Seven Steps to Reducing Pressure Ulcers

Institution-acquired pressure ulcers are a leading threat to modern quality healthcare. Research by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality shows that pressure ulcers cost the nation's healthcare system more than $11 billion a year. The condition is both excruciatingly painful for patients and costly for providers since it is considered preventable and, therefore, does not qualify for reimbursement by government and other payers.  Below is a list of seven key steps clinicians might use to help prevent pressure ulcers, as recommended by recently released guidelines from the National Pressure Ulcer Advisory Panel (NPUAP):

  1. Conduct repeated comprehensive risk assessments to identify individuals at risk of developing pressure ulcers.
    • Reassess risk if individual's condition has significantly changed.
  2. Inspect skin upon admission and as part of every risk assessment.
    • Conduct a head-to-toe assessment with particular focus on skin overlying bony prominences.
    • Inspect skin under and around medical devices at least twice daily.
  3. Practice preventive skin care.
    • Keep skin clean and dry and use barrier products to reduce moisture related risk.
    • Develop an individualized continence management plan.
    • Consider using prophylactic dressings to protect skin.
  4. Assess nutritional status and develop an individualized nutrition care plan.
    • Ensure adequate energy and protein intake and proper hydration.
    • Monitor unintended weight changes and the effect of psychological stress or neurophysiological problems.
  5. Reposition all patients at risk of pressure ulcers unless medically contraindicated.
    • Determine repositioning frequency based on the individual's medical condition, degree of risk and support surface used.
    • Avoid positioning individual on an area of erythema whenever possible.
    • Use the Thirty Degree Rule: 30 degree side-lying position and no more than 30 degree head of bed elevation to prevent shearing forces unless medically contraindicated.
    • Avoid pressure and shear forces when repositioning patient.
  6. Inspect heels regularly and elevate them to prevent heel pressure ulcers.
    • Use heel suspension devices that elevate and offload the heel completely without placing pressure on the Achilles tendon.
  7. Select a support surface that meets the individual's needs.
    • Consider patient's level of immobility and inactivity, as well as size/weight of the patient and need for microclimate control and reduction of shear forces.

For 2014 NPUAP Pressure Ulcer Prevention and Treatment Guidelines, visit:


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