Nursing Practice Guidelines: Pressure Ulcer Prevention And Treatment Policy

Nottingham University Hospitals NHS Trust
Nottinghamshire County tPCT
Nottinghamshire Healthcare NHS Trust
Private Care Homes

Nursing Practice Guidelines:
Pressure Ulcer Prevention and Treatment Policy

"This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician.
If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date."
Reference:
Distribution:

TV/PUPAT/08
All Wards and Departments

Author/Lead Clinician:
(To include job title)
Service:

Alison Parnham / Dale Copson / Sarah Pankhurst
Clinical Nurse Specialists
Tissue Viability
3

Final Draft: April 2008

GUIDELINE 1
All patients will be risk assessed using a recognised risk assessment tool.
Practitioners are responsible for being familiar with the tool used in their clinical area. Identifying patients at risk through the use of a risk assessment tool helps to provide a systematic approach to assessment whilst justifying the provision of pressure-relieving equipment (Shakespeare, 1994). However, risk assessment tools are criticised for being subjective in the interpretation of the scoring system and for over-predicting the potential of a pressure ulcer developing (Hampton and Collins, 2004). It is therefore essential that using a risk assessment tool is combined with the practitioner’s clinical judgement to ensure appropriate preventative measures are taken (Flanagan, 1993; Scott, 2000).
There is currently limited evidence to date to suggest which tool is more effective than the other (Hampton and Collins, 2004). Examples of risk assessment tools used in Nottingham are as follows;

Risk Assesssment Tool

Clinical Area

The Douglas Risk Assessment Tool
(Pritchard, 1986)

Community Primary Care Trusts, NUH Queens Campus, Nursing Homes

Waterlow Risk Assessment Tool
(Waterlow,
Clients will have the suitability of equipment reassessed taking into consideration progress or deterioration in;
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Physical condition, in particularly movement and mobility Nutritional status
Skin state
Level of risk
General skin assessment
General health status
Patient comfort/concordance
Lifestyle of the patient
Ability of the patient to reposition, or be repositioned.

2.3.4. The following items will not be used as pressure relieving aids -

Water-filled gloves
Sheepskins
Ring cushions
Pillows as chair cushions
PVC wheelchair cushions
Dressings
Barrier creams

2.3.5. Specialist pressure relieving aids may be used for specific areas of the body. Further advice may be sought from the
Tissue Viability Service
2.3.6 All long term wheelchair users should be assessed by the specialist team at the Mobility Centre
2.3.7 The discharge policy for equipment provision will be referred to when planning patients’ discharge

Guideline 9

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Final Draft: April 2008