapeutic agent in wound management
Keith F Cutting MN, RN, Dip N, Cert Ed. Principal lecturer Tissue Viability. Buckinghamshire New University

Maureen Benbow gives an overview of pressure ulcer prevention clinical guidelines.

Maureen Benbow MSc, BA, RGN, HERC is a Senior Lecturer at the University of Chester

Article accepted for publication: September 2010