Short Tissue Viability Quiz 1.

1. Short Tissue Viability Quiz 1. Pressure Ulcer Prevention

2. 1. There is only 1 pressure ulcer risk assessment tool in the UK. • False • At the last count there were over 40 risk assessment tools in use – there are 3 at KGH. • Risk factors for children or women in labour are not the same as those for elderly medical or surgical patients. • The environment of care also influences the tool used (e.g. Waterlow is unsuitable for patients in day case areas as it only looks at now rather than what’s going to happen next).

3. 2. Everyone will get the same pressure ulcer risk score for each particular patient. • False • Most risk assessment tools are subjective (what does “average” mean to you?) • Waterlow especially is known to greatly exaggerate risk, more so if the user isn’t trained in how to use it.

4. 3. All diabetic patients score 4 – 6 in the Waterlow risk assessment tool. • False • Regardless of the type of diabetes or how well it is managed, the diagnosis doesn’t increase pressure ulcer risk. • Look at the Waterlow chart and the title of the section with diabetes in it (NEUROLOGICAL DEFICIT). • Peripheral neuropathy (loss of feeling) is the risk factor NOT the diagnosis – ask the patient if they have any loss of sensation in feet or legs. See. “Waterlow 2005” and “guidance for completion” in the “Documentation” section of the tissue viability web site.

5. 4. Anyone who doesn’t move will eventually develop a pressure ulcer even if they’re not ill. • True A pressure ulcer is localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers: the significance of these factors is yet to be elucidated. EPUAP/NPUAP, 2009 The time needed to cause tissue damage may be longer in those who are younger or fitter but continued pressure and/or shear will eventually affect anyone. In the elderly or ill, pressure ulcers can occur in as little as 2 hours.

6. 5. Pressure ulcers are only caused by pressure & shear – other factors increase the risk but do not cause pressure injuries • True • Risk factors relate to the body’s ability to defend itself against pressure damage. • If skin is already compromised it will injure more quickly (e.g. incontinence reaction weakens skin and pressure vs. time needed to cause damage is less than if it wasn’t there) but without pressure or shear any injury that occurs IS NOT a pressure ulcer

7. 6. Repositioning is the single most important factor in pressure ulcer prevention. • True • All patients MUST be moved – this can include using an electric bed to sit, lower or tilt to redistribute load. • The interval at which this is needed may vary but (generally) turning anyone every 2 hours will prevent pressure ulcers. • As this is impractical, assess each patients need for frequency of repositioning and include in care plan

8. 7. Support surface is decided by the ability of the patient to move or be moved safely by staff. • True • Movement is the important factor. Many patients with limited mobility can’t move at all when they’re placed on air mattresses. • In these cases its better to use a foam mattress so they can reposition without being dependant on staff • Movement is what prevents pressure ulcers

9. 8. Patients on air mattresses don’t need to be turned for pressure relief • False • This is a misquote from Prof. Michael Clark in the 1980s when he commented on a specific product. • He went on to say that it is unthinkable that patients wouldn’t be moved for social and care delivery needs. • Whatever a patient is on they MUST be moved.

10. 9. All patients should be in a chair for at least part of every day. • False • There is no reason to put a patient in a chair unless its for that patients benefit (e.g. during rehab when mobility is developing) • Hoisting or lifting a patient into a chair to later hoist or lift them back is a hazard to both patient and staff. • Use an electric bed to get the benefits of posture from sitting – its much easier to lay them down again with a button than a hoist.

11. 10. Patients at risk of or with pressure ulcers may only be in a chair for 2 hours on each occasion regardless of cushion in use. • True • This is definitive statement form NICE and EPUAP guidelines. • See the TV website for links to these.

12. 11. Any patient who needs turning by staff must have an accurate and complete repositioning record • True • If each “turn” isn’t recorded, how will the staff on the next shift know when its due again? • This is the major missing piece of evidence in every litigation for pressure ulcers against the NHS • Simple entries in notes like “turned for pressure relief” are insufficient. What position? How often? What time? Who by?

13. 12. Barrier products such as Cavilon can be used to prevent or treat pressure ulcers • False • These products are to prevent skin damage from exposure to irritants (incontinence) or to improve adherence of dressings. • They work well for moisture lesions and reduce the risk of compromised skin (see slide 5) but have no effect on pressure or shear.

14. 13. Foam dressings such as Biatain or Allevyn can be used to “pad” pressure areas to prevent pressure ulcers. • False • Foam dressings are designed to absorb fluid – this is their only function. • Using them on intact skin dries the skin and increases the risk of damage. • The foam is not nearly thick or elastic enough to provide pressure relief – in fact it digs in causing depressions in the skin (higher pressure).

15. 14. Individual nurses can lose their registration if they fail to prevent pressure ulcers • True • But only if you don’t take all available actions to prevent them in the first place. • A minority of pressure ulcers are unpreventable • Acting outside best practice or national/local guidance makes you liable – following these makes your employer liable. • In 2009 a nurse was suspended from the NMC register for failing to complete a skin assessment.

16. 15. Trusts and individuals can be sued by patients/carers if preventable pressure ulcers happen • True • The key word here is “preventable” and if those preventive measures weren’t taken you can be sued for negligence. • A UK trust was recently charged with corporate manslaughter when a patient died from a pressure ulcer acquired whilst in their care.