The NY Times has an informative article on the multi-disciplinary approach needed to prevent pressure ulvers in nursing home residents. 

The article defines a pressure ulcer as an area of skin breakdown that occurs when sustained pressure cuts off blood circulation — usually in patients confined to their beds nursing homes — a bedsore can result in a wound so deep (sometimes to the bone) and painful that some patients require narcotics. If a bedsore becomes infected, the complications can be fatal.

Experts estimate that two million Americans suffer from pressure ulcers each year, usually through some combination of immobility, poor nutrition, dehydration and incontinence.  New research requires a team approach, enlisting everyone from nurses and nursing assistants to laundry workers, nutritionists, maintenance workers and even in-house beauticians.

In a study of a collaborative program involving 52 nursing homes around the country, The Journal of the American Geriatrics Society reported last August that team efforts had reduced the number of severe pressure ulcers acquired in-house by 69 percent. 

Dr. Joanne Lynn, who helped begin the project when she was a senior natural scientist with the RAND Corporation (she has since joined the Medicare centers), said the goal was to educate nursing home workers in bedsore prevention and to encourage them to come up with creative, low-tech solutions of their own. “It was a combination of education, cheerleading and something like systems engineering,” Dr. Lynn recalled.

Nutrition including additional protein, special mattresses made of high-density foam to reduce pressure in key areas, keeping feet elevated, repositioning frequently, keeping incontinent residents dry with routine changes, and proper fitting clothes are easy low tech solutions to preventing the developement or worsening of pressure ulcers. 

Clinicians document four stages of pressure ulcers, in which Stages 1 and 2 are superficial sores and Stages 3 and 4 are deep wounds that result from death of the skin and underlying tissues.

Dr. Horn, of the Institute for Clinical Outcomes Research, praised the collaborative as “the first major national effort driven by Medicare to reduce pressure ulcers.” But she said that better outcomes could be achieved if more nursing homes improved their documentation, so that all of the information on a given resident, including details on eating, urinary and bowel function, appeared on a single sheet, with key reminders to nursing assistants and other staff members about best practices.

Bedsores are “a major quality-of-life issue, and a self-esteem issue,” said Joanie Jones, a nurse at David Place in Nebraska. “No one wants to have sores on their bottom. I don’t care how old you are. You still want your skin intact.”

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