WHS guidelines for the treatment of pressure ulcers-2023 update.

The major populations at risk for developing pressure ulcers are older adults who have multiple risk factors that increase their vulnerability, people who are critically ill and those with spinal cord injury/disease. The reported prevalence of pressure ulcers in the United States is 2.5 million. However, this estimate is derived from acute care facilities and does not include people who are living at home or in nursing facilities. Despite the implementation of hospital and facility-based preventive measures, the incidence of pressure ulcers has not decreased in decades. In addition to the burden of pain, infection and death, it is estimated that hospital-acquired pressure ulcers cost the health system $26.8 billion annually with over 50% of the cost attributed to treating Stage 3 and 4 pressure injuries. Thus, it is critical to examine the literature and develop guidelines that will improve the outcomes of this complex and costly condition. This guideline update is a compendium of the best available evidence for the treatment of Pressure Ulcers published since the last update in 2015 and includes a new section based on changing demographics entitled 'Palliative wound care for seriously ill patients with pressure ulcers'. The overall goal of the Wound Healing Society Guideline project is to present clear, concise and commercial free guidelines that clinicians can use to guide care, that researchers can use to develop studies that will improve treatment and that both clinicians and researchers can use to understand the gaps in our knowledge base.

Overview of guidelines for the prevention and treatment of venous leg ulcers: a US perspective.

Comprehensive care of chronic venous insufficiency and associated ulcers requires a multipronged and interprofessional approach to care. A comprehensive treatment approach includes exercise, nutritional assessment, compression therapy, vascular reconstruction, and advanced treatment modalities. National guidelines, meta-analyses, and original research studies provide evidence for the inclusion of these approaches in the patient plan of care. The purpose of this paper is to review present guidelines for prevention and treatment of venous leg ulcers as followed in the US. The paper further explores evidence-based yet pragmatic tools for the interprofessional team to use in the management of this complex disorder.

Pressure ulcer prevention in patients with advanced illness.

PURPOSE OF REVIEW: Pressure ulcers can be challenging to prevent, particularly in patients with advanced illnesses. This review summarizes the relevant literature since 2011. RECENT FINDINGS: Through a MEDLINE and CINAHL database search from January 1, 2011 to June 1, 2012, a total of 14 abstracts were found addressing the prevention of pressure ulcers in persons with advanced illness. Search terms included pressure ulcer, prevention, and control. Advanced illness was defined as patients transitioning from curative to supportive and palliative care. Ten original studies and four review articles specifically addressed pressure ulcer prevention. There were four articles that specifically addressed patients with advanced illness. The studies varied in quality. One systematic review, one randomized controlled trial, three prospective trials, two retrospective trials, one cost-effectiveness analysis, one quality improvement project, one comparative descriptive design, and four review articles were found. The interventions for pressure ulcer prevention were risk assessment, repositioning, surface selection, nutritional support and maintenance of skin integrity with or without incontinence. SUMMARY: The quality of pressure ulcer prevention studies in persons with advanced illness is poor. Increased number and higher quality studies are needed to further investigate this important topic for these fragile patients.

Factors associated with physician and nurse practitioner pressure ulcer staging practices in rehabilitative and long term care.

Pressure ulcer (PrU) documentation is a common clinical challenge in long term care and rehabilitative settings. This pilot observational study examined PrU staging documentation practices by physicians and nurse providers in two long term care facilities with short-term rehabilitative units. The study enrolled 57 subjects with PrUs, and only 30 (52.6%) of them had PrU staging documentation by the physician or nurse practitioner. Use of powered mattresses (adjusted relative risk (RR) 2.43 with 95% CI 1.19, 4.97) and physical therapy documentation (RR 1.72 with 95% CI 1.04, 2.81) were factors significantly associated with providers documenting the PrU stage. Inadequate statistical power, due to the small study sample size, may have prevented detecting of other significant associations between patient factors and documentation practices. Future research that is adequately powered is needed to replicate these results and detect other potential factors associated with documentation.

Wound care in short-term rehabilitation facilities and long-term care: special needs for a special population.

Chronic wounds can pose a challenging diagnostic and treatment dilemma in the older frail adult population. The benefits of short-term rehabilitation and long-term care settings are the access to interdisciplinary resources. Rehabilitative specialists, dieticians, and skilled nurses are readily available to meet the patients' needs as they transition to home or remain in a long-term care setting for their higher level of care needs. This article follows 3 cases: a skin tear complicated by venous ulceration, a pressure ulcer with fever, and arterial ulcers in a patient who opts for comfort care. The cases illustrate the higher needs of this population and emphasize the attention that must be paid to respect nursing-time intensiveness, incorporate realistic goals of care for wound healing, and ensure excellent communication with the team members, patients, and family.

Pressure ulcers in long-term care.

Pressure ulcers are common, costly, and debilitating chronic wounds, which occur preferentially in people with advanced age, physical or cognitive impairments, and multiple comorbidities. Residents with pressure ulcers have decreased quality of life and increased morbidity and mortality, and facilities with high rates of pressure ulcers have higher costs and risks of litigation. Health professionals who practice in this setting should be well versed in pressure ulcer management. This article reviews the significance, risk factors, pathophysiology, prevention, diagnosis, and management of pressure ulcers in long-term care.

Dry skin in the elderly: complexities of a common problem.

Dry skin, or xerosis, is a common skin condition in older adults, but it is not a normal part of aging. The geriatric patient may have several incurable, but treatable, chronic diseases that affect their skin. Xerosis in older adults is multifactorial: intrinsic changes in keratinization and lipid content, use of diuretics and similar medications, and overuse of heaters or air conditioners all contribute. Xerosis causes pruritus, which then leads to excoriations and risk of skin infections. Patients can minimize the effect of xerosis by increasing the ambient humidity, modifying their bathing technique and products, and using emollients to replace the lipid components of the skin. Care should be made to avoid skin sensitizers, such as lanolin, aloe vera, and parabens, that are commonly found in emollients. These may lead to a delayed hypersensitivity reaction. This contribution reviews the intrinsic and extrinsic aging processes of skin aging and advises practical changes in environment and emollient application that can be distributed to patients.

Beyond the medical model: the culture change revolution in long-term care.

Culture change in long-term care facilities involves a shift in philosophy and practice from an overemphasis on safety, uniformity, and medical issues toward resident-directed, consumer-driven health promotion and quality of life. Fundamental to this shift is a focus on the importance of the relationships between residents and direct care staff. This review presents and discusses the key elements of culture change, including workforce redesign, resident-centered care, leadership, and the implementation process and evaluation. A case report describes how medical staff can participate in this grassroots movement and help foster the social, cultural, programmatic, and physical changes that can alter the culture of long-term care one home at a time.