Ask the expert: Choosing a pressure ulcer prevention method

Nurse Leader Insider, December 19, 2011

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This week, Karen S. Clay, RN, BSN, CWCN, explains what to consider when deciding which pressure ulcer prevention method is best for your facility.

Q: My unit has been having difficulty deciding which prevention method to use for pressure ulcers. What are some effective ways I can consider when presenting the methods to leadership?

A: To create an effective program for pressure ulcer prevention, first conduct a risk assessment to identify risk factors, and then focus your prevention program on minimizing their negative effects. When addressing pressure ulcers as a risk-management problem, prevention is the number one solution. It alleviates needless patient suffering, unnecessary healthcare costs, and associated litigation. This focus will include management of pressure, friction, shear, moisture, and any other individual factors.
When deciding which prevention method is best for your facility, here are a few things to consider:

  • Positioning: Frequent positioning of the patient can help prevent capillary occlusion, which leads to tissue ischemia and pressure ulcers. The Agency for Healthcare Research and Quality recommends at least every two hours. However, the frequency of repositioning required to prevent ischemia depends on capillary-closing pressures, which vary by person and pressure point. No matter what the staffing circumstances, use the "rule of 30" when repositioning patients. This rule indicates that you should elevate the head of the bed to 30 degrees or less and that the body, when repositioned to either side, should be placed in a 30-degree laterally inclined position.
  • Contractures: Contractures, which cause shortened and flexed positions of the affected area, develop in predictable patterns, so splinting, range-of-motion exercises, and proper positioning can help prevent their occurrence. Such prevention is necessary not only because contractures cause the loss of strength and function, but also because they may compromise positioning and hygiene. Although a contracture may not necessarily result in a pressure ulcer, healing of any pressure ulcer that does erupt will be complicated by the poor perfusion of the limb.

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